User Profile and Factors Correlating to Duration of Intrauterine Device Use

Objective: To determine the demographic and clinical profile of intrauterine device (IUD) users and factors correlating to duration of IUD use. Method: We conducted a prospective observational study of 867 patients who underwent IUD insertion in Raden Saleh Outpatient Clinic during the period of January - December 2011. All patients were followed for 1 year to ascertain any complaint of discharge after insertion. Spearman correlation test was conducted to inves- tigate the strength of correlation and significance between age, parity, and discharge, with duration of IUD use. Result: During year 2011, 867 patients (median of age=34 [range=14-49]; median parity=2 [range=0-7]) underwent IUD insertion in Raden Saleh Clinic. The majority of subjects were aged between 31-35 years old and were willing to use IUD for 4 years. Bivariate analysis revealed a significant correlation between age, parity, and vaginal discharge with duration of IUD use. The strongest correlation was identified between age and duration of use (r=0.25, p0.002 for parity and duration of use; r=0.05 p=0.045 for discharge and duration of use). Conclusion: Most IUD users were aged 31-35 years, who were willing to use IUD for 4 years. Factors that correlated with duration of IUD use were age, parity, and vaginal discharge. Keywords: contraceptive, duration of use, family planning, intrauterine devic

HUBUNGAN PARITAS TERHADAP PENGGUNAAN KONTRASEPSI IUD DALAM TINJAUAN LITERATURE REVIEW

Abstrak Tujuan Studi : Penelitian ini dilakukan dengan metode tinjauan literature review bertujuan untuk mengetahui hubungan antara paritas terhadap  penggunaan kontrasepsi IUD. Metodologi : Metode penelitian ini adalah literature review dengan mengambil 15 jurnal yang terdiri dari 10 jurnal internasional dan 5 jurnal nasional. Jurnal dianalisis dengan menggunakan metode critical appraisal duffy research yang berisi 51 pertanyaan untuk menilai kekuatan jurnal tersebut. Hasil : Hasil analisis 15 jurnal penelitian berdasarkan 3 database yaitu google Scholar, Pubmed, dan DOAJ terdapat 10 jurnal penelitian yang menunjukkan adanya hubungan signifikan antara paritas terhadap penggunaan kontrasepti IUD dan 5 jurnal yang menyatakan bahwa tidak adanya hubungan antara paritas terhadap penggunaan kontasepsi IUD. Manfaat : Memberikan masukan dan informasi secara teori yang dianalisis dari jurnal penelitian dengan systematic literature review yang berhubungan antara paritas dengan penggunaan KB IUD.    Kata kunci: paritas, kontrasepsi IUD Abstract Purpose of study : This study was conducted using a literature review method with the aim of knowing the relationship between parity and the use of IUD contraception. Methodology : This research method is a literature review by taking 15 journals consisting of 10 international journals and 5 national journals. Journals were analyzed using the critical appraisal duffy research method which contained 51 questions to assess the strength of the journal. Results : The results of the analysis of 15 research journals based on 3 databases, namely Google Scholar, Pubmed, and DOAJ, there were 10 research journals that showed a significant relationship between parity with IUD contraceptive use and 5 journals which stated that there was no relationship between parity and IUD contraceptive use. Conslusion : Provide input and theoretical information analyzed from research journals with a systematic literature review that relates parity to the use of IUD contraception.    Keyword : parity, contraceptive IU

Doctor of Philosophy

dissertationThree decades have passed since the discovery of HIV and still no viable vaccine technologies exist to prevent the spread of the virus. The concept of interrupting HIV transmission with oral or topical antiretroviral drugs (ARV), also known as pre-exposureprophylaxis (PrEP), has been proven in several clinical efficacy trials. One PrEP strategy has been to formulate the ARV tenofovir (TFV) into topically applied vaginal gels. However, the vaginal gel approach has met with mixed results, likely due to poor user adherence. Globally, high incidence of HIV infection correlates with high incidence of unintended pregnancy, especially in resource-poor regions. Combining HIV PrEP with contraception into a single, easy-to-use product could have a synergistic effect, further motivating women to protect themselves against HIV infection. Thus, a concerted effort is underway to develop long-acting multipurpose prevention technologies (MPT) capable of simultaneously preventing sexual HIV transmission and pregnancy. The nearly half-century-old technology of the intravaginal ring (IVR) has undergone a renaissance in the past decade due to the potential of IVR to leverage both the principles of topical HIV PrEP and of long-acting controlled drug release systems. This dissertation details several new observations and innovations regarding drug delivery from intravaginal rings (IVR). First, an injection-molded, hydrophilic poly(ether urethane) (HPEU) matrix IVR capable of sustained release of milligram-per-day quantities of TFV over 90 days is described. In the final two chapters, a secondiv generation reservoir TFV IVR is combined with a reservoir poly(ether urethane) segment that releases microdoses of the contraceptive progestin levonorgestrel (LNG), in a multisegment IVR design, concluding with assessments of product stability and in vivo pharmacokinetics in order to confirm the suitability of the IVR for clinical investigation. This dissertation represents an engineer's approach to designing and testing IVR, which are most commonly considered a pharmaceutical product rather than a medical device. Accordingly, much attention is given to the development and usage of mathematical models for drug release and mechanical properties from IVR, and in general to a mechanistic understanding of the underlying mechanisms of their operation

Fertility regulation: from laboratory bench to service delivery

Paper 1. Glasier AF. Contraception: past and future. Nature Medicine. 2002;8(S1): S3-S6. || Paper 2. McNeilly AS, Glasier A, Howie PW. Endocrine control of lactational infertility I. In: Maternal Nutrition and Lactational Infertility. Nestle Nutrition Workshop Series Vol 9, 1985 pp 1-19. Raven Press. New York.. || Paper 3. Glasier AF, Baird DT, Hillier SG. FSH and the control of follicular growth. J. Steroid Biochemistry 1989; 32: 167-170. || Paper 4. Glasier A, Wickings EJ, Rodger MW, Hillier SG, Baird DT. Both LH and FSH are required for the development of the normal follicle. J. Endocrinology 1988; 119: Suppl. 2. Abstract No 159. || Paper 5. McNeilly AS, Howie PW, Glasier A. Lactation and the return of ovulation: Natural Human Fertility. In Diggory P, Potts M, Thapa S (eds) Social and Biological Determinants. Proc XXIIIrd Annual Symp. Eugenics Society, London 1986. Macmillan Press: ppl02-l 17. || Paper 6. Tay CCK, Glasier A, McNeilly AS. The 24h pattern of pulsatile luteinising hormone, follicle stimulating hormone and prolactin release during the first eight weeks of lactational amenorrhoea in breastfeeding women. Human Reproduction 1992; 7: 951-958. || Paper 7. McNeilly AS, Tay CCK, Glasier A. Physiological Mechanisms Underlying Lactational Amenorrhoea. In Campbell KL, Wood JW (eds) Human Reproductive Ecology: Interactions of environment, fertility and behaviour. Annals New York Academy of Sciences 1994; 709: 145-155. || Paper 8. Tay CCK, Glasier AF, McNeilly AS. Effect of antagonists of dopamine and opiates on the basal and GnRH induced secretion of luteinizing hormone, follicle stimulating hormone and prolactin during lactational amenorrhoea in breastfeeding women. Human Reproduction 1993; 8: 532-539. || Paper 9. Glasier A, McNeilly AS. The Physiology of Lactation. In Franks S. (ed) Endocrinology of Pregnancy. Bailliere Tindall Clinical Endocrinology and Metabolism 1990; 4: 379 - 395. || Paper 10. Tay CCK, Glasier AF, McNeilly AS. Twenty-four hour patterns of prolactin secretion during lactation and the relationship to suckling and the resumption of fertility in breast-feeding women. Human Reproduction 1996; 11: 950-955. || Paper 11. Tay CCK, Glasier AF, Illingworth PJ, Baird DT. Abnormal twenty-four hour pattern of pulsatile luteinizing hormone secretion and the response to naloxone in women with hyperprolactinaemic amenorrhoea. Clinical Endocrinology 1993; 39: 599-606. || Paper 12. Glasier A, McNeilly AS, Baird DT. Induction of ovarian activity after pulsatile therapy in women with lactational amenorrhoea. Clinical Endocrinology 1986;24:243-252. || Paper 13. Glasier A, Baird, DT, McNeilly AS. Evidence for gonadal desensitization by pulsatile infusion of LHRH in women with amenorrhoea? Clinical Endocrinology 1987; 26: 441-451. || Paper 14. World Health Organization Task Force on Methods for the Natural Regulation of Fertility. The World Health Organization Multinational Study of Breastfeeding and Lactational Amenorrhoea. 1. Description of infant feeding patterns and the return of menses. Fertility & Sterility 1998; 70: 448-460. || Paper 15. World Health Organization Task Force on Methods for the Natural Regulation of Fertility. The World Health Organization Multinational Study of Breastfeeding and Lactational Amenorrhoea. II. Factors associated with the length of amenorrhoea. Fertility & Sterility 1998; 70: 461-471. || Paper 16. World Health Organization Task Force on Methods for the Natural Regulation ofFertility. The World Health Organization Multinational Study of Breast-feeding and Lactational Amenorrhoea. III. Pregnancy during breastfeeding. Fertility & Sterility 1999;72: 431- 440 || Paper 17. Caird LE, Reid-Thomas V, Hannan WJ, Gow S, Glasier AF. Oral progestogen-only contraception may protect against loss of bone mass in breast-feeding women. Clinical Endocrinology 1994; 41: 739-745. || Paper 18. Glasier AF, Logan J, McGlew TJ. Who gives advice about post partum contraception? Contraception 1996; 53: 217-220. || Paper 19. Smith, KB, van der Spuy Z, Cheng L, Elton R, Glasier AF. Is postpartum contraceptive advice given antenatally of value? Contraception 2002; 65: 237-243. || Paper 20. Glasier A. Contraception. In Edmonds DK (ed) Dewhurst's Textbook of Obstetrics and Gynaecology for Postgraduates. Sixth Edition 1999. pp 373-386. Blackwell Science. Oxford England. || Paper 21. Baird DT, Glasier AF. Hormonal Contraception. New EnglandJournal of Medicine 1993; 328: 1543-1549 || Paper 22. Glasier A. Hormonal Contraception. In Wass S, Shalet S (eds) Oxford Textbook ofEndocrinology and Diabetes. 2002 Chapter 8.1.2 pp. 1068-1079. Oxford University Press. || Paper 23. Glasier A. New developments in contraceptive drugs for use by women. Expert Opinion on Investigational Drugs 2002; 11(9): 1239-51 || Paper 24. Glasier A. Implantable contraceptives for women: effectiveness, discontinuation rates, return of fertility and outcome of pregnancies. Contraception 2002; 65: 29-37. || Paper 25. Davie J, Hiremath K, Glasier A. The introduction of a new contraceptive; two years experience with Norplant. Health Bulletin 1996; 54(4): 314-317. || Paper 26. Glasier Anna. The levonorgestrel-releasing intrauterine system. IPPF Medical Bulletin 1997; 31(5): 2-3. || Paper 27. Glasier A, Gebbie A. Contraception for the older woman. In Glasier A (Ed) Contraception. Balliere's Clinical Obstetrics and Gynaecology 1996; 10 :121- 138. || Paper 28. Gebbie AE, Glasier A, Sweeting V. Incidence of Ovulation in Perimenopausal Women Before and during Hormone Replacement Therapy. Contraception 1995; 52: 221-222. || Paper 29. Glasier A. Sterilization. In Glasier A, Gebbie AE (eds). The Handbook of Family Planning and Reproductive Healthcare. Harcourt Brace. 2000 pp. 177-200 || Paper 30. Penney GC, Souter V, Glasier A, Templeton AA. Laparoscopic sterilisation: opinion and practice among gynaecologists in Scotland. . British J. Obstetrics & Gynaecology 1997; 104: 71-77. || Paper 31. Fleming D, Davie J, Glasier A. Continuation rates of long-acting methods of contraception. A comparative study ofNorplant implants and intrauterine devices. Contraception 1998; 57:19-21. || Paper 32. Baird DT, Glasier AF. Menstrual bleeding patterns and Contraception. IPPF. Medical Bulletin 1991; 25 no.4. || Paper 33. Critchley HOD, Wang H, Kelly RW, Gebbie AE, Glasier AF. Progestin receptor isoforms and prostaglandin dehydrogenase in the endometrium of women using a levonorgestrel-releasing intrauterine system. Human Reproduction 1998; 13: 1210-1217. || Paper 34. Critchley HOD, Wang H, Jones RL, Kelly RW, Drudy TA, Gebbie AE, Buckley CH, McNeilly AS, Glasier AF. Morphological and functional features of endometrial decidualization following long-term intrauterine levonorgestrel delivery. Human Reproduction 1998; 13: 1218-1224. || Paper 35. Skinner JL, Riley SC, Gebbie AE, Glasier AF, Critchley HOD. Regulation of matrix metalloproteinase-9 in endometrium during the menstrual cycle and following administration of intrauterine levonorgestrel. Human Reproduction 1999; 14: 793-799. || Paper 36. Glasier AF, Wang H, Davie JE, Kelly RW, Critchley HOD. Administration anti-progesterone upregulates estrogen receptors in the endometrium of women using Norplant®: a pilot study. Fertility & Sterility 2002; 77 ; 366-72. || Paper 37. Cheng L, Zhu H, Wang A, Ren F, Chen J, Glasier A. Once a month administration of mifepristone improves bleeding patterns in women using subdermal contraceptive implants releasing levonorgestrel. Human Reproduction 2000; 15 : 1969-72. || Paper 38. Baird DT, Glasier A. Science, medicine and the future; Contraception. British Medical Journal 1999; 319: 969-972. || Paper 39. Hapangama DK, Brown A, Glasier AF, Baird DT. Feasibility of administering mifepristone as a once a month contraceptive pill. Human Reproduction 2001 ; 16: 1145-1150. || Paper 40. Glasier A, Thong KJ, Dewar M, Mackie M, Baird DT. Comparison of mifepristone and high dose oestrogen-progestogen for emergency post coital contraception. New England Journal of Medicine 1992; 327: 1041-44. || Paper 41. Rimmer C, Horga M, Cerar V, Alder E.M, Baird DT. Glasier A. Do women want a once a month pill? Human Reproduction 1992; 7: 608-611. || Paper 42. Glasier AF, Smith KB, Cheng L, Ho PC, van der Spuy Z, Baird DT. An international study on the acceptability of a once-a-month pill. Human Reproduction 1999; 14 : 3018-22. || Paper 43. Glasier AF, Smith K,Van der Spuy Z, Ho PC, Cheng L, Dada K, Wellings K, Baird DT. Amenorrhoea associated with contraception - an international study on acceptability. Contraception 2003; 67: 1-8. || Paper 44. Martin CW, Anderson RA, Cheng L, Ho PC, van der Spuy Z, Smith KB, Glasier AF, Everington D, Baird DT. Potential impact of hormonal male contraception: cross-cultural implications for development of novel preparations. Human Reproduction 2000; 15; 637-645. 325. Paper 45. Glasier AF, Anakwe R, Everington D, Martin CW, Van der Spuy Z, Cheng L, Ho PC, Anderson RA. Would women trust their partners to use a male pill? Human Reproduction 2000; 15: 646-649. || Paper 46. Hapangama, DK, Glasier, AF, Baird, DT. Noncompliance among a group of women using a novel method of contraception. Fertility and Sterility 2001; 76: 1196-1201. || Paper 47. Glasier A. Therapeutic termination of pregnancy. In Kubba A, Sanfilippo J, Hampton N. (eds). Contraception and Office Gynecology: Choices in Reproductive Healthcare. 1999 pp 319-331. W.B.Saunders London UK. || Paper 48. Glasier A. The organisation ofAbortion Services. Current Obstetrics and Gynaecology 1993; 3 : 23-27 || Paper 49. Glasier A., Thong KJ. The establishment of a centralised abortion referral service leads to earlier abortion. Health Bulletin 1991; 49/5: 254-259. || Paper 50. Penney GC, Glasier A, Templeton A. Multicentre criterion based audit of the management of induced abortion in Scotland. British Medical Journal 1994; 309: 15-18. || Paper 51. Penney GC, Glasier A, Templeton A. Agreeing criteria for audit of the management of induced abortion: an approach by national concensus survey. Quality in Health Care 1993; 2: 167-169. || Paper 52. Cameron ST, Glasier AF, Logan J, Benton L, Baird DT. Impact of new medical methods on therapeutic abortions at the Royal Infirmary of Edinburgh. British J. Obstetrics & Gynaecology 1996; 103: 1222-1229. || Paper 53. Penney GC, Templeton AA, Glasier A. Patients' views on abortion care in Scottish Hospitals. Health Bulletin 1994; 6: 431-437. || Paper 54. Glasier A. Counselling for abortion. In Baird DT, Grimes DA, Van Look PFA (eds) Modern Methods of Inducing Abortion. 1995. pp 112-124. Blackwell Science. || Paper 55. Glasier A. The acceptability of medical abortion and other uses of mifepristone. Reproductive Health Matters 1995; 6: 147 - 151. || Paper 56. Glasier A. Emergency post-coital contraception. New England Journal of Medicine 1997; 337; 1058-1064 || Paper 57. Glasier Anna. Emergency Contraception. In Human Reproduction: Pharmaceutical and Technical advances. In Millar RP, Baird DT (eds). British Medical Bulletin 2000; 56 : 729-738 || Paper 58. Glasier A, Ketting E, Palan VT et al. Case studies in emergency contraception from six countries. International Family Planning Perspectives 1996; 22:57-61. || Paper 59. Hapangama D, Glasier AF, Baird DT. The effects of peri-ovulatory administration of Levonorgestrel on the menstrual cycle. Contraception 2001; 63 : 123-129. || Paper 60. Stirling A, Glasier A. Estimating the efficacy of emergency contraception; how reliable are the data ? . Contraception 2002; 66: 19-22. || Paper 61. Glasier A. Safety of Emergency Contraception. Journal of the American Medical Women's Association 1998; 53 Suppl 2; 219-221. || Paper 62. Glasier A. Emergency Contraception - Time for de-regulation? British Journal of Obstetrics and Gynaecology 1993; 100: 611-612. || Paper 63. Graham A, Green L, Glasier A. Teenagers' knowledge of emergency contraception: questionnaire survey in south east Scotland. British Medical Journal 1996;312:1567-1569. || Paper 64. Kettle H, Cay S, Brown A, Glasier A. Screening for chlamydia trachomatis is indicated in women under 30 using emergency contraception. Contraception 2002; 66: 251-3 || Paper 65. Glasier A, Baird DT. The effects of Self-Administering Emergency Contraception. New England Journal of Medicine 1998; 339: 1-4. || Paper 66. Glasier A, Fairhurst K, Wyke S, Ziebland S, Seaman P, Walker J, Lakha F. Advanced provision of emergency contraception has not reduced abortion rates in Lothian. Contraception (in press, Contraception 2004) || Paper 67. Fairhurst K, Ziebland S, Wyke S, Seaman P, Glasier A. Emergency Contraception (EC): why can't you give it away? Qualitative findings from an evaluation of advance provision of EC. (submitted to BMJ)

Family Planning and Reproductive Health

Female reproductive topics are very common and can affect the patient’s quality of life. Such topics include puberty, endometriosis, breastfeeding, subfertility, menstrual problems, polycystic ovary syndrome, problems during pregnancy, uterine fibroids, various benign and malignant conditions of the reproductive organs, various sexually transmitted infections, family planning, and contraception. Good reproductive health covers the physical, mental, and social well-being. However, to maintain it, women need to be informed and empowered to protect themselves through access to services that can help them have a fit pregnancy, safe delivery, and healthy baby. This book is intended to cover some of the female reproductive issues for all specialties involved in health care for women

Imaging heritage and other metal surfaces with X-ray excited optical microscopy

Heritage tourism represents a significant source of income for the European Union. Metals are vital to this, but corrode and degrade over time unless curative actions are taken. Conservators require non-destructive analysis techniques and specific instrumentations for the study and analysis of ancient objects that comprise our tangible cultural heritage. XEOM 1, a novel X-ray-excited optical microscopy system, is presented as a new addition to the conservator’s toolbox. XEOM 1 allows non-destructive chemical imaging of heritage metal surfaces (approximately top 200 nm) in air and controlled atmosphere. XEOM exploits the effect in which X-ray absorption results in the emission of electromagnetic radiation in the visible and near-visible bands, a phenomenon known as X-ray-excited optical luminescence (XEOL). The work presented in the thesis comprises ground work for imaging of copper and copper corrosion products on assessment samples of varying patination; a multimethod analysis of heritage artefacts retrieved from King Henry VIII's flagship: the 'Mary Rose' and the study for an alternative excitation source for use of XEOM 1 outside the synchrotron. The research and development of X-ray-excited optical microscopy was supplemented with the research regarding the copper corrosion of frameless coppr and copper- gold intrauterine devices (IUDs)

The treatment of menorrhagia with an evaluation of endometrial ablation and its evolution

This thesis is based on work performed in the Department of Gynaecology ofAberdeen Royal Infirmary. This is a regional referral centre with an established reputation in menstrual research, focusing on surgical trials. The work of this thesis continues and expands on this.Chapter 1 outlines and reviews the current literature on the treatment of menstrual disorders. The aetiology, epidemiology and options both surgical and medical are reviewed. A detailed review of the development, scientific and technical aspects of Microwave Endometrial Ablation is made. The evidence base is reviewed and discussed with a focus on randomised trials.Chapter 2 describes the 5 year follow up of an original trial comparing women initially referred to a gynaecologist with excessive menses who were randomised to either standard medical treatment or endometrial ablation in the form of Transcervical Resection of the Endometrium (TCRE). This represents the longest follow up of women randomised to medical treatment for menorrhagia. Those allocated to ablation were significantly more likely to report themselves as totally satisfied at 5 years as those allocated medical treatment. Acceptability was high for both arms but only 20% of women treated medically would recommend this to a friend compared to 79% of the ablation arm. Amenorrhoea rates were significantly higher in the ablation arm versus the medical arm (88% versus 66%). Quality of life measures using the generic tool SF 36 revealed that scores for the women in the ablation arm were restored to normative levels in all 8 subsets, whilst this was improved in only 4 for the medical arm. During the follow up period 77% of those in the medical arm underwent ablative surgery. The impact of offering ablative surgery early did not result in an increase in the incidence of recourse to hysterectomy with similar numbers in each arm (17% versus 18%) being hysterectomised at 5 years.Chapter 3 describes a multi-centre international randomised controlled trial comparing the first generation technique of Rollerball Endometrial Ablation (RBEA) with the second generation technique of Microwave Endometrial Ablation (MEA). This trial had 8 centres, both academic and private, in the United States, Canada and the United Kingdom. The trial randomised 322 women to MEA or RBEA in a 2:1 ratio. Menstrual Loss (PBLAC) diaries were used in the recruitment, follow up and definition of success (PBLAC score < 75). When comparing women allocated to MEA versus those allocated to RBEA they reported similar success rates and satisfaction. Higher post operative amenorrhoea rates were reported in the MEA arm but the result was not significant. In the subgroup of women with BMI's of over 30kg/m2 MEA was significantly more likely to be associated with success. The presence or absence of non-obstructing fibroids (< 3cm) did not affect success rates or amenorrhoea rates between MEA and RBEA. MEA treatment was significantly more often performed under local anaesthesia. This trial established MEA as being comparable in the majority of outcome measures to RBEAChapter 4 describes a randomised controlled trial of MEA performed in an outpatient setting in the early post menstrual phase to standard treatment performed in a day case theatre after endometrial preparation. All procedures were performed under local anaesthesia plus or minus sedation. 210 women were randomised in a 1:1 ratio to the treatment arms. Significantly more women found treatment post menses acceptable (89.5% versus 76%). Similar numbers were totally or generally satisfied (92.5% versus 84%). Amenorrhoea rates were similar (55.9% versus 61.9%). A significant difference in direct cost was seen with treatment as an outpatient in the post menses arm costing £124 less than treatment in day case theatre after endometrial preparation.Chapter 5 reviews the rates of surgery for excessive menstrual bleeding in Scotland and the Grampian region from 1998 - 2004. A 43% reduction in the hysterectomy rate is seen in Scotland over the time scale. A smaller reduction (34%) is seen in the figure for Grampian. This may be a reflection of Aberdeens pro-ablation stance and early general uptake of the procedure .A 25% reduction is seen in the total number of procedures in Scotland. The ratios of hysterectomy to ablation alter over time with a reduction from 5:1 to 1.7:1 seen. The ratio is Aberdeen is more marked with a ratio of 0.5 to 1, twice as many ablations being done as hysterectomy. The low uptake of vaginal hysterectomy and decline in minimally invasive technologies of Laparoscopic Assisted Vaginal Hysterectomy are outlined. Overall an increase of 65% in ablation rates in Scotland is seen with a shift from first generation to second generation techniques (11% reduction in 1st versus a 65% increase in 2nd generation technologies).Chapter 6 reviews the conclusions made form the work described in this thesis and there relevance to medical practice. Suggestions are made for areas of future research

ADIPOSITY IN BRITISH PAKISTANI AND WHITE BRITISH SCHOOL CHILDREN AGED 7-11 YEARS LIVING IN MIDDLESBROUGH, UK: ASSOCIATIONS WITH ETHNICITY, GENERATION, AND BIRTH WEIGHT

People of South Asian ethnicities in the UK are at a high risk of obesity and related illnesses. This thesis tests predictions derived from the developmental origins literature regarding adiposity in British Pakistanis in middle childhood. Based on previous research, it was predicted that British Pakistani children would be more adipose and have lower birth weights compared to white British children. It was also predicted that second generation British Pakistani children would be more adipose and have lower birth weights than the third generation. White British children (n=211) and British Pakistani children (n=137), including second generation (n=82) and third generation (n=51), aged 7-11 years were measured for body mass index (BMI), waist circumference, triceps and subscapular skinfold thicknesses, blood pressure, and resting heart rate. Birth weight data were collected from one hospital in Middlesbrough (n=184). In addition, a pilot study was conducted on lifestyle, which explored potential differences in British Pakistani children’s lifestyle that may affect adiposity. Dietary data (n=30) were gathered by multiple-pass recall interviews. Physical activity data were collected by accelerometry (n=27) and also by multiple-pass recall interviews (n=30). A questionnaire was developed for the lifestyle pilot to gain an understanding of parents’ (n=24) knowledge and practices of healthy lifestyles. Focus group interviews were conducted in one school with children (n=18), which explored children’s knowledge and practices of healthy lifestyles. The same focus groups also explored the issue of child participation in the study to understand different motivations between ethnicities and sexes. Compared to white British children, British Pakistani children were significantly fatter by standard deviation scores for triceps (p=0.003) and subscapular skinfolds (p<0.000), but not by BMI (p=0.599) or waist circumference (p=0.253). British Pakistani children had significantly lower birth weights (p<0.001), and were more frequently classified as low birth weight (p=0.01) and small-for-gestational age (p<0.001). These results may support the foetal origins hypothesis, which is that early life influences can adversely affect later health, by linking foetal development with adiposity in childhood. There was a higher proportion of overfat by subscapular skinfold thickness (p<0.001) in second generation British Pakistani boys compared to the third generation. The two generation groups did not differ significantly in any measure of birth weight. The lifestyle pilot sub-study suggests that differences in lifestyle patterns may exist between the British Pakistani and white British families who participated, and it could provide a basis for a full study on this topic. Methods implemented in public health research should reconsider using the body mass index alone as a predictor of body fatness, especially in populations including British Pakistanis. Qualitative methodologies should be used to inform study design as a way of illuminating complex and interrelated issues such as obesity and ethnicity