Exposure of children and adolescents to alcohol marketing on social media websites.

AIMS: In 2011, online marketing became the largest marketing channel in the UK, overtaking television for the first time. This study aimed to describe the exposure of children and young adults to alcohol marketing on social media websites in the UK. METHODS: We used commercially available data on the three most used social media websites among young people in the UK, from December 2010 to May 2011. We analysed by age (6-14 years; 15-24 years) and gender the reach (proportion of internet users who used the site in each month) and impressions (number of individual pages viewed on the site in each month) for Facebook, YouTube and Twitter. We further analysed case studies of five alcohol brands to assess the marketer-generated brand content available on Facebook, YouTube and Twitter in February and March 2012. RESULTS: Facebook was the social media site with the highest reach, with an average monthly reach of 89% of males and 91% of females aged 15-24. YouTube had a similar average monthly reach while Twitter had a considerably lower usage in the age groups studied. All five of the alcohol brands studied maintained a Facebook page, Twitter page and YouTube channel, with varying levels of user engagement. Facebook pages could not be accessed by an under-18 user, but in most cases YouTube content and Twitter content could be accessed by those of all ages. CONCLUSION: The rise in online marketing of alcohol and the high use of social media websites by young people suggests that this is an area requiring further monitoring and regulation

Improving the effectiveness and efficiency of outpatient services: a scoping review of interventions at the primary-secondary care interface.

Objectives Variation in patterns of referral from primary care can lead to inappropriate overuse or underuse of specialist resources. Our aim was to review the literature on strategies involving primary care that are designed to improve the effectiveness and efficiency of outpatient services. Methods A scoping review to update a review published in 2006. We conducted a systematic literature search and qualitative evidence synthesis of studies across five intervention domains: transfer of services from hospital to primary care; relocation of hospital services to primary care; joint working between primary care practitioners and specialists; interventions to change the referral behaviour of primary care practitioners and interventions to change patient behaviour. Results The 183 studies published since 2005, taken with the findings of the previous review, suggest that transfer of services from secondary to primary care and strategies aimed at changing referral behaviour of primary care clinicians can be effective in reducing outpatient referrals and in increasing the appropriateness of referrals. Availability of specialist advice to primary care practitioners by email or phone and use of store-and-forward telemedicine also show potential for reducing outpatient referrals and hence reducing costs. There was little evidence of a beneficial effect of relocation of specialists to primary care, or joint primary/secondary care management of patients on outpatient referrals. Across all intervention categories there was little evidence available on cost-effectiveness. Conclusions There are a number of promising interventions which may improve the effectiveness and efficiency of outpatient services, including making it easier for primary care clinicians and specialists to discuss patients by email or phone. There remain substantial gaps in the evidence, particularly on cost-effectiveness, and new interventions should continue to be evaluated as they are implemented more widely. A move for specialists to work in the community is unlikely to be cost-effective without enhancing primary care clinicians' skills through education or joint consultations with complex patients.This project was funded by the National Institute for Health Research Health Services and Delivery Research programme (project number 12/135/02).This is the final version of the article. It first appeared from SAGE via http://dx.doi.org/10.1177/1355819616648982

Diet quality and depressive symptoms in adolescence: no cross-sectional or prospective associations following adjustment for covariates.

OBJECTIVE: Adolescence is a critical period for development of depression and understanding of behavioural risk factors is needed to support appropriate preventive strategies. We examined associations between adolescent diet quality and depressive symptoms, cross-sectionally and prospectively, in a large community cohort, adjusting for behavioural and psychosocial covariates. DESIGN: Prospective community-based cohort study (ROOTS). SETTING: Secondary schools in Cambridgeshire and Suffolk, UK. SUBJECTS: Study participants (n 603) who completed 4 d diet diaries at age 14 years and reported depressive symptoms (Moods and Feelings Questionnaire (MFQ)) at 14 and 17 years of age. RESULTS: Diet data were processed to derive a Mediterranean diet score (MDS) and daily servings of fruit and vegetables, and fish. At age 14 years, a negative association between fruit and vegetable intake and MFQ score was seen in the unadjusted cross-sectional regression model (β=-0·40; 95 % CI -0·71,-0·10), but adjustment for behavioural covariates, including smoking and alcohol consumption, attenuated this association. Fish intake and MDS were not cross-sectionally associated with MFQ score. No prospective associations were found between MDS, fruit and vegetable intake or fish intake and later MFQ score. CONCLUSIONS: Diet quality was not associated with depressive symptoms in mid-adolescence. Previously reported associations in this age range may be due to confounding. Further longitudinal studies are needed that investigate associations between adolescent diet and depression across different time frames and populations, ensuring appropriate adjustment for covariates

How do short-term associations between diet quality and metabolic risk vary with age?

Abstract: Purpose: Poor diet quality is one of the key contributors to poor cardiovascular health and associated morbidity and mortality. This study aimed to assess how the short-term associations between diet quality and metabolic risk factors change with age. Methods: This longitudinal, observational study used data from the National Diet and Nutrition Survey (2008–2016) (n = 2024). Diet quality was measured using the Dietary Approaches to Stop Hypertension (DASH) index, fruit and vegetable (F&V) intake, and a F&V biomarker score. We assessed associations between measures of diet quality and a metabolic risk z score (generated from five metabolic risk factors) among those aged 11–60 years, and then tested effect modification by age group (adolescents 11–18 years, young adults 19–35 years, mid-aged adults 36–60 years). Results: Analysis across all age groups showed inverse associations between standardised DASH index and metabolic risk z score of − 0.19 (95% CI − 0.26, − 0.11). These associations were moderated by age group, with strong associations seen in mid-aged adults: − 0.27 (95% CI − 0.39, − 0.16), but associations were significantly attenuated in young adults [− 0.10 (95% CI − 0.22, 0.01)] and adolescents [0.03 (95% CI − 0.05, 0.11)]. Similar results were found for F&V intake and F&V biomarker score. Conclusions: Short-term associations between diet quality and metabolic risk are not consistent across adolescent and young adult age groups, suggesting that mechanisms by which diet impacts on metabolic risk may be acting differently in younger age groups compared to adults. Further research is warranted using longitudinal study designs and replication in different populations to understand changes in determinants of cardiometabolic health with age

How do associations between sleep duration and metabolic health differ with age in the UK general population?

Background: Despite a growing body of evidence suggesting that short sleep duration may be linked to adverse metabolic outcomes, how these associations differ between age groups remains unclear. We use eight years of data from the UK National Diet and Nutritional Survey (NDNS) (2008–2016) to analyse cross-sectional relationships between sleep duration and metabolic risk in participants aged 11–70 years. Methods: Participants (n = 2008) who provided both metabolic risk and sleep duration data were included. Self-reported sleep duration was standardised by age, to account for differences in age-related sleep requirements. A standardised metabolic risk score was constructed, comprising: waist circumference, blood pressure, serum triglycerides, serum high-density lipoprotein cholesterol, and fasting plasma glucose. Regression models were constructed across four age groups from adolescents to older adults. Results: Overall, decreased sleep duration (hrs) was associated with an increased metabolic risk (standard deviations) with significant quadratic (B:0.028 [95%CI: 0.007, 0.050]) and linear (B:-0.061 [95%CI: -0.111, -0.011]) sleep duration coefficients. When separated by age group, stronger associations were seen among mid-aged adults (36-50y) (quadratic coefficient: 0.038 [95%CI: 0.002, 0.074]) compared to other age groups (e.g. adolescents (11-18y), quadratic coefficient: -0.009 [95%CI: -0.042, 0.025]). An increased difference between weekend and weekday sleep was only associated with increased metabolic risk in adults aged 51–70 years (B:0.18 [95%CI: 0.005, 0.348]). Conclusions: Our results indicate that sleep duration is linked to adverse metabolic risk and suggest heterogeneity between age groups. Longitudinal studies with larger sample sizes are required to explore long-term effects of abnormal sleep and potential remedial benefits

Community Hospitals in Selected High Income Countries: A Scoping Review of Approaches and Models.

BACKGROUND: There is no single definition of a community hospital in the UK, despite its long history. We sought to understand the nature and scope of service provision in community hospitals, within the UK and other high-income countries. METHODS: We undertook a scoping review of literature on community hospitals published from 2005 to 2014. Data were extracted on features of the hospital model and the services provided, with results presented as a narrative synthesis. RESULTS: 75 studies were included from ten countries. Community hospitals provide a wide range of services, with wide diversity of provision appearing to reflect local needs. Community hospitals are staffed by a mixture of general practitioners (GPs), nurses, allied health professionals and healthcare assistants. We found many examples of collaborative working arrangements between community hospitals and other health care organisations, including colocation of services, shared workforce with primary care and close collaboration with acute specialists. CONCLUSIONS: Community hospitals are able to provide a diverse range of services, responding to geographical and health system contexts. Their collaborative nature may be particularly important in the design of future models of care delivery, where emphasis is placed on integration of care with a key focus on patient-centred care.This project was funded by the National Institute for Health Research Health Services and Delivery Research programme (project number 12/177/14)

Cohabiting and becoming a parent: associations with changes in physical activity in the 1970 British cohort study

Abstract: Background: We examined the association between family–related life events (cohabitation/marriage and becoming a parent) and change in physical activity. Methods: Longitudinal data (n = 8045) from the 1970 British Cohort Study (30 and 34 years) were included. Life events (beginning cohabitation/marriage and becoming a parent) were reported and coded: 0 no, 1 yes, for each event occurring between 30 and 34 years. Participants reported frequency of participation in leisure-time physical activity at 30 and 34 years (Likert scale: mean change calculated ranging between − 4 and 4). Linear regression models were used to examine the association between life events and physical activity change (comparing individuals experiencing events between 30 and 34 years versus never experiencing the event - excluding participants that experienced previous events – with a final analysis sample of n = 3833 in parenthood analysis; n = 1137 in cohabitation analysis). Interaction terms were used to analyse combined parenthood and cohabitation status. Analyses were adjusted for level of education achieved, ethnicity, country of origin and other life events. ANCOVA was used to examine associations between change in physical activity and child age. Results: Compared to remaining without children, becoming a parent was associated with a greater reduction in physical activity among men [β:-0.234(95%CI:-0.396 to − 0.072)] but not women [0.126(− 0.048;0.301)]. No associations were found between cohabitation and physical activity. Men who became fathers both while cohabitating [− 0.201(− 0.383;-0.020)] and without cohabiting [− 0.937(− 1.623;-0.250)] experienced greater physical activity declines than those remaining single and without children; the decline was greatest among non-cohabiting fathers. These associations did not differ by child age. Conclusions: Parenthood appears to differentially impact physical activity for men and women; this association also differs by cohabitation status. Parenthood appears to be most detrimental to physical activity levels among men. Interventions for physical activity could target new or soon-to-be parents, especially fathers. Further analyses with device-measured physical activity data would be valuable to advance understanding of these associations

Cohabitation and marriage during the transition between adolescence and emerging adulthood : a systematic review of changes in weight-related outcomes, diet and physical activity

Our aim was to systematically review the effect of cohabitation and marriage on physical activity, diet and weight-related outcomes during emerging adulthood. A systematic search of six electronic databases was conducted until July 2019 (PROSPERO:CRD42018106943). Prospective studies were included if data were presented for a weight-related outcome, physical activity, and/or diet among 15–35 years-old participants assessed pre- and post-cohabitation or marriage and compared to a consistently non-cohabiting/non-married (single) reference group. Following title/abstract screening, two reviewers independently screened full-text and assessed risk of bias. There were 11 studies that met inclusion criteria. Outcomes included: body mass index (BMI) only (n = 3), physical activity only (n = 4), diet only (n = 2), BMI and physical activity (n = 1), and all outcomes (n = 1). Cohabitation or marriage was associated with greater BMI increases compared to remaining single among both men and women. Three studies analysed separately cohabitation and marriage and 3 of 4 found that only marriage was associated with higher BMI. Compared to being consistently single, starting cohabitation or getting married were associated with decreased physical activity in 2 of 4 studies among men and 4 of 6 studies among women, with no differences between marriage and cohabitation. Of the three studies examining change in diet, two showed no difference between individuals beginning to cohabit compared to those remaining single; without gender differences. Starting cohabitation and getting married may be valuable targets for weight management interventions, but more studies are needed to investigate the effect of cohabitation and marriage on health behaviours

Changes in physical activity, diet, and body weight across the education and employment transitions of early adulthood: A systematic review and meta-analysis.

Early adulthood is a time when individuals go through important life transitions, such as moving from high school into higher education or employment, but the impact of these life transitions on changes in body weight, diet, and physical activity is not known. We searched six electronic databases to July 2019 for longitudinal observational studies providing data on adiposity, diet, and/or physical activity across education or employment transitions in young people aged between 15 and 35 years. We found 19 studies, of which 17 assessed changes in physical activity, three body weight, and five diet or eating behaviours. Meta-analysis (n=9) found that leaving high school was associated with a decrease of -7.04 (95% CI, -11.26, -2.82) min/day of moderate-to-vigorous physical activity. Three studies reported increases in body weight on leaving high school. A small number of studies suggested decreases in diet quality on leaving high school (n=2/4 papers) and leaving university (n=1) but not on starting employment (n=1). Studies suggested no change in physical activity on leaving university (n=4) but decreases in physical activity on starting employment (n=2/3). The transition of leaving high school is an important time to support individuals to prevent decreases in physical activity and gains in body weight.This study was supported by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence (RES-590-28-0002). Funding from the British Heart Foundation, Department of Health, Economic and Social Research Council, Medical Research Council, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. The work is additionally supported by the Medical Research Council (MC_UU_12015/7). Rebecca Love is funded by a Gates Cambridge Scholarship. Campbell Foubister is funded by a NIHR School for Public Health PhD Studentship