Physical Activity, Sedentary Time and Physical Capability in Early Old Age: British Birth Cohort Study

Purpose To investigate the associations of time spent sedentary, in moderate-to-vigorous-intensity physical activity (MVPA) and physical activity energy expenditure (PAEE) with physical capability measures at age 60-64 years. Methods Time spent sedentary and in MVPA and, PAEE were assessed using individually calibrated combined heart rate and movement sensing among 1727 participants from the MRC National Survey of Health and Development in England, Scotland and Wales as part of a detailed clinical assessment undertaken in 2006-2010. Multivariable linear regression models were used to examine the cross-sectional associations between standardised measures of each of these behavioural variables with grip strength, chair rise and timed up-&-go (TUG) speed and standing balance time. Results Greater time spent in MVPA was associated with higher levels of physical capability; adjusted mean differences in each capability measure per 1standard deviation increase in MVPA time were: grip strength (0.477 kg, 95% confidence interval (CI): 0.015 to 0.939), chair rise speed (0.429 stands/min, 95% CI: 0.093 to 0.764), standing balance time (0.028 s, 95% CI: 0.003 to 0.053) and TUG speed (0.019 m/s, 95% CI: 0.011 to 0.026). In contrast, time spent sedentary was associated with lower grip strength (-0.540 kg, 95% CI: -1.013 to -0.066) and TUG speed (-0.011 m/s, 95% CI: -0.019 to -0.004). Associations for PAEE were similar to those for MVPA. Conclusion Higher levels of MVPA and overall physical activity (PAEE) are associated with greater levels of physical capability whereas time spent sedentary is associated with lower levels of capability. Future intervention studies in older adults should focus on both the promotion of physical activity and reduction in time spent sedentary

Investigating the impact of technologies on the quality of data collected through surveys

Social surveys continue to play an important role in social science and policy making. In addition to providing information about attitudes and behaviours, they act as a vehicle for the collection of many different types such as biomeasures, geographical data, administrative records, social media posts and so on. The resilience and adaptability of the social survey owes much to the way that they have adapted to the enormous changes in the technological environment. Radical changes in telephony, personal computing, the internet, and mobile devices have transformed many aspects of the research process. While these changes have brought many benefits, the application of each new technology in survey data collection needs careful consideration in terms of ethics, burden, cost, and implementation. Moreover, they may introduce representation errors and measurement errors that must be accounted for. In this context, this thesis considers the effects of new technologies on data quality and measurement error. It presents three examples of the use of technologies in social surveys and examines an aspect of data quality in relation to each. The thesis makes specific recommendations and encourages further methodological research in the use of technology in survey data collection.The focus of the first study is on three biomeasures which are frequently collected in health or multidisciplinary surveys but may be recorded using different equipment. A randomised cross-over trial of 118 healthy adults aged 45-74 years was conducted using two sphygmomanometers to measure blood pressure, four handgrip dynamometers to measure grip strength, and two spirometers to measure lung function. For each of these three measures, multiple readings from each device were combined with information about the individual, drawn from a self-completion questionnaire, to build a pseudo-anonymised analytical dataset. Evidence was found of differences in measurements when assessed using alternative devices. For blood pressure, there is a difference, on average, of 3.85 mm Hg for Systolic Blood Pressure and 1.35 mm Hg for Diastolic Blood Pressure. For grip strength, two electronic dynamometers record measurementson average 4-5kg higher than either a hydraulic or a spring-gauge dynamometer. For lung function, a difference of 0.47 litres, on average, was found for measures of Forced Vital Capacity, but no difference was found in measures of Forced Expiratory Volume. The primary analysis was conducted using Bland and Altman plots. Sensitivity analyses tested different definitions of each measure and used multilevel regression modelling as an alternative way of estimating device effects. The findings have implications for analysts who may want to test the sensitivity of their findings to the average differences observed with these combinations of devices and may help investigators who are selecting equipment for new studies or changing equipment for longitudinal studies. Further trials are needed to replicate the comparison of these devices and to test different device combinations, both in stand-alone studies and within larger observational surveys. Future analysts may wish to consider using multilevel modelling to assess device effects.The second paper also considers device effects, this time, exploring whether the device used to complete an online survey (that is a PC, smartphone, or tablet) affects data quality. The study is based on the Wellcome Trust Science Education Tracker, a mobile-optimised, online survey of over 4,000 pupils aged 14-18. It uses the Wellcome Science Education Tracker 2016 dataset, available through the UK Data Archive, with additional survey process variables obtained with the agreement of the Wellcome Trust. The study uses propensity scores (more specifically, Inverse Probability Treatment Weights) to balance the samples, to reduce the possibility that measurement effects are confounded by selection. The analysis draws on linked geographical, administrative and survey process data which provides an opportunity to assess the use of exogenous confounder variables in the matching process. The large sample size makes it possible to test the sensitivity of the finding to the inclusion or exclusion of tablet users. Overall, the study identifies few consistent device effects, and those that are observed are small, providing reassurance for survey practitioners and analysts. After controlling for selection, those who use a mobile device are seen to have higher levels of “don’t know” responses and are more likely to have interruptions during survey completion. Contrary to the findings of some earlier studies, smartphone responders complete the survey more quickly than PC responders. The results for straightlining are mixed and no clear pattern between mobile and PC could be found. The findings encourage the inclusion of a wide range of covariates when controlling for selection, beyond basic demographics, ideally including exogenous variables, and including those which capture topic salience.The third research study addresses the potential for app-based research. It is an exploratory study which assesses the quality of data collected using an app-based expenditure diary over a one-month period. A total of 268 members of the Understanding Society Innovation Panel agreed to take part. The analysis uses a combination of two datasets from Understanding Society: Spending Study 1 (2016-2017) and Wave 9 of the Innovation Panel (2016), both of which are available fromthe UK Data Archive. Other analyses have explored initial response rates to this study, noting that just 16.5% of the invited sample completed the registration process and fewer still downloaded the app. In this study, the investigation of data quality involved defining and examining four measures of adherence to protocol, and the extent to which these aspects of adherence were sustained over the duration of the study period. The research identifies a reasonable level of engagement from those who agreed to participate in the app study. For example, the mean number of app use days in the one-month period was 21.7 and the mean number of spending events reported was 27.6. Almost all participants (96.6%) reported at least one spending event and of those, most (95%) used a combination of photographing receipts and making direct entries, or only photographed receipts, with 61% of all spending events reported by photographing receipts. Almost all of those (94.9%) who photographed one or more receipts which had relevant date information did so within, on average, 24 hours of the time of the spending event. Although adherence based on all four measures clearly declines across the study month, it remains reasonably high. This study provides encouragement for further development of the app, and further methodological research and experimentation to increase full and sustained adherence to protocol. If a spending study app is to be embedded successfully in a large-scale study such as Understanding Society, future efforts will inevitably focus on ways to raise initial participation rates, but it would be unfortunate if the particular benefits of app-based research, such as capturing detailed spending data from receipts using photographs, were entirely let go in favour of achieving higher initial response rates

Immunoglobulin G; structure and functional implications of different subclass modifications in initiation and resolution of allergy.

IgE and not IgG is usually associated with allergy. IgE lodged on mast cells in skin or gut and basophils in the blood allows for the prolonged duration of allergy through the persistent expression of high affinity IgE receptors. However, many allergic reactions are not dependent on IgE and are generated in the absence of allergen specific and even total IgE. Instead, IgG plasma cells are involved in induction of, and for much of the pathogenesis of, allergic diseases. The pattern of IgG producing plasma cells in atopic children and the tendency for direct or further class switching to IgE are the principle factors responsible for long-lasting sensitization of mast cells in allergic children. Indirect class switching from IgG producing plasma cells has been shown to be the predominant pathway for production of IgE while a Th2 microenvironment, genetic predisposition, and the concentration and nature of allergens together act on IgG plasma cells in the atopic tendency to undergo further immunoglobulin gene recombination. The seminal involvement of IgG in allergy is further indicated by the principal role of IgG4 in the natural resolution of allergy and as the favourable immunological response to immunotherapy. This paper will look at allergy through the role of different antibodies than IgE and give current knowledge of the nature and role of IgG antibodies in the start, maintenance and resolution of allergy

Системы здравоохранения в действии: Кыргызстан

Система здравоохранения Кыргызстана предоставляет гарантированный государством пакет услуг, однако существуют значительные пробелы в охвате населения, а объем финансируемой государством помощи ограничен. Большинство пациентов вынуждены вносить сооплату за стационарное лечение, в то время как государство покрывает всего 50% так называемой базисной цены ограниченного списка (около 70) лекарственных средств. Государственные расходы на здравоохранение сократились, при этом увеличивается доля государственных расходов, направляемых в другие сектора. Частные расходы заполнили образовавшийся дефицит финансирования, и в настоящее время чуть более половины расходов на здравоохранение оплачивается из собственных средств. Сильная зависимость от платежей из собственных средств граждан может привести к катастрофическим и разорительным расходам на здравоохранение. Текущие реформы в области управления государственными финансами призваны обеспечить более рациональное и эффективное расходование государственных средств. Несмотря на усилия по обеспечению доступа к услугам здравоохранения, остаются заметные различия в обеспечении сельских и городских районов, а также барьеры, связанные со стоимостью и пробелами в обязательном медицинском страховании. В целом, Кыргызстан сталкивается с серьезными проблемами в области здравоохранения как в плане инфекционных, так и неинфекционных заболеваний. До пандемии COVID-19 ожидаемая продолжительность жизни росла, но все еще остается одной из самых низких в Европейском регионе ВОЗ

The politics of ageing: health consumers, markets and hegemonic challenge

In recent years ageing has travelled from the placid backwaters of politics into the mainstream of economic, social and cultural debate. What are the forces that have politicised ageing, creating a sustained opposition to the supply side hegemony of pharmaceuticals, medicine and state which has historically constructed, propagated and legitimised the understanding of ageing as decline in social worth? In addressing this question, the paper develops Gramsci's theory of hegemony to include the potentially disruptive demand side power of consumers and markets. It shows how in the case of ageing individuals acting in concert through the mechanisms of the market, and not institutionalised modes of opposition, may become the agents of hegemonic challenge through a combination of lifecourse choice and electoral leverage. In response, the hegemony is adapting through the promotion of professionally defined interpretations of ‘active ageing’ designed to retain hegemonic control. With the forces of hegemony and counter‐hegemony nicely balanced and fresh issues such as intergenerational justice constantly emerging, the political tensions of ageing are set to continue

The impact of variation in the device used to measure grip strength on the identification of low muscle strength: Findings from a randomised cross-over study

Grip strength is commonly used to identify people with low muscle strength. It is unclear what impact the type of dynamometer used to measure grip strength has on the identification of low muscle strength so we aimed to assess this. Study participants were 118 men and women aged 45-74y from a randomised, repeated measurements cross-over study. Maximum grip strength was assessed using four hand-held dynamometers (Jamar Hydraulic; Jamar Plus+ Digital; Nottingham Electronic; Smedley) in a randomly allocated order. EWGSOP2 cut-points were applied to estimate prevalence of low muscle strength for each device. Agreement between devices was compared. Prevalence of low muscle strength varied by dynamometer ranging between 3% and 22% for men and, 3% and 15% for women. Of the 13 men identified as having low muscle strength by at least one of the four dynamometers, only 8% were identified by all four and 54% by just one. Of the 15 women classified as having low muscle strength by at least one of the four dynamometers, only 7% were identified by all four and 67% by only one. Variation in the measures of grip strength acquired by different hand-held dynamometers has potentially important implications when identifying low muscle strength

A review of new technologies and data sources for measuring household finances: Implications for total survey error

We review process generated data sources and new technologies that could be used to improve the measurement of household finances. The sources include data generated by financial aggregator services, customer loyalty programmes, credit/debit card transactions, and credit rating agencies. The technologies include scanning of barcodes or shopping receipts and smartphone applications. For each of the data sources and technologies, we review what, if anything, is known about (i) the content of what can be measured, (ii) examples of research for which these data have been used, (iii) whether the data have been used as free-standing data sources or linked to probability sample surveys, and (iv) the quality of the data regarding representativeness and measurement quality. The review is structured around an adapted version of the Total Survey Error framework we have developed for evaluating these new data sources, and concludes with a discussion of implications for survey practice and research needs