Moving in later life – Qualitative Research within a Population-Based Cohort Study
Fiona Scheibl 1 , Jane Fleming 1 , Robert Evans 1 , Jackie Buck 2 , Stephen Barclay 1 Morag Farquhar 1 , Carol Brayne 1 , Cambridge City over-75s Cohort (CC75C) study collaboration
1 University of Cambridge 2 University of East Anglia
This paper uses qualitative data from the CC75C longitudinal study of ageing to examine older people’s experience of moving in later life and how the decision to move is made. It reports the findings of a thematic analysis of 26 very old people (aged ≥95) who moved. It develops an earlier model of moving later in life (Pope and Kang 2010) that distinguishes between moves that are reactive and those that are proactive. The paper makes a series of policy recommendations that could increase the support available to older people (and their families) for home adaptions and with moving before the risk of health crisis associated with frailty and dementia forces ‘reactive’ moves which tend to be traumatic and distressing for families and their loved ones.
Characterizing gene-specific effects of LDL cholesterol on type 2 diabetes using metabolomics
Li C., Lotta L.A., Wittemans L.B., Day F.R., Willems S.M., Stewart I.D., Wareham N.J. Scott R.A., Langenberg C.
MRC Epidemiology Unit, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
Background: LDL-cholesterol-lowering genetic variants near the targets of lipid-lowering therapies (including statins and ezetimibe) are associated with lower risk of coronary heart disease, with an effect size directly proportional to the magnitude of their association with LDL cholesterol. These variants are associated with higher risk of T2D, but with heterogeneity in effect size, suggesting underlying mechanisms may be gene-specific and not solely related to the magnitude of LDL lowering.
Objectives: To investigate potential molecular mechanisms of gene-specific associations of LDL-cholesterol lowering alleles on T2D.
Methods: We first investigated associations of 5 LDL-lowering loci at genes encoding lipid-lowering therapeutic targets with T2D and glycaemic traits. Then, to explore potential sources of heterogeneity in their T2D associations, I analysed their effects on 122 metabolites measured by nuclear magnetic resonance spectrometry (Kettunen J. et al. Nat Commun. 2016).
Results: Lead single nucleotide polymorphism (SNP) (rs2073547) at NPC1L1 gene exhibited robust association with T2D (OR per 1-standard deviation [SD] reduction of LDL cholesterol, 2.71; 95% confidence interval [CI], 2.64-2.77; p=5.34E-05), and while associations present at the other four genes, HMG-CoA reductase, PCSK9, ABCG5/G8, and LDL receptor were weaker (OR per 1-SD reduction of LDL cholesterol, 1.13 to 1.39). NPC1L1 alleles exhibited a different association pattern from the overall LDL-lowering genetic risk score with the ratio of bis-allylic bonds to total fatty acids in lipids (I2=82.8%, p=0.03); with acetate levels(I2=75.8%, p=0.04); and with the densities of LDL (I2=82.8%, p=0.02) and very-low-density lipoprotein(I2=81.6%, p=0.02).
Conclusions: We found an association of LDL-lowering variants in NPC1L1 with T2D that was larger in magnitude than for other LDL-lowering loci, suggesting a gene-specific effect on T2D beyond LDL cholesterol regulation. Based on our current metabolomic analyses, molecular mechanisms of how NPC1L1 affects T2D risk are not well understood, but may involve regulations on the saturation of fatty acids and lipoprotein metabolism.
Connected for Cognitive Health in Later Life (CHILL): A community based participatory research (CBPR) Scoping study.
Introduction: Identifying risk and developing prevention strategies are key objectives in public health research, yet poor understanding of the impact of cultural, ethnic, geographical differences on perceptions of ageing well and how to age ‘well’, challenges our ability to develop actions that are acceptable and meaningful to local communities. This suggests a need for research embedded in sub-populations, seeking to understand their reality, understanding and interpretation of health and health risk; and, taking account of local context.
Aims and objectives: The long term aim of this work is to describe and understand the influence of community and beliefs on modifiable risk factors for dementia; and to co-develop responses. Two key areas of focus are: identifying perceptions and beliefs around health, barriers and facilitators; and, exploring the value and potential of community engaged approaches in communicating and responding to knowledge. This goal of this scoping project was to scope the potential of, and lay the foundations for, CBPR into mid-life risk factors within a particular locality.
Method: Employing principles and methods of community based participatory research with recruitment via street samples, leafleting, social media and local press, and targeting key community interest groups. Research and dissemination techniques leaned to the more creative, inclusive and accessible, e.g. ‘vox pop’, diagramming, workshops and peer interviewing.
Results and conclusions: We identified common questions and beliefs about cognitive health, and held community forums to present research evidence on risk and to explore community responses. A working group was set up to investigate local ‘context’, within an asset-based approach and to generate ideas the community wanted to take forward. The scoping project is completed in August 2016, but work continues to build local capacity for CBPR.
Funders: Project funded by the Gillings School of Public Health, University of North Carolina.
The weekend effect in the UK: a systematic review and meta-analysis
Objective: The ‘weekend effect’ is the observed association between weekend admission and subsequently greater mortality. The results and interpretation of prior studies differ. This systematic review aims to answer the following questions: 1) Is there an association between weekend admission and mortality? 2) Does this observed association vary with methodological, patient, or hospital factors? 3) What is the overall strength of evidence?
Methods: Pubmed, EMBASE, SCOPUS, Cochrane database of systematic reviews, and Web of Science were searched from database inception to 16 May 2016. Any study written in English which had a UK hospital population, considered weekend admission, compared this to weekday admission, and had mortality as an outcome, was eligible for inclusion. A random effects meta-analysis model was deployed; heterogeneity was assessed by the I2 statistic. Study quality was assessed by the Newcastle-Ottowa Criteria, and publication bias assessed by constructing a contour funnel plot and performing Egger’s test. Strength of evidence was assessed by the GRADE criteria.
Results: 53 eligible studies were identified. 42 of these were eligible for meta-analysis, but only 12 studies (comprising 17 cohorts) could be included in the primary analysis due to overlapping cohorts (n > 54 656 444). Weekend admission was associated with an increased risk of death, although with very high heterogeneity (OR 1.16; 95% confidence interval 1.07 to 1.26; P <0.001; I2 = 99.2%). Secondary analyses revealed cohorts of elective admissions had a greater weekend effect than cohorts of emergency admissions. There was a non-significant trend towards cohorts using administrative data having greater weekend effects than those using clinical data, and for estimates adjusted for case-mix being lower than unadjusted estimates; by contrast weekend effects observed high or low weekend staffing contexts were numerically similar. Overall strength of evidence by GRADE criteria was below ‘very low’ (score 0) for the association of weekend admission with elevated mortality, and for whether this is mediated by hospital or patient factors.
Conclusions: Weekend admission in the UK is associated with modestly elevated risk of mortality, although the overall strength of evidence supporting this is low. The numerical trends in secondary analysis provide fractionally more support for methodological or patient factor explanations than for hospital factor explanations of the weekend effect, but aetiology remains opaque. Given the unclear evidence of benefit and probable high cost, seven-day services reform in the NHS is contraindicated on the current evidence.
Registration: PROSPERO database, CRD42016036099.
Pilot-testing the Age-Friendly Cities evaluation tool
In the context of rapid population ageing and urbanisation, there is a growing recognition of the need to ensure that urban environments foster healthy ageing and a good quality of life in older age. The WHO has been playing a leading role in supporting relevant endeavours through its Age-Friendly Cities (AFC) initiative.
Based on fieldwork in Liverpool/UK as a city with an age-friendly agenda, an evidence-based evaluation tool for AFCs has been developed. The tool has been designed to be adaptable to different urban contexts where age-friendliness is to be assessed and monitored.
As well as presenting the evaluation tool, this poster provides an overview of its pilot-testing in different settings. This includes the initial application of the tool to Liverpool’s AFC initiative, and to falls as a case study within the city’s wider AFC framework. It also includes the current use of the tool in Sheffield to assess the city’s work on Dementia-friendliness as part of an age-friendly approach. Finally, insights from adapting the tool to inform the development of Northstowe/Cambridge as a new Healthy New Town with an age-friendly remit are considered.
The aim is to demonstrate how the evaluation tool can be applied and adapted in different contexts to support efforts to make urban settings more age-friendly.
Young people, clinicians and researchers co-produce a Transition Preparation Programme to improve experience and outcomes for young people leaving Child and Adolescent Mental Health Services
NIHR CLAHRC/University of Cambridge, Dept of Psychiatry
This project was completed earlier this year but implementation and development work continues. The poster was co-designed by a young person who participated in the project and took on a co-researcher role.
Poster title: Young people, clinicians and researchers co-produce a Transition Preparation Programme to improve experience and outcomes for young people leaving Child and Adolescent Mental Health Services (CAMHS)
Context: Currently young people using Child and Adolescent Mental Health Services (CAMHS) are discharged or transferred to an adult service at age 17/18. This age-based cut-off is not in the best interests of young people as they deal with the multiple and complex changes and demands of adolescence. CAMHS transition has been shown to be poorly managed and poorly experienced by young people (Singh 2009) but improved preparation to face this major change may be beneficial (Memarzia 2015).
Aims: To explore young people’s preparation needs and to co-produce, with Child and Adolescent Mental health Services (CAMHS) users and leavers, a CAMHS Transition Preparation Programme, flexible to individuals’ needs, to enable young people to transition when they are most likely to succeed in the world of adult services or self-care.
Methods: NIHR CLAHRC East of England* researchers worked with 18 young people using and leaving CAMHS and 30 practitioners in three NHS Mental Health Foundation Trusts. In each Trust NHS participation/inclusion staff, with established relationships with the young people, were key members of the research teams and took part in the workshops. We opted for a participatory, active, creative workshop approach over more traditional research methods which are enjoyable and engaging for young people. They provide the time and space to reflect, generate, share and debate their ideas and experiences. The project was structured in three stages: i. two-day active and creative workshops with young people to explore the issues and generate ideas; ii. short active workshops for mental health service practitioners (in two trusts), co-hosted by young people, to gain the service provider perspective on barriers and deliverability; iii. one day ‘harvesting’ workshops in which young people brought together the material and made a set of recommendations and an outline TPP. Consensus with young people on the important points and themes was reached through a process of ongoing reflective discussions.
Results: The young people made a number of recommendations on transition policy and practice and a set of detailed preparation requirements relating to the specific needs of vulnerable young people transferring from CAMHS.
Implementation: Two Trusts are committed to developing the young people’s ideas with a view to implementation as they review their CAMHS transition procedures.
*National Institute of Health Research Collaboration for Leadership in Applied Health Research & Care (CLAHC) East of England: a collaboration of academics, clinicians and managers who undertake high quality applied health research focused on the needs of patients and service users, supporting the translation of research evidence into practice in the NHS and social care.
Evidence@Cambridge Group: Survey on expertise and interests
Tennie Videler and Mila Petrova
Evidence@Cambridge is a 66-member group within the PublicHealth@ Cambridge Network. It is for colleagues interested in systematic reviews and other research synthesis methods. It is a forum for networking and collaboration. All researchers are welcome, regardless of level of expertise in systematic reviewing.
Recently we conducted a survey on the expertise and interests of group members and summarise the results here.
Frailty Trajectories: Understanding Tipping Points Across Care Settings
Louise Lafortune & Joyce Coker on behalf of the Frailty Trajectories team
Older adults are heavy users of health and social services, but not all use all types of services. Heavy utilisation is concentrated in the frailest and those nearing the end of their life. Frailty is a distinct health state of vulnerability characterised by increased risks of adverse outcomes or sudden/disproportionate deterioration in physical, cognitive or mental health triggered by an apparently minor event. Around 10% of people ≥65 are estimated frail and 25-50% of those ≥85, with findings suggesting levels of frailty are higher in recent cohorts, and in the poorest wealth groups. In that context, decision makers are equally concerned with increased demand by frail older people as with quality, safety and equity across the continuum of health and social care services.
This project aims to 1) describe care trajectories to capture the process of frailty in later life, 2) test the effects of known predictors of transitions, adverse events or harm, and 3) describe configurations of service utilisation and costs. This will inform preventive and management practices as well as commissioning in the context of integrated care to improve quality of care and avert harms.
The project will rely on analysis of linked administrative datasets and robust statistical tools to identify trajectories of service utilisation across settings for various levels of frailty. The meaning of these trajectories for clinicians, healthcare professionals, commissioners and members of the public will be derived using qualitative methods, such as individual interviews and focus groups. Also, our findings will be informed by regional and national integrated care initiatives/projects to help us understand how enabling organisational factors influence expenditures.
A range of stakeholders are currently involved in the project in a truly co-productive partnership, including the Addenbrookes’s Hospital, EAHSN, Cambridgeshire County Council, CPFT, East of England Ambulance Trust, and the CCG. Public involvement is being sought via collaborations with organisations across the region.
Changing risk behaviours and promoting cognitive health in older adults - An evidence based resource for local authorities and commissioners
Louise Lafortune, Sarah Kelly, Olawale Olanrewaju, Andy Cowan, Carol Brayne
As part of the Cognitive Health Theme of the SPHR Ageing Well Programme and CLAHRC East of England, we conducted three rapid evidence reviews to inform the development of the National Institute for Health and Care Excellence (NICE) guideline on mid-life approaches to prevent or delay onset of dementia, disability and frailty (NICE 2015).
Building on that work, three new systematic reviews of the scientific literature look at the effectiveness of interventions to promote healthy behaviours and cognitive health in older adults, and the barriers and facilitators of behaviour change in this population. PHE has asked the CIPH research team to develop an evidence-based resource for commissioners and local authorities based on the reviews’ key findings.
The resource is intended for local authority commissioners and clinical commissioning groups to provide a steer as to what types of interventions they should focus on to help the uptake and maintenance of healthy behaviours and promote cognitive health among older adults living in the community. It is also intended for providers of lifestyle behaviour change programmes to support the development of evidence informed prevention packages for older adults. Finally, it is produced in a way that makes it accessible to managers and practitioners with public health as part of their remit, working in the public, private and third sector.
Vaccine uptake in the Irish Travelling community: an audit of general practice records
1. C. Dixon1, R. Mullis2, T. Blumenfeld3
1) School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0SP, UK 2) Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge CB1 8RN, UK 3) Institute of Public Health, School of Clinical Medicine, University of Cambridge, The Primary Care Unit, Box 113 Cambridge Biomedical Campus, Cambridge CB2 0SR, UK
Background: Compared to the general population, the Traveller community has substantial health inequalities. Vaccination coverage in Traveller children is estimated to be low and Travellers are at higher risk of vaccine-preventable diseases due to their social circumstances.
Methods: Audit of vaccination history of Traveller (n = 214) and non-Traveller (n = 776) children registered at a general practice in England. The Green Book childhood immunization schedule was used as a reference standard.
Results: There was significantly lower coverage for Traveller children compared to non-Traveller children for all vaccinations in the routine childhood immunization schedule. The percentage of children completing the schedule at all time points was significantly lower in the Traveller community.
Traveller communities have significantly lower uptake of vaccinations, and therefore Travellers’ children should be targeted by general practitioners for catch-up vaccination to improve outcomes for individuals and local herd immunity.
Public health outcomes of complex community interventions: community volunteering and Time Credits in the UK
Gemma Burgess1, Louise Lafortune2
Project collaborators: Spice, Cambridgeshire County Council, Cambridge Housing Society
1Cambridge Centre for Housing and Planning Research 2Cambridge Institute of Public Health
Time Credits are a way of recognising and celebrating the time people spend volunteering with a local organisation, community group, volunteer group or a statutory sector service provider. In exchange for their contribution, they ‘earn’ printed Time Credit notes, one for every hour they give, which they can then ‘spend’ on a range of leisure and other opportunities in a network of Spice partners across the UK.
A Time Credit project has been established in Wisbech, England, an area with above average levels of deprivation and a range of challenging social issues. The outcomes of the project are being researched by the University of Cambridge. The aim of the research is to evaluate the potential of the Time Credit project to tackle social exclusion, loneliness and deprivation and to assess the extent to which it can reduce health inequalities and secure positive public health outcomes.
The research uses a mixed methods approach that engages service users, practitioners and policy makers through interviews, surveys, focus groups and ethnographic research methods. In particular, it uses validated scales to measure change in health behaviours, social determinants of health and health outcomes.
This paper presents emerging findings about the ways in which this community intervention can lead to positive public health outcomes and the conceptual underpinnings of such an approach to reducing health inequalities.
Bone Health in Gambian Women: Impact and implications of rural-urban migration and the nutrition transition
Sarah Dalzell1; Landing MA Jarjou2; Ann Prentice1,2; Kate Ward1; Gail R Goldberg1,2
1MRC Elsie Widdowson Laboratory, Cambridge, UK; 2MRC Keneba, MRC Unit The Gambia
Background: Urbanisation has been associated with the relatively rapid and recent rise in osteoporotic fragility fracture incidence in many countries, with predictions indicating that hip fracture incidence will increase 6-fold in Africa and Asia by 2050. The Gambia is a West African country in nutritional, demographic and epidemiological transition. Over 50% of Gambian people now reside in urban areas; many having internally migrated from rural areas.
Objective: The primary objective of this observational study was to explore the impact of rural-urban migration on bone phenotype in Gambian premenopausal women (aged 35-50years).
Design: Eighty-two rural women were studied at the MRC field station of Keneba and fifty-eight urban migrant women at the MRC Fajara site in The Gambia. Bone phenotype (bone mineral content (BMC); bone area (BA); areal bone mineral density (aBMD), and size-adjusted BMC (height, weight and BA) of the whole-body, lumbar spine and hip) was measured by dual energy x-ray absorptiometry (DXA) with further characterisation of bone phenotype by peripheral quantitative CT (pQCT). Data was also collected on anthropometry, body composition, nutrient intakes, physical activity, socio-demographic characteristics and vitamin D status.
Results: Complete data were collected for 140 women. Mean age and height of rural and urban groups were not significantly different (p>0.05). Urban migrant women were significantly heavier (p<0.01), urban 69.2 ± 15.6kg and rural were 60.5 ± 12.2kg (p<0.01). Significant differences in BMC and aBMD were found between groups at all skeletal sites, with urban women having higher BMC and aBMD. The greatest difference in BMC was found at the lumbar spine (9.0% ± SE 3.0, p<0.01). After adjusting for size, the differences between urban and rural spine BMC remained significant (6.6% ± SE 2.1, p<0.01).
Data analysis is continuing in order to explore additional bone parameters measured by pQCT, at both the radius and tibia, as well as other diet and lifestyle variables which may affect bone health.
Acknowledgements: Supported by the UK Medical Research Council (MRC) under programs U105960371 and U123261351. This research is jointly funded by the MRC and the Department for International Development (DFID) under the MRC/DFID Concordat agreement. SD is in receipt of a MRC PhD studentship.
Modifiable barriers to meeting care and support needs of patients with advanced Chronic Obstructive Pulmonary Disease (COPD) and their informal carers
C Moore1, G Ewing1, AC Gardener1, P White2, P Burge3, R Mahadeva4, S Howson5, S Booth1, T Ling3, M Farquhar1 on behalf of the Living with Breathlessness study team
1 University of Cambridge, Cambridge, UK; 2 King’s College London, London, UK; 3 RAND Europe, Cambridge, UK; 4 Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
Introduction: COPD is a progressive condition with high symptom burden. Advanced COPD management should relieve symptoms, optimise daily functioning and reduce carer burden. Our knowledge of clinician barriers and facilitators to meeting the needs of these patients and their informal carers is limited.
Aim: To identify modifiable barriers to meeting care and support needs of patients with advanced COPD and their carers.
Methods: Purposively-sampled clinicians nominated by a population-based cohort of patients with advanced COPD participating in the Living with Breathlessness Study, took part in longitudinal qualitative interviews on barriers and facilitators to meeting needs, and analysed using a Framework approach. Identified barriers were reviewed and recommendations to overcome them presented to stakeholders via workshop and online survey methods.
Results: Identification and assessment of patient need, and barriers and facilitators to doing so, were largely driven by organisational and medical agendas, rather than person-centred care models. There was little evidence of clinician engagement with patients’ informal carers. There was a mismatch between clinicians’ perceptions of changes in patient need during the 18-month study duration and those of patients and carers. Clinicians felt unprepared for end-of-life care discussions and found patient readiness for these conversations difficult to assess. Clinician-identified patient, organisational and professional facilitators included trust, time and accessibility.
Conclusion: Actioning recommendations such as stopping focusing on the challenge of prognostication as a barrier to meeting need, changing targets to incentivise person-centred care and identifying and supporting carers could improve care and support of patients and carers living with advanced COPD.
Funders: Marie Curie & NIHR CDF
*This report is independent research supported by the National Institute for Health Research (Career Development Fellowship, CDF-2012-05-218). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.
Changes in bone mineral density within the first three months of lactation in HIV-infected women on antiretroviral therapy in Kampala, Uganda
Florence Nabwire1, 2, Gail Goldberg1, Adeodata Kekitiinwa2, Mary Glenn Fowler3, Josephat
Byamugisha4, Matthew Hamill1, Monica Nolan3 and Ann Prentice1
1MRC Elsie Widdowson Laboratory Cambridge UK; 2 Baylor College of Medicine Children’s Foundation-Uganda; 3Makerere University – Johns Hopkins University Care Ltd, Uganda; 4Makerere University, Uganda.
Introduction: HIV-infection in children is mainly through Mother-To-Child Transmission (MTCT) during pregnancy, delivery and breastfeeding. For prevention of MTCT, WHO recommend all HIV-infected (HIV+ve) pregnant and lactating women to initiate lifelong antiretroviral therapy (ART). Also, HIV+ve women in resource limited settings are advised to breastfeed for at least 2 years. However, ART initiation is associated with a 2-6% decrease in bone mineral density (BMD) regardless of drug
regimen. Pregnancy and lactation is associated with temporary reductions in BMD (up to 4.5%).
Currently, the magnitude of changes in BMD and implications for public health among lactating HIV+ve women on ART are unknown. The aim of this study was to investigate if HIV+ve women on ART experience greater reductions in BMD within the first 3 months of lactation compared to HIV uninfected (HIV-ve) women.
Methods: A longitudinal observational study involving 100 HIV+ve and 100 HIV –ve women in Kampala, Uganda. Women were recruited during pregnancy between January 2015 and January 2016. HIV+ve women initiated ART during current pregnancy per prevailing guidelines. Sets of DXA scans (lumbar spine [LS] and total hip [TH] were performed at 2 (PP2) and 14 weeks postpartum (PP14) to measure aBMD, with and without correction for body size and weight. The primary outcome was the difference in % change (± SE) in maternal BMD at LS between PP2 and PP14.
Results and conclusion: 155 women completed both PP2 and PP14 visits, 81 HIV+ve and 74 HIV-ve. The median age was 23 yrs. HIV+ve women were lighter compared to HIV-ve at PP2 (mean: 59.8 kg vs 63.1kg). Overall, BMD reduced at LS and TH in both groups. There was no significant difference in % change between groups at LS (HIV+ve: -1.8 ± 0.004, HIV-ve: -2.3% ± 0.004, p=0.4). The greatest reduction in BMD was observed at TH and HIV+ve women lost more BMD compared to HIV-ve (HIV+ve: -3.8 ± 0.003, HIV-ve: -2.7% ± 0.003, p=0.004). At PP14, HIV+ve women had significantly higher BMD for their size and weight at LS and TH compared to HIV-ve (LS: 1.1% ± 0.005, p=0.037; TH: 2.2 ± 0.003, p<0.001). Data analysis is ongoing to investigate the mechanisms and effects on infant growth.
Longitudinal changes in maternal 25(OH)D3 and free 25(OH)D, vitamin D binding protein and the relationship with cord vitamin D metabolites
I. Schoenmakers, S. Assar, S. E. Moore, A. Prentice, K. S. Jones,
MRC Elsie Widdowson Laboratory and MRC Keneba, The Gambia
Background: Low maternal vitamin D (VD) status is associated with adverse obstetric outcomes and fetal development. VD status is assessed by the measurement of plasma 25-hydroxyvitamin (25(OH)D) concentration. In the circulation, 25(OH)D is primarily bound to the vitamin D binding protein (DBP) with a small fraction present as free 25(OH)D. The relative importance of bound and free 25(OH)D, their gestational changes and their impact on fetal cord 25(OH)D concentration are unclear.
Methods: In rural Gambian women (n 21) with abundant, year-round UVB exposure we assessed 25(OH)D, free-25(OH)D and DBP plasma concentrations before pregnancy, at gestational weeks 13, 20, and 30 and in cord blood. 25(OH)D was measured using UPLC-MS/MS, and free 25(OH)D and DBP concentrations were measured by ELISA.
Results: Concentrations (mean ± standard deviation) of 25(OH)D and DBP increased from pre-pregnancy across gestation to gestational week 30 (P<0.0001) (25(OHD: 64±13 to 100±23 nmol/L; DBP: 356±47 to 625±105 mg/L). Across the same period, there was no change in free 25(OH)D concentration (P=0.2). Cord plasma concentrations of 25(OH)D3 (58±15 nmol/L) and DBP (270±48 mg/L) were lower than maternal plasma at week 30 (P<0.0001), and free 25(OH)D (15.5±5.0 pmol/L) was higher (P=0.03). Maternal (week 30) and cord concentrations were highly correlated for free 25(OH)D (P<0.0001), but not 25(OH)D (P=0.2).
Conclusions: In this population with adequate VD status and year-round UVB exposure, gestational increases in both 25(OH)D and DBP concentrations were in keeping with the unchanging free 25(OH)D concentration. These data suggest efficient placental transfer of free 25(OH)D and contribute to our understanding of maternal and neonatal VD requirements. Additional work is required to understand the impact of maternal VD supplementation on neonatal VD status.
This work was jointly supported by the Medical Research Council (Programme Grants U105960371, U123261351, and MCA760-5QX00) and the Department for International Development under the Medical Research Council/Department for International Development Concordat agreement.
NNEdPro Global Centre for Nutrition and Health: A Multidisciplinary Initiative bridging Research, Education and Practice
Gabriele Mocciaro1, Shivani Bhat2, Pauline Douglas3, Daniele Del Rio4, Minha Rajput-Ray5 and Sumantra Ray5
1NNEdPro Assistant Co-Ordinator 2NNEdPro Deputy Co-Lead Network Engagement Panel3 Vice-Chair and Education Director 4 Scientific Director 5Medical Director 6NNEdPro Founding Chair and Executive Director
Background: It is widely known that nutrition related illnesses are preventable. Lack of training and difficulty accessing reliable nutritional evidence results in health professionals being unable to incorporate nutrition effectively into practice. Via a multidisciplinary network of health professionals (physicians, dieticians, nutritionists, educational experts and translational researchers), NNEdPro (Need for Nutrition Education/Innovation Programme) has been able to establish a world leading and highly innovative think-tank, training academy and knowledge network, bringing together the best of education, research, evaluation and advocacy, particularly in nutrition-related aspects of health and healthcare systems.
Methods: Using a knowledge-to-action framework, phases of work were launched and this included:
- Synthesis and generation of high-quality evidence
- Development and evaluation of teaching materials
- Innovative educational interventions enabling translation of evidence into practice and policy changes
Results: NNEdPro’s successes have been illustrated via research outputs and activities including 1) the establishment of a government-funded curriculum strand in clinical and public health nutrition at the University of Cambridge; 2) the inception and delivery of Annual International Summits on Medical Education Research; 3) Mobilizing global leaders in nutrition education and medical research using network hubs in India, Australia/New Zealand, and Canada; 4) Delivering an accredited Summer School in Applied Human Nutrition; 5) the Complete Nutrition National Award for Outstanding Achievement in 2015 and designation as an Education Team of the Year by the BMJ Awards in 2016.
Future Direction: To develop self-sustaining knowledge, skills and capacity in nutrition and health through: 1) A Global Training Academy delivering nutrition education to impact knowledge, attitudes and practices; 2) Consultancy services and action-orientated research to design and conduct education and implementation programmes; 3) the NNEdPro Cambridge Foundation to facilitate public understanding of nutrition; 4) the Consortium of Research Laboratories to combine Non Communicable Disease Prevention (including Cardiovascular aspects of Nutrition) and Dietary Bioactives research capabilities. Using these four sections of specialist capability, knowledge and skills NNEdPro continues to employ the education of health professionals as a sustainable intervention tool to enable primary research studies, generation of new evidence and translation into policy and practice.
Dying comfortably in very old age with or without dementia – a representative “older old” population study
Fleming J, Calloway R, Perrels A, Farquhar M, Barclay S, Brayne C and CC75C Cambridge City over-75s Cohort study collaboration
Palliat Med April 2016 vol. 30 no. 4 S36 (P45); e-pub March 6, 2016, doi:10.1177/0269216316631462
Palliative Care Congress, Glasgow, Mar 2016
Fleming J, Evans R, Scheibl F, Buck J, Barclay S, Farquhar M, Brayne C, and Cambridge City over-75s Cohort (CC75C) study collaboration.
BMJ Supportive & Palliative Care 2016; 6(3):392.
Royal Society of Medicine and Marie Curie Annual Palliative Care Conference:
Round the clock: Making 24/7 palliative care a reality, London, Oct 2016
The Cascade study – Case-finding in hospitals: impacts on care for people with dementia
Fleming J, Bunn F, Burn A, Martin S, Turner D, Arthur T, Fox C, O’Brien J, Brayne C
NIHR CLAHRC East of England
Individual- and area-level risk factors of generalized anxiety disorder