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Alhulaefi SS, Watson AW, Ramsay SE, Jakubovics NS, Matu J, Griffiths A, Kimble R, Siervo M, Brandt K, Shannon OM. Effects of dietary nitrate supplementation on oral health and associated markers of systemic health: a systematic review. Crit Rev Food Sci Nutr 2024:1-16. [PMID: 38733290 DOI: 10.1080/10408398.2024.2351168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
Poor oral health can impact an individual's ability to eat and has been associated with an increased risk of non-communicable diseases. While the benefits of nitrate consumption on oral health were first proposed more than 20 years ago, no systematic review has been published examining effects of dietary nitrate on oral health. This systematic review investigated the effects of dietary nitrate on markers of oral health in vivo in randomized controlled trials (RCTs). Five databases (PubMed, The Cochrane Library, CINAHL, MEDLINE, and SPORTDiscus) were searched from inception until March 2023. Nine articles reporting data on 284 participants were included. Dietary nitrate was provided via beetroot juice in most studies. The duration of the interventions ranged from one day to six weeks. Dietary nitrate supplementation increased the relative abundance of several individual bacterial genera including Neisseria and Rothia. Dietary nitrate supplementation increased salivary pH and decreased salivary acidification following consumption of a sugar-sweetened beverage. Furthermore, dietary nitrate supplementation resulted in a decrease in the gingival inflammation index. The results of this systematic review suggest that dietary nitrate could represent a potential nutritional strategy to positively modify oral health by impacting the oral microbiome, altering salivary pH, and minimizing gingival inflammation.
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Affiliation(s)
- Shatha S Alhulaefi
- Human Nutrition & Exercise Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Nutrition, Taif University, Taif, Saudi Arabia
| | - Anthony W Watson
- Human Nutrition & Exercise Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nick S Jakubovics
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Jamie Matu
- School of Health, Leeds Beckett University, Leeds, UK
| | | | - Rachel Kimble
- Division of Sport, Exercise and Health, Health and Life Sciences, University of the West of Scotland, Glasgow, UK
| | - Mario Siervo
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Kirsten Brandt
- Human Nutrition & Exercise Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Oliver M Shannon
- Human Nutrition & Exercise Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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McGowan LJ, John DA, Kenny RPW, Joyes EC, Adams EA, Shabaninejad H, Richmond C, Beyer FR, Landes D, Watt RG, Sniehotta FF, Paisi M, Bambra C, Craig D, Kaner E, Ramsay SE. Improving oral health and related health behaviours (substance use, smoking, diet) in people with severe and multiple disadvantage: A systematic review of effectiveness and cost-effectiveness of interventions. PLoS One 2024; 19:e0298885. [PMID: 38635524 PMCID: PMC11025870 DOI: 10.1371/journal.pone.0298885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/31/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND People experiencing homelessness co-occurring with substance use or offending ('severe and multiple disadvantage' SMD) often have high levels of poor oral health and related health behaviours (particularly, substance use, smoking, poor diet). This systematic review aimed to assess the effectiveness and cost-effectiveness of interventions in adults experiencing SMD to improve oral health and related health behaviours. METHODS AND FINDINGS From inception to February 2023, five bibliographic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, and Scopus) and grey literature were searched. Two researchers independently screened the search results. Randomized controlled trials (RCTs), comparative studies and economic evaluations were included that reported outcomes on oral health and the related health behaviours. Risk of bias was assessed and results narratively synthesized. Meta-analyses were performed where appropriate. This review was registered with PROSPERO (reg. no: CRD42020202416). Thirty-eight studies were included (published between 1991 and 2023) with 34 studies reporting about effectiveness. Most studies reported on substance use (n = 30). Interventions with a combination of housing support with substance use and mental health support such as contingent work therapy appeared to show some reduction in substance use in SMD groups. However, meta-analyses showed no statistically significant results. Most studies had short periods of follow-up and high attrition rates. Only one study reported on oral health; none reported on diet. Three RCTs reported on smoking, of which one comprising nicotine replacement with contingency management showed improved smoking abstinence at 4 weeks compared to control. Five studies with economic evaluations provided some evidence that interventions such as Housing First and enhanced support could be cost-effective in reducing substance use. CONCLUSION This review found that services such as housing combined with other healthcare services could be effective in improving health behaviours, particularly substance use, among SMD groups. Gaps in evidence also remain on oral health improvement, smoking, and diet. High quality studies on effectiveness with adequate power and retention are needed to address these significant health challenges in SMD populations.
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Affiliation(s)
- Laura J. McGowan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Deepti A. John
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ryan P. W. Kenny
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Emma C. Joyes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Emma A. Adams
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Hosein Shabaninejad
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Catherine Richmond
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fiona R. Beyer
- Evidence Synthesis Group and Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - David Landes
- NHS England & Improvement, Newcastle Upon Tyne, United Kingdom
| | - Richard G. Watt
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Falko F. Sniehotta
- NIHR Policy Research Unit Behavioural Science, Newcastle University, Newcastle Upon Tyne, United Kingdom
- Department of Public Health, Social and Preventive Medicine, Centre for Preventive Medicine and Digital Health (CPD), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Martha Paisi
- Faculty of Medicine and Dentistry, Peninsula Dental School, University of Plymouth, Plymouth, United Kingdom
| | - Claire Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sheena E. Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Mills S, Kaner EFS, Ramsay SE, McKinnon I. What are the key influences and challenges around weight management faced by patients in UK adult secure mental health settings? A focused ethnographic approach. BMJ Open 2024; 14:e079406. [PMID: 38553050 PMCID: PMC10982710 DOI: 10.1136/bmjopen-2023-079406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 03/12/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES Excess weight is highly prevalent in secure (forensic) mental health services and impacts negatively on patients' physical and mental health. This study sought to identify the key influences and challenges around weight management in UK adult secure mental health settings. DESIGN Qualitative focused ethnography. Analysis of written fieldnotes was undertaken through a combined inductive and deductive approach, informed by thematic analysis. SETTING Low secure male mental health ward and associated patient activities and events, in a National Health Service Trust delivering mental health, intellectual disability and neurorehabilitation services in the UK. PARTICIPANTS 12 males (primarily white British) on the low secure ward; additional male participants from low and medium secure services, who took part in group events and activities; and multidisciplinary low and medium secure services staff. Approximately 23 hours of observation were undertaken over a 6-month period from April 2022. RESULTS Secure mental healthcare delivered an environment predisposing patients to excessive weight gain and sedentary behaviour, which was often perceived as inevitable. Key themes highlighted the heightened salience of food in secure settings; inadequacy of catered hospital food and shortcomings of alternative food options; limited physical activity opportunities; and a ward culture that was not conducive to healthy behaviours. Perceptions and behaviour towards the ethnographer were primarily positive and accepting. CONCLUSIONS Weight management in secure services is a complex challenge. In future, whole setting-based interventions to promote healthy weight are likely to be required. These should integrate physical and mental health, incorporate underpinning determinants such as adequate staffing and a culture promoting weight management, and involve both patients and staff.
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Affiliation(s)
- Susanna Mills
- Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Eileen F S Kaner
- Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Sheena E Ramsay
- Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Iain McKinnon
- Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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Phelps NH, Singleton RK, Zhou B, Heap RA, Mishra A, Bennett JE, Paciorek CJ, Lhoste VPF, Carrillo-Larco RM, Stevens GA, Rodriguez-Martinez A, Bixby H, Bentham J, Di Cesare M, Danaei G, Rayner AW, Barradas-Pires A, Cowan MJ, Savin S, Riley LM, Aguilar-Salinas CA, Baker JL, Barkat A, Bhutta ZA, Branca F, Caixeta RB, Cuschieri S, Farzadfar F, Ganapathy S, Ikeda N, Iotova V, Kengne AP, Khang YH, Laxmaiah A, Lin HH, Ma J, Mbanya JCN, Miranda JJ, Pradeepa R, Rodríguez-Artalejo F, Sorić M, Turley M, Wang L, Webster-Kerr K, Aarestrup J, Abarca-Gómez L, Abbasi-Kangevari M, Abdeen ZA, Abdrakhmanova S, Abdul Ghaffar S, Abdul Rahim HF, Abdurrahmonova Z, Abu-Rmeileh NM, Abubakar Garba J, Acosta-Cazares B, Adam I, Adamczyk M, Adams RJ, Adu-Afarwuah S, Aekplakorn W, Afsana K, Afzal S, Agbor VN, Agdeppa IA, Aghazadeh-Attari J, Ågren Å, Aguenaou H, Agyemang C, Ahmad MH, Ahmad NA, Ahmadi A, Ahmadi N, Ahmadi N, Ahmed I, Ahmed SH, Ahrens W, Aitmurzaeva G, Ajlouni K, Al-Hazzaa HM, Al-Hinai H, Al-Lahou B, Al-Lawati JA, Al-Raddadi R, Al Asfoor D, Al Hourani HM, Al Qaoud NM, Alarouj M, AlBuhairan F, AlDhukair S, Aldwairji MA, Alexius S, Ali MM, Alieva AV, Alkandari A, Alkerwi A, Alkhatib BM, Allin K, Alomary SA, Alomirah HF, Alshangiti AM, Alvarez-Pedrerol M, Aly E, Amarapurkar DN, Amiano Etxezarreta P, Amoah J, Amougou N, Amouyel P, Andersen LB, Anderssen SA, Androutsos O, Ängquist L, Anjana RM, Ansari-Moghaddam A, Anufrieva E, Aounallah-Skhiri H, Araújo J, Ariansen I, Aris T, Arku RE, Arlappa N, Aryal KK, Assefa N, Aspelund T, Assah FK, Assembekov B, Assunção MCF, Aung MS, Aurélio de Valois CJM, Auvinen J, Avdičová M, Avi S, Azad K, Azevedo A, Azimi-Nezhad M, Azizi F, Babu BV, Bacopoulou F, Bæksgaard Jørgensen M, Baharudin A, Bahijri S, Bajramovic I, Bakacs M, Balakrishna N, Balanova Y, Bamoshmoosh M, Banach M, Banegas JR, Baran J, Baran R, Barbagallo CM, Barbosa Filho V, Barceló A, Baretić M, Barnoya J, Barrera L, Barreto M, Barros AJD, Barros MVG, Bartosiewicz A, Basit A, Bastos JL, Bata I, Batieha AM, Batista AP, Batista RL, Battakova Z, Baur LA, Bayauli PM, Beaglehole R, Bel-Serrat S, Belavendra A, Ben Romdhane H, Benedek T, Benedics J, Benet M, Benitez Rolandi GE, Benzeval M, Bere E, Berger N, Bergh IH, Berhane Y, Berkinbayev S, Bernabe-Ortiz A, Bernotiene G, Berrios Carrasola X, Bettiol H, Beutel ME, Beybey AF, Bezerra J, Bhagyalaxmi A, Bharadwaj S, Bhargava SK, Bi H, Bi Y, Bia D, Biasch K, Bika Lele EC, Bikbov MM, Bista B, Bjelica DJ, Bjerregaard AA, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Blychfeld Magnazu M, Bo S, Bobak M, Boddy LM, Boehm BO, Boer JMA, Boggia JG, Bogova E, Boissonnet CP, Bojesen SE, Bonaccio M, Bongard V, Bonilla-Vargas A, Bopp M, Borghs H, Botomba S, Bourne RRA, Bovet P, Boymatova K, Braeckevelt L, Braeckman L, Bragt MCE, Braithwaite T, Brajkovich I, Breckenkamp J, Breda J, Brenner H, Brewster LM, Brian GR, Briceño Y, Brinduse L, Bringolf-Isler B, Brito M, Brophy S, Brug J, Bruno G, Bugge A, Buoncristiano M, Burazeri G, Burns C, Cabrera de León A, Cacciottolo J, Cai H, Cama T, Cameron C, Camolas J, Can G, Cândido APC, Cañete F, Capanzana MV, Čapková N, Capuano E, Capuano R, Capuano V, Cardol M, Cardoso VC, Carlsson AC, Carmuega E, Carvalho J, Casajús JA, Casanueva FF, Casas M, Celikcan E, Censi L, Cervantes-Loaiza M, Cesar JA, Chamnan P, Chamukuttan S, Chan A, Chan Q, Charchar FJ, Charles MA, Chaturvedi HK, Chaturvedi N, Che Abdul Rahim N, Chee ML, Chen CJ, Chen F, Chen H, Chen LS, Chen S, Chen Z, Cheng CY, Cheng YJ, Cheraghian B, Chetrit A, Chikova-Iscener E, Chinapaw MJM, Chinnock A, Chiolero A, Chiou ST, Chirita-Emandi A, Chirlaque MD, Cho B, Christensen K, Christofaro DG, Chudek J, Cifkova R, Cilia M, Cinteza E, Cirillo M, Claessens F, Clare P, Clarke J, Clays E, Cohen E, Cojocaru CR, Colorado-Yohar S, Compañ-Gabucio LM, Concin H, Confortin SC, Cooper C, Coppinger TC, Corpeleijn E, Cortés LY, Costanzo S, Cottel D, Cowell C, Craig CL, Crampin AC, Cross AJ, Crujeiras AB, Cruz JJ, Csányi T, Csilla S, Cucu AM, Cui L, Cureau FV, Czenczek-Lewandowska E, D'Arrigo G, d'Orsi E, da Silva AG, Dacica L, Dahm CC, Dallongeville J, Damasceno A, Damsgaard CT, Dankner R, Dantoft TM, Dasgupta P, Dastgiri S, Dauchet L, Davletov K, de Assis Guedes de Vasconcelos F, de Assis MAA, De Backer G, De Bacquer D, De Bacquer J, de Bont J, De Curtis A, de Fragas Hinnig P, de Gaetano G, De Henauw S, De Miguel-Etayo P, De Neve JW, Duarte de Oliveira P, De Ridder D, De Ridder K, de Rooij SR, de Sá ACMGN, De Smedt D, Deepa M, Deev AD, DeGennaro VJ, Delisle H, Delpeuch F, Demarest S, Dennison E, Dereń K, Deschamps V, Devrishov RD, Dhimal M, Di Castelnuovo A, Dias-da-Costa JS, Díaz-Sánchez ME, Diaz A, Díaz Fernández P, Díez Ripollés MP, Dika Z, Djalalinia S, Djordjic V, Do HTP, Dobson AJ, Dominguez L, Donati MB, Donfrancesco C, Dong G, Dong Y, Donoso SP, Döring A, Dorobantu M, Dorosty AR, Dörr M, Doua K, Dragano N, Drygas W, Du S, Duan JL, Duante CA, Duboz P, Duleva VL, Dulskiene V, Dumith SC, Dushpanova A, Dwyer T, Dyussupova A, Dzerve V, Dziankowska-Zaborszczyk E, Ebrahimi N, Echeverría G, Eddie R, Eftekhar E, Efthymiou V, Egbagbe EE, Eggertsen R, Eghtesad S, Eiben G, Ekelund U, El-Khateeb M, El Ammari L, El Ati J, Eldemire-Shearer D, Elliott P, Enang O, Endevelt R, Engle-Stone R, Erasmus RT, Erem C, Ergor G, Eriksen L, Eriksson JG, Escobedo-de la Peña J, Eslami S, Esmaeili A, Evans A, Evans RG, Faeh D, Fagherazzi G, Fakhradiyev I, Fakhretdinova AA, Fall CH, Faramarzi E, Farjam M, Farrugia Sant'Angelo V, Farzi Y, Fattahi MR, Fawwad A, Fawzi WW, Felix-Redondo FJ, Ferguson TS, Fernandes RA, Fernández-Bergés D, Ferrante D, Ferrao T, Ferrari G, Ferrari M, Ferrario MM, Ferreccio C, Ferreira HS, Ferrer E, Ferrieres J, Figueiró TH, Fijalkowska A, Fink G, Fisberg M, Fischer K, Foo LH, Forsner M, Fottrell EF, Fouad HM, Francis DK, Franco MDC, Fras Z, Fraser B, Frontera G, Fuchs FD, Fuchs SC, Fujiati II, Fujita Y, Fumihiko M, Furdela V, Furusawa T, Gabriela SA, Gaciong Z, Gafencu M, Galán Cuesta M, Galbarczyk A, Galcheva SV, Galenkamp H, Galeone D, Galfo M, Galvano F, Gao J, Gao P, Garcia-de-la-Hera M, García Mérida MJ, García Solano M, Gareta D, Garnett SP, Gaspoz JM, Gasull M, Gaya ACA, Gaya AR, Gazzinelli A, Gehring U, Geiger H, Geleijnse JM, George R, Gerdts E, Ghaderi E, Ghamari SH, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Gialluisi A, Giampaoli S, Gianfagna F, Gieger C, Gill TK, Giovannelli J, Gironella G, Giwercman A, Gkiouras K, Glushkova N, Godara R, Godos J, Gogen S, Goldberg M, Goltzman D, Gómez G, Gómez Gómez JH, Gomez LF, Gómez SF, Gomula A, Gonçalves Cordeiro da Silva B, Gonçalves H, Gonçalves M, González-Alvarez AD, Gonzalez-Chica DA, González-Gil EM, Gonzalez-Gross M, González-Leon M, González-Rivas JP, González-Villalpando C, González-Villalpando ME, Gonzalez AR, Gottrand F, Graça AP, Grafnetter D, Grajda A, Grammatikopoulou MG, Gregg EW, Gregor RD, Gregório MJ, Grøholt EK, Grøntved A, Grosso G, Gruden G, Gu D, Guajardo V, Gualdi-Russo E, Guallar-Castillón P, Gualtieri A, Gudmundsson EF, Gudnason V, Guerchet M, Guerrero R, Guessous I, Guimaraes AL, Gujral UP, Gulliford MC, Gunnlaugsdottir J, Gunter MJ, Guo XH, Guo Y, Gupta PC, Gupta R, Gureje O, Gurinović MA, Gutiérrez González E, Gutierrez L, Gutzwiller F, Gwee X, Ha S, Hadaegh F, Hadjigeorgiou CA, Haghshenas R, Hakimi H, Halkjær J, Hambleton IR, Hamzeh B, Hanekom WA, Hange D, Hanif AAM, Hantunen S, Hao J, Hardman CM, Hardy L, Hari Kumar R, Harmer Lassen T, Harooni J, Hashemi-Shahri SM, Hassapidou M, Hata J, Haugsgjerd T, Hayes AJ, He J, He Y, He Y, Heidinger-Felső R, Heier M, Heinen M, Hejgaard T, Hendriks ME, Henrique RDS, Henriques A, Hernandez Cadena L, Herrala S, Herrera-Cuenca M, Herrera VM, Herter-Aeberli I, Herzig KH, Heshmat R, Heude B, Hill AG, Ho SY, Ho SC, Hobbs M, Höfelmann DA, Holdsworth M, Homayounfar R, Homs C, Hoogendijk E, Hopman WM, Horimoto ARVR, Hormiga CM, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Hu Y, Huerta JM, Huhtaniemi IT, Huiart L, Huidumac Petrescu C, Husseini A, Huu CN, Huybrechts I, Hwalla N, Hyska J, Iacoviello L, Iakupova EM, Ibarluzea J, Ibrahim MM, Ibrahim Wong N, Igland J, Ijoma C, Ikram MA, Iñiguez C, Irazola VE, Ishida T, Isiguzo GC, Islam M, Islam SMS, Islek D, Ittermann T, Ivanova-Pandourska IY, Iwasaki M, Jääskeläinen T, Jackson RT, Jacobs JM, Jadoul M, Jafar T, Jallow B, James K, Jamil KM, Jamrozik K, Jan N, Jansson A, Janszky I, Janus E, Jarani J, Jarnig G, Jarvelin MR, Jasienska G, Jelaković A, Jelaković B, Jennings G, Jiang CQ, Jimenez RO, Jöckel KH, Joffres M, Jokelainen JJ, Jonas JB, Jonnagaddala J, Jøran Kjerpeseth L, Jørgensen T, Joshi P, Joshi R, Josipović J, Joukar F, Jóźwiak JJ, Judge DS, Juolevi A, Jurak G, Jurca Simina I, Juresa V, Kaaks R, Kaducu FO, Kadvan AL, Kafatos A, Kaj M, Kajantie EO, Kakutia N, Kállayová D, Kalmatayeva Z, Kalter-Leibovici O, Kameli Y, Kanala KR, Kannan S, Kapantais E, Karaglani E, Karakosta A, Kårhus LL, Karki KB, Karlsson O, Kassi Anicet A, Katchunga PB, Katibeh M, Katz J, Katzmarzyk PT, Kauhanen J, Kaur P, Kavousi M, Kazakbaeva GM, Kaze FF, Kazembe BM, Ke C, Keil U, Keinan Boker L, Keinänen-Kiukaanniemi S, Kelishadi R, Kelleher C, Kemper HCG, Keramati M, Kerimkulova A, Kersting M, Key T, Khader YS, Khaledifar A, Khalili D, Kheiri B, Kheradmand M, Khosravi A, Khouw IMSL, Kiechl-Kohlendorfer U, Kiechl SJ, Kiechl S, Killewo J, Kim HC, Kim J, Kindblom JM, Kingston A, Klakk H, Klanarong S, Klanova J, Klimek M, Klimont J, Klumbiene J, Knoflach M, Kobel S, Koirala B, Kolle E, Kolo SM, Kolsteren P, König J, Korpelainen R, Korrovits P, Korzycka M, Kos J, Koskinen S, Kouda K, Koussoh Simone M, Kovács É, Kovacs VA, Kovalskys I, Kowlessur S, Koziel S, Kratenova J, Kratzer W, Kriaucioniene V, Kriemler S, Kristensen PL, Krizan H, Kroker-Lobos MF, Krokstad S, Kromhout D, Kruger HS, Kruger R, Kryst Ł, Kubinova R, Kuciene R, Kujala UM, Kujundzic E, Kulaga Z, Kulimbet M, Kulothungan V, Kumar RK, Kumari M, Kunešová M, Kurjata P, Kusuma YS, Kutsenko V, Kuulasmaa K, Kyobutungi C, La QN, Laamiri FZ, Laatikainen T, Labadarios D, Lachat C, Lackner KJ, Lai D, Laid Y, Lall L, Lam TH, Landaeta Jimenez M, Landais E, Lankila T, Lanska V, Lappas G, Larijani B, Larissa SP, Lateva MP, Latt TS, Laurenzi M, Lauria L, Lazo-Porras M, Le Coroller G, Le Nguyen Bao K, Le Port A, Le TD, Lee J, Lee J, Lee PH, Lehtimäki T, Lemogoum D, Leong E, Leskošek B, Leszczak J, Leth-Møller KB, Leung GM, Levitt NS, Li Y, Liivak M, Lilly CL, Lim C, Lim WY, Lima-Costa MF, Lin X, Lind L, Lingam V, Linkohr B, Linneberg A, Lissner L, Litwin M, Liu J, Liu L, Liu L, Liu X, Lo WC, Loit HM, Long KQ, Longo Abril G, Lopes L, Lopes MSS, Lopes O, Lopez-Garcia E, Lopez T, Lotufo PA, Lozano JE, Lukrafka JL, Luksiene D, Lundqvist A, Lunet N, Lunogelo C, Lustigová M, Łuszczki E, M'Buyamba-Kabangu JR, Ma G, Ma X, Machado-Coelho GLL, Machado-Rodrigues AM, Macia E, Macieira LM, Madar AA, Madraisau S, Madsen AL, Maestre GE, Maggi S, Magliano DJ, Magnacca S, Magriplis E, Mahasampath G, Maire B, Majer M, Makdisse M, Mäki P, Malekpour MR, Malekzadeh F, Malekzadeh R, Malhotra R, Mallikharjuna Rao K, Malta DC, Malyutina SK, Maniego LV, Manios Y, Mann JI, Mannix MI, Mansour-Ghanaei F, Manyanga T, Manzato E, Mapatano MA, Marcil A, Margozzini P, Maria-Magdalena R, Mariño J, Markaki A, Markey O, Markidou Ioannidou E, Marques-Vidal P, Marques LP, Marrugat J, Martin-Prevel Y, Martin R, Martorell R, Martos E, Maruf FA, Maruszczak K, Marventano S, Masala G, Mascarenhas LP, Masinaei M, Masoodi SR, Mathiesen EB, Mathur P, Matijasevich A, Matłosz P, Matsha TE, Matsudo V, Matteo G, Maulik PK, Mavrogianni C, Mazur A, McFarlane SR, McGarvey ST, McKee M, McLean RM, McLean SB, McNairy ML, McNulty BA, Mediene Benchekor S, Medzioniene J, Mehlig K, Mehrparvar AH, Meirhaeghe A, Meisfjord J, Meisinger C, Melgarejo JD, Melkumova M, Mello J, Méndez F, Mendivil CO, Menezes AMB, Menon GR, Mensink GBM, Menzano MT, Meshram II, Meto DT, Meyer HE, Mi J, Michaelsen KF, Michels N, Mikkel K, Miłkowska K, Miller JC, Milushkina O, Minderico CS, Mini GK, Miquel JF, Mirjalili MR, Mirkopoulou D, Mirrakhimov E, Mišigoj-Duraković M, Mistretta A, Mocanu V, Modesti PA, Moghaddam SS, Mohamed SF, Mohammad K, Mohammadi MR, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohanna S, Mohd Yusoff MF, Mohebbi I, Moitry M, Møllehave LT, Møller NC, Molnár D, Momenan A, Mondo CK, Monroy-Valle M, Montenegro Mendoza RA, Monterrubio-Flores E, Monyeki KDK, Moon JS, Moosazadeh M, Mopa HT, Moradpour F, Moreira LB, Morejon A, Moreno LA, Morey F, Morgan K, Morin SN, Mortensen EL, Moschonis G, Moslem A, Mosquera M, Mossakowska M, Mostafa A, Mostafavi SA, Mota-Pinto A, Mota J, Motlagh ME, Motta J, Moura-dos-Santos MA, Movsesyan Y, Mridha MK, Msyamboza KP, Mu TT, Muc M, Muca F, Mugoša B, Muiesan ML, Müller-Nurasyid M, Münzel T, Mursu J, Murtagh EM, Musa KI, Musić Milanović S, Musil V, Musinguzi G, Muyer MT, Nabipour I, Nagel G, Najafi F, Nakamura H, Nalecz H, Námešná J, Nang EEK, Nangia VB, Nankap M, Narake S, Narayan KMV, Nardone P, Naseri T, Nathalie M, Neal WA, Neelapaichit N, Nejatizadeh A, Nekkantti C, Nelis K, Nenko I, Neovius M, Nervi F, Ng TP, Nguyen CT, Nguyen ND, Nguyen QN, Ni MY, Nicolescu R, Nie P, Nieto-Martínez RE, Nikitin YP, Ning G, Ninomiya T, Nishi N, Nishtar S, Noale M, Noboa OA, Nogueira H, Nordendahl M, Nordestgaard BG, Norton KI, Noto D, Nowak-Szczepanska N, Nsour MA, Nuhoğlu I, Nunes B, Nurk E, Nuwaha F, Nyirenda M, O'Neill TW, O'Reilly D, Obreja G, Ochimana C, Ochoa-Avilés AM, Oda E, Odili AN, Oh K, Ohara K, Ohlsson C, Ohtsuka R, Olafsson Ö, Oldenburg B, Olinto MTA, Oliveira IO, Omar MA, Omar SM, Onat A, Ong SK, Onland-Moret NC, Ono LM, Onodugo O, Ordunez P, Ornelas R, Ortiz AP, Ortiz PJ, Osler M, Osmond C, Ostojic SM, Ostovar A, Otero JA, Ottendahl CB, Otu A, Overvad K, Owusu-Dabo E, Oyeyemi AY, Oyeyemi AL, Paccaud FM, Padez CP, Pagkalos I, Pahomova E, de Paiva KM, Pająk A, Pajula N, Palloni A, Palmieri L, Pan WH, Panda-Jonas S, Pandey A, Pang Z, Panza F, Paoli M, Papadopoulou SK, Papandreou D, Pareja RG, Park SW, Park S, Parnell WR, Parsaeian M, Pascanu IM, Pasquet P, Patel ND, Pattussi M, Pavlyshyn H, Pechlaner R, Pećin I, Pednekar MS, Pedro JM, Peer N, Peixoto SV, Peltonen M, Pereira AC, Peres MA, Perez-Londoño A, Pérez CM, Peterkova V, Peters A, Petkeviciene J, Petrauskiene A, Petrovna Kovtun O, Pettenuzzo E, Peykari N, Pfeiffer N, Phall MC, Pham ST, Phiri FP, Pichardo RN, Pierannunzio D, Pierre-Marie P, Pigeot I, Pikhart H, Pilav A, Piler P, Pilotto L, Pistelli F, Pitakaka F, Piwonska A, Pizarro AN, Plans-Rubió P, Platonova AG, Poh BK, Pohlabeln H, Polka NS, Pop RM, Popkin BM, Popovic SR, Porta M, Posch G, Poudyal A, Poulimeneas D, Pouraram H, Pourfarzi F, Pourshams A, Poustchi H, Price AJ, Price JF, Prista A, Providencia R, Puder JJ, Pudule I, Puhakka S, Puiu M, Punab M, Qadir MS, Qasrawi RF, Qiao Q, Qorbani M, Quintana HK, Quiroga-Padilla PJ, Quoc Bao T, Rach S, Radic I, Radisauskas R, Rahimikazerooni S, Rahman M, Rahman M, Raitakari O, Raj M, Rajabov T, Rakhmatulloev S, Rakovac I, Ramachandra Rao S, Ramachandran A, Ramadan OPC, Ramires VV, Ramirez-Zea M, Ramke J, Ramos E, Ramos R, Rampal L, Rampal S, Ramsay SE, Rangelova LS, Rarra V, Rascon-Pacheco RA, Rashidi MM, Rech CR, Redon J, Reganit PFM, Regecová V, Renner JDP, Repasy JA, Reuter CP, Revilla L, Reynolds A, Rezaei N, Rezaianzadeh A, Rho Y, Ribas-Barba L, Ribeiro R, Riboli E, Rigo F, Rigotti A, Rinaldo N, Rinke de Wit TF, Risérus U, Rito AI, Ritti-Dias RM, Rivera JA, Roa RG, Robinson L, Roccaldo R, Rodrigues D, Rodriguez-Perez MDC, Rodríguez-Villamizar LA, Rodríguez AY, Roggenbuck U, Rohloff P, Rohner F, Rojas-Martinez R, Rojroongwasinkul N, Romaguera D, Romeo EL, Rosario RV, Rosengren A, Rouse I, Rouzier V, Roy JGR, Ruano MH, Rubinstein A, Rühli FJ, Ruidavets JB, Ruiz-Betancourt BS, Ruiz-Castell M, Ruiz Moreno E, Rusakova IA, Rusek W, Russell Jonsson K, Russo P, Rust P, Rutkowski M, Saamel M, Saar CG, Sabanayagam C, Sabbaghi H, Sacchini E, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saghi MH, Saidi O, Saieva C, Sakata S, Saki N, Šalaj S, Salanave B, Salazar Martinez E, Salhanova A, Salmerón D, Salomaa V, Salonen JT, Salvetti M, Samoutian M, Sánchez-Abanto J, Sánchez Rodríguez I, Sandjaja, Sans S, Santa-Marina L, Santacruz E, Santos DA, Santos IS, Santos LC, Santos MP, Santos O, Santos R, Santos TR, Saramies JL, Sardinha LB, Sarrafzadegan N, Sathish T, Saum KU, Savva S, Savy M, Sawada N, Sbaraini M, Scazufca M, Schaan BD, Schaffrath Rosario A, Schargrodsky H, Schienkiewitz A, Schindler K, Schipf S, Schmidt B, Schmidt CO, Schmidt IM, Schneider A, Schnohr P, Schöttker B, Schramm S, Schramm S, Schröder H, Schultsz C, Schultz G, Schulze MB, Schutte AE, Sebert S, Sedaghattalab M, Selamat R, Sember V, Sen A, Senbanjo IO, Sepanlou SG, Sequera G, Serra-Majem L, Servais J, Ševčíková Ľ, Sewpaul R, Shalnova S, Shamah-Levy T, Shamshirgaran SM, Shanthirani CS, Sharafkhah M, Sharma SK, Sharman A, Shaw JE, Shayanrad A, Shayesteh AA, Shengelia L, Shi Z, Shibuya K, Shimizu-Furusawa H, Shimony T, Shiri R, Shrestha N, Si-Ramlee K, Siani A, Siantar R, Sibai AM, Sidossis LS, Silitrari N, Silva AM, Silva CRDM, Silva DAS, Silva KS, Sim X, Simon M, Simons J, Simons LA, Sjöberg A, Sjöström M, Skoblina EV, Skoblina NA, Slazhnyova T, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, So HK, Soares FC, Sobek G, Sobngwi E, Sodemann M, Söderberg S, Soekatri MYE, Soemantri A, Sofat R, Solfrizzi V, Solovieva YV, Somi MH, Sonestedt E, Song Y, Soofi S, Sørensen TIA, Sørgjerd EP, Sossa Jérome C, Soto-Rojas VE, Soumaré A, Sousa-Poza A, Sovic S, Sparboe-Nilsen B, Sparrenberger K, Spencer PR, Spinelli A, Spiroski I, Staessen JA, Stamm H, Stang A, Starc G, Staub K, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Steinsbekk S, Stergiou GS, Stessman J, Stevanović R, Stieber J, Stöckl D, Stokwiszewski J, Stoyanova E, Stratton G, Stronks K, Strufaldi MW, Sturua L, Suárez-Medina R, Suarez-Ortegón MF, Suebsamran P, Sugiyama M, Suka M, Sulo G, Sun CA, Sun L, Sund M, Sundström J, Sung YT, Sunyer J, Suriyawongpaisal P, Sweis NWG, Swinburn BA, Sy RG, Sylva RC, Szponar L, Tabone L, Tai ES, Takuro F, Tambalis KD, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanrygulyyeva M, Tanser F, Tao Y, Tarawneh MR, Tarp J, Tarqui-Mamani CB, Taxová Braunerová R, Taylor A, Taylor J, Tchibindat F, Te Velde S, Tebar WR, Tell GS, Tello T, Tessema M, Tham YC, Thankappan KR, Theobald H, Theodoridis X, Thomas N, Thorand B, Thrift AG, Tichá Ľ, Timmermans EJ, Tjandrarini DH, Tjonneland A, Tolonen HK, Tolstrup JS, Tomaszewski M, Topbas M, Topór-Mądry R, Torheim LE, Tornaritis MJ, Torrent M, Torres-Collado L, Toselli S, Touloumi G, Traissac P, Tran TTH, Tremblay MS, Triantafyllou A, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tshepo L, Tsigga M, Tsintavis P, Tsugane S, Tuitele J, Tuliakova AM, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Twig G, Tynelius P, Tzala E, Tzotzas T, Tzourio C, Udoji N, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Unal B, Usupova Z, Uusitalo HMT, Uysal N, Vaitkeviciute J, Valdivia G, Vale S, Valvi D, van Dam RM, van den Born BJ, Van der Heyden J, van der Schouw YT, Van Herck K, Van Lippevelde W, Van Minh H, Van Schoor NM, van Valkengoed IGM, Vanderschueren D, Vanuzzo D, Varbo A, Varela-Moreiras G, Vargas LN, Varona-Pérez P, Vasan SK, Vasques DG, Vatasescu R, Vega T, Veidebaum T, Velasquez-Melendez G, Velika B, Verloigne M, Veronesi G, Verschuren WMM, Victora CG, Viegi G, Viet L, Vik FN, Vilar M, Villalpando S, Vioque J, Viriyautsahakul N, Virtanen JK, Visser M, Visvikis-Siest S, Viswanathan B, Vladulescu M, Vlasoff T, Vocanec D, Vollenweider P, Völzke H, Vourli G, Voutilainen A, Vrijheid M, Vrijkotte TGM, Vuletić S, Wade AN, Waldhör T, Walton J, Wambiya EOA, Wan Bebakar WM, Wan Mohamud WN, Wanderley Júnior RDS, Wang C, Wang H, Wang MD, Wang N, Wang Q, Wang X, Wang YX, Wang YW, Wannamethee SG, Wareham N, Wartha O, Weber A, Wedderkopp N, Weghuber D, Wei W, Weres A, Werner B, Westbury LD, Whincup PH, Wichstrøm L, Wickramasinghe K, Widhalm K, Widyahening IS, Więcek A, Wild PS, Wilks RJ, Willeit J, Willeit P, Williams J, Wilsgaard T, Wirth JP, Wojtyniak B, Woldeyohannes M, Wolf K, Wong-McClure RA, Wong A, Wong EB, Wong JE, Wong TY, Woo J, Woodward M, Wu FC, Wu HY, Wu J, Wu LJ, Wu S, Wyszyńska J, Xu H, Xu L, Yaacob NA, Yamborisut U, Yan L, Yan W, Yang L, Yang X, Yang Y, Yardim N, Yasuharu T, Yépez García M, Yiallouros PK, Yngve A, Yoosefi M, Yoshihara A, Yotov Y, You QS, You SL, Younger-Coleman NO, Yu YL, Yu Y, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zayed AA, Zdrojewski T, Żegleń M, Zejglicova K, Zeljkovic Vrkic T, Zeng Y, Zentai A, Zhang B, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhecheva YV, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zimmet P, Zins M, Zitt E, Zocalo Y, Zoghlami N, Zuñiga Cisneros J, Zuziak M, Ezzati M. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet 2024; 403:1027-1050. [PMID: 38432237 PMCID: PMC7615769 DOI: 10.1016/s0140-6736(23)02750-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. METHODS We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). FINDINGS From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. INTERPRETATION The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity. FUNDING UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union.
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John DA, Adams EA, McGowan LJ, Joyes EC, Richmond C, Beyer FR, Landes D, Watt RG, Sniehotta FF, Paisi M, Bambra C, Craig D, Kaner E, Ramsay SE. Factors influencing implementation and sustainability of interventions to improve oral health and related health behaviours in adults experiencing severe and multiple disadvantage: a mixed-methods systematic review. BMJ Open 2024; 14:e080160. [PMID: 38216193 PMCID: PMC10806606 DOI: 10.1136/bmjopen-2023-080160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/18/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES Among people experiencing severe and multiple disadvantage (SMD), poor oral health is common and linked to smoking, substance use and high sugar intake. Studies have explored interventions addressing oral health and related behaviours; however, factors related to the implementation of these interventions remain unclear. This mixed-methods systematic review aimed to synthesise evidence on the implementation and sustainability of interventions to improve oral health and related health behaviours among adults experiencing SMD. METHODS Bibliographic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, EBSCO, Scopus) and grey literature were searched from inception to February 2023. Studies meeting the inclusion criteria were screened and extracted independently by two researchers. Quality appraisal was undertaken, and results were synthesised using narrative and thematic analyses. RESULTS Seventeen papers were included (published between 1995 and 2022). Studies were mostly of moderate quality and included views from SMD groups and service providers. From the qualitative synthesis, most findings were related to aspects such as trust, resources and motivation levels of SMD groups and service providers. None of the studies reported on diet and none included repeated offending (one of the aspects of SMD). From the quantitative synthesis, no difference was observed in programme attendance between the interventions and usual care, although there was some indication of sustained improvements in participation in the intervention group. CONCLUSION This review provides some evidence that trust, adequate resources and motivation levels are potentially important in implementing interventions to improve oral health and substance use among SMD groups. Further research is needed from high quality studies and focusing on diet in this population. PROSPERO REGISTRATION NUMBER CRD42020202416.
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Affiliation(s)
- Deepti A John
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma A Adams
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Laura J McGowan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma C Joyes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Richmond
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona R Beyer
- Evidence Synthesis Group and Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - David Landes
- NHS England and NHS Improvement, Newcastle upon Tyne, UK
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Falko F Sniehotta
- NIHR Policy Research Unit Behavioural Science, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Public Health, Social and Preventive Medicine, Centre for Preventive Medicine and Digital Health (CPD), Heidelberg University Medical Faculty Mannheim, Mannheim, Germany
| | - Martha Paisi
- Faculty of Medicine and Dentistry, Peninsula Dental School, Plymouth University, Plymouth, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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John DA, McGowan LJ, Kenny RPW, Joyes EC, Adams EA, Shabaninejad H, Richmond C, Beyer F, Landes D, Watt RG, Sniehotta FF, Paisi M, Bambra C, Craig D, Kaner E, Ramsay SE. Interventions to improve oral health and related health behaviours of substance use, smoking, and diet in people with severe and multiple disadvantage: a systematic review of effectiveness and cost-effectiveness. Lancet 2023; 402 Suppl 1:S58. [PMID: 37997101 DOI: 10.1016/s0140-6736(23)02151-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/11/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Homelessness overlapping with substance use and offending is described as severe and multiple disadvantage (SMD). People experiencing SMD have poor oral health along with high levels of related behaviours such as substance use, smoking, and poor diet. Existing evidence largely describes the prevalence of oral health problems, substance use, and smoking in SMD groups. Little is known about interventions that can address these conditions in SMD groups. We aimed to review the effectiveness and cost-effectiveness of interventions on oral health and related health behaviours in adults experiencing SMD. METHODS For this systematic review, we searched bibliographic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, EBSCO, Scopus) and grey literature for papers published from inception to February 2023. Two researchers independently reviewed the searches. Randomised controlled trials (RCTs), comparative studies and economic evaluations were included. Risk of bias was assessed. Population included adults experiencing SMD (including homelessness and substance use or repeat offending). Outcomes included oral health, and related behaviours (substance use, smoking, poor diet). Results were narratively synthesised. This review was registered with PROSPERO, CRD42020202416. FINDINGS The review included 38 studies (published between 1991 and 2023), with 34 reporting effectiveness. These studies comprised of 23 RCTs and 11 quasi-experimental studies conducted in the USA (25 studies), Canada (seven studies), France (one study), and Spain (one study). The interventions involving multiple components, such as housing services with substance use and mental health support, effectively reduced substance use in SMD groups; these were mostly individual-level interventions. However, these studies had short follow-up periods and high attrition rates. Only one study addressed oral health outcomes, none focused on diet, and three RCTs covered smoking, with one intervention showing smoking abstinence at 4 weeks. Some limited evidence suggested cost-effectiveness of substance use interventions. INTERPRETATION This review found that integrating services such as housing with other health-care services together could be effective in improving health behaviours, especially substance use among SMD groups. More evidence is needed specifically on oral health, smoking, and diet-related interventions. The generalisability of findings of this review is limited to high-income countries and shorter-term outcomes. FUNDING National Institute for Health and Care Research (NIHR) Policy Research Programme.
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Affiliation(s)
- Deepti A John
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Laura J McGowan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ryan P W Kenny
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma C Joyes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma A Adams
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hosein Shabaninejad
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Richmond
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Beyer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - David Landes
- NHS England & Improvement, Newcastle Upon Tyne, UK
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Falko F Sniehotta
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Martha Paisi
- Faculty of Medicine and Dentistry, Peninsula Dental School, University of Plymouth, Plymouth, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Adams EA, Aquino MRJ, Bartle V, Brennan-Tovey K, Kennedy J, Koehne S, McGrath J, Ogden M, Parker J, Thirkle S, Kaner E, Ramsay SE. International evidence on lived experiences of trauma during homelessness and effects on mental health including substance use: a co-produced qualitative systematic review. Lancet 2023; 402 Suppl 1:S18. [PMID: 37997057 DOI: 10.1016/s0140-6736(23)02075-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/17/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Trauma is an experience (physical or emotional) that is life-threatening, harmful, or out of the ordinary and has lasting effects on mental health and wellbeing. Much of the information about trauma within homeless populations focuses on events in childhood. Using coproduction principles, we aimed to synthesise qualitative evidence exploring the impact of trauma during adulthood homelessness on mental health, including substance use. METHODS In this qualitative systematic review, we searched ASSIA, CINAHL, Cochrane, EMBASE, MEDLINE, Proquest theses and dissertations, PsychInfo, Scopus, and Web of Science for studies published from inception until Sept 6, 2022, alongside grey literature from relevant websites. Search terms were developed based on the PICO framework. No language, date, or geographical limits were applied. Any qualitative research reporting experiences of trauma and its impact on mental health during homelessness in adults was eligible. We extracted relevant data (eg, methodology, sample characteristics, homelessness, and findings). People with lived experience of homelessness were provided with bespoke training by the lead researcher. They contributed to refining the review aims, screening, coding, and theme development. Quality was assessed using the CASP Qualitative Studies Checklist. FINDINGS We included 26 qualitative papers, including 876 adults experiencing homelessness between ages 18 and 70 years (448 [51%] women and 428 [49%] men). All papers focused on urban settings. Eight papers were from the USA, five from Canada, four from the UK and Australia, three from Brazil, and one from Ethiopia and Iran. A framework synthesis of these 26 papers identified three preliminary themes. People experiencing homelessness make sense of trauma in three ways: internalised understanding, relationality to others, and with a survival lens. Coping strategies for managing feelings of fear, anxiety, and depression included substance use, self-rationalisation, and strategies to feel safe. Finally, when people experienced repeated trauma, they became either dissociated, and accepted their situation, or resilient, wishing to change their circumstances. INTERPRETATION Further evidence is needed in rural or coastal regions, where people experiencing homelessness may face greater isolation. Trauma rarely takes place in isolation, and often previous experiences of trauma shape how people experiencing homelessness make sense of trauma and cope with it. Support to address coping with the effects of trauma should focus on ensuring people do not become desensitised and prevent deterioration of mental health and substance use. The strength of this review is its coproduction with people with lived experience. Single person data extraction with secondary checks was a limitation. FUNDING National Institute for Health and Care Research (NIHR) School for Primary Care Research as part of the Three NIHR Research Schools Mental Health Programme.
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Affiliation(s)
- Emma A Adams
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
| | - Maria Raisa Jessica Aquino
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Kerry Brennan-Tovey
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Joanne McGrath
- Department of Social Work, Education, and Community Wellbeing, Northumbria University, UK
| | | | | | - Steven Thirkle
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Bush KJ, Papacosta AO, Lennon LT, Rankin J, Whincup PH, Wannamethee SG, Ramsay SE. Influence of neighborhood-level socioeconomic deprivation and individual socioeconomic position on risk of developing type 2 diabetes in older men: a longitudinal analysis in the British Regional Heart Study cohort. BMJ Open Diabetes Res Care 2023; 11:e003559. [PMID: 37907278 PMCID: PMC10619023 DOI: 10.1136/bmjdrc-2023-003559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/06/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Evidence from longitudinal studies on the influence of neighborhood socioeconomic deprivation in older age on the development of type 2 diabetes mellitus (T2DM) is limited. This study investigates the prospective associations of neighborhood-level deprivation and individual socioeconomic position (SEP) with T2DM incidence in older age. RESEARCH DESIGN AND METHODS The British Regional Heart Study studied 4252 men aged 60-79 years in 1998-2000. Neighborhood-level deprivation was based on the Index of Multiple Deprivation quintiles for participants' 1998-2000 residential postcode. Individual SEP was defined as social class based on longest-held occupation. A cumulative score of individual socioeconomic factors was derived. Incident T2DM cases were ascertained from primary care records; prevalent cases were excluded. Cox proportional hazard models were used to examine the associations. RESULTS Among 3706 men, 368 incident cases of T2DM were observed over 18 years. The age-adjusted T2DM risk increased from the least deprived quintile to the most deprived: HR per quintile increase 1.14 (95% CI 1.06 to 1.23) (p=0.0005). The age-adjusted T2DM HR in social class V (lowest) versus social class I (highest) was 2.45 (95% CI 1.36 to 4.42) (p=0.001). Both associations attenuated but remained significant on adjustment for other deprivation measures, becoming non-significant on adjustment for body mass index and T2DM family history. T2DM risk increased with cumulative individual adverse socioeconomic factors: HR per point increase 1.14 (95% CI 1.05 to 1.24). CONCLUSIONS Inequalities in T2DM risk persist in later life, both in relation to neighborhood-level and individual-level socioeconomic factors. Underlying modifiable risk factors continue to need to be addressed in deprived older age populations to reduce disease burden.
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Affiliation(s)
- Kathryn J Bush
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - A Olia Papacosta
- Primary Care and Population Health, University College London, London, UK
| | - Lucy T Lennon
- Primary Care and Population Health, University College London, London, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - S Goya Wannamethee
- Primary Care and Population Health, University College London, London, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Kimble R, Papacosta AO, Lennon LT, Whincup PH, Weyant RJ, Mathers JC, Wannamethee SG, Ramsay SE. The Relationship of Oral Health with Progression of Physical Frailty among Older Adults: A Longitudinal Study Composed of Two Cohorts of Older Adults from the United Kingdom and United States. J Am Med Dir Assoc 2023; 24:468-474.e3. [PMID: 36584971 PMCID: PMC10398566 DOI: 10.1016/j.jamda.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To investigate the prospective associations between oral health and progression of physical frailty in older adults. DESIGN Prospective analysis. SETTING AND PARTICIPANTS Data are from the British Regional Heart Study (BRHS) comprising 2137 men aged 71 to 92 years from 24 British towns and the Health, Aging, and Body Composition (HABC) Study of 3075 men and women aged 70 to 79 years. METHODS Oral health markers included denture use, tooth count, periodontal disease, self-rated oral health, dry mouth, and perceived difficulty eating. Physical frailty progression after ∼8 years follow-up was determined based on 2 scoring tools: the Fried frailty phenotype (for physical frailty) and the Gill index (for severe frailty). Logistic regression models were conducted to examine the associations between oral health markers and progression to frailty and severe frailty, adjusted for sociodemographic, behavioral, and health-related factors. RESULTS After full adjustment, progression to frailty was associated with dentition [per each additional tooth, odds ratio (OR) 0.97; 95% CI: 0.95-1.00], <21 teeth with (OR 1.74; 95% CI: 1.02-2.96) or without denture use (OR 2.45; 95% CI 1.15-5.21), and symptoms of dry mouth (OR ≥1.8; 95% CI ≥ 1.06-3.10) in the BRHS cohort. In the HABC Study, progression to frailty was associated with dry mouth (OR 2.62; 95% CI 1.05-6.55), self-reported difficulty eating (OR 2.12; 95% CI 1.28-3.50) and ≥2 cumulative oral health problems (OR 2.29; 95% CI 1.17-4.50). Progression to severe frailty was associated with edentulism (OR 4.44; 95% CI 1.39-14.15) and <21 teeth without dentures after full adjustment. CONCLUSIONS AND IMPLICATIONS These findings indicate that oral health problems, particularly tooth loss and dry mouth, in older adults are associated with progression to frailty in later life. Additional research is needed to determine if interventions aimed at maintaining (or improving) oral health can contribute to reducing the risk, and worsening, of physical frailty in older adults.
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Affiliation(s)
- Rachel Kimble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Division of Sport and Exercise Science, School of Health and Life Sciences, University of the West of Scotland, Blantyre, UK.
| | - A Olia Papacosta
- Department of Primary Care and Population Health, UCL, London, UK
| | - Lucy T Lennon
- Department of Primary Care and Population Health, UCL, London, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, London, UK
| | - Robert J Weyant
- Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - John C Mathers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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10
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Cannon I, Robinson-Barella A, McLellan G, Ramsay SE. From Drugs to Dry Mouth: A Systematic Review Exploring Oral and Psychological Health Conditions Associated with Dry Mouth in Older Adults with Polypharmacy. Drugs Aging 2023; 40:307-316. [PMID: 36943673 DOI: 10.1007/s40266-023-01017-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Approximately 60% of older adults complain of dry mouth, which may be associated with polypharmacy, common in this population. Existing studies have reported treatment approaches to dry mouth but do not address long-term preventative measures that would more positively benefit the health and well-being of older adults. OBJECTIVE We aimed to explore the consequences of dry mouth, associated with polypharmacy, on the physical and psychological health of older adults in order to establish the importance of preventing dry mouth. METHODS This systematic review was conducted of studies reporting health conditions of dry mouth, in relation to polypharmacy in older adults (aged ≥ 65 years). MEDLINE, EMBASE, PsycINFO and CINAHL databases were searched using keywords such as 'polypharmacy', 'dry mouth', 'oral health' and 'quality of life' (PROSPERO: CRD42021288945). Joanna Briggs Institute critical appraisal tools were used to assess study quality. RESULTS Of the 6852 citations screened, nine studies (cross-sectional, n = 8; longitudinal, n = 1) were included that comprised 37,459 participants (mean age range 68.5-85.0 years). Studies were published between 2005 and 2019. Because of the heterogeneity of reported study outcomes, a narrative synthesis was undertaken. The health conditions identified in this review were categorised as 'physical' or 'psychological'. The main physical health conditions reported in the studies related to dental health, such as tooth loss, and functional impairments, such as swallowing difficulties. An increase in the number of medicines taken, from 0 to 5, decreased the number of natural teeth remaining from 16 (standard deviation [SD] ± 9) to 12 (SD ± 8), respectively. Additionally, the number of dental complications increased from 1 (SD ± 2) to 2 (SD ± 2) as the number of medicines increased from 1 to ≥ 3. There was a paucity of studies (n = 2) that investigated psychological health conditions of dry mouth among older adults, with depression identified as a significant issue among older adults with dry mouth (where the reported prevalence was as high as 64%). An additional six psychological health conditions were identified: self-consciousness, feeling tense, difficulty relaxing, irritability, difficulty completing tasks and feeling less satisfied in life. CONCLUSIONS High levels of physical health conditions of dry mouth are observed in older adults and, to a lesser extent, psychological health conditions. These conditions can negatively affect quality of life. There remains a need to prevent dry mouth and the adverse health conditions associated with it in older adults. The modifiable nature of polypharmacy could be targeted to minimise, and potentially prevent, dry mouth. The optimisation of medication regimes to effectively treat chronic conditions, but also limit the likelihood of dry mouth, is a practical approach. Dry mouth prevention should be a priority and polypharmacy can pave the way for prevention strategies, avoiding the need to treat dry mouth.
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Affiliation(s)
- India Cannon
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
| | - Anna Robinson-Barella
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gillian McLellan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Rodgers J, Goodwin J, Nielsen E, Bhattarai N, Heslop P, Kharatikoopaei E, O’Connor RC, Ogundimu E, Ramsay SE, Steele K, Townsend E, Vale L, Walton E, Wilson C, Cassidy S. Adapted suicide safety plans to address self-harm, suicidal ideation, and suicide behaviours in autistic adults: protocol for a pilot randomised controlled trial. Pilot Feasibility Stud 2023; 9:31. [PMID: 36855212 PMCID: PMC9972793 DOI: 10.1186/s40814-023-01264-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/14/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Suicide prevention is a national priority for the UK government. Autistic people are at greater risk of experiencing self-harm and suicidal thoughts and behaviours than the general population. Safety plans are widely used in suicide prevention but have not yet been designed with and for autistic people. We developed the first safety plan specifically targeting suicidality in autistic adults: the Autism Adapted Safety Plan (AASP). It consists of a prioritised list of hierarchical steps that can be used prior to or during a crisis to mitigate risk of self-harm and suicidal behaviour. This is a pilot study that aims to assess the feasibility and acceptability of the AASPs and the research processes, including the response rates, potential barriers and reach of AASPs, methods of recruitment, what comprises usual care, and economic evaluation methods/tools. METHODS This is an external pilot randomised controlled trial of a suicide prevention tool aimed at mitigating the risk of self-harm and suicidal behaviour in autistic adults: AASPs. Participants will be assessed at baseline and followed up 1 month and 6 months later. Assessments include questions about self-harm, suicidality, service use, and their experience of the AASP/taking part in the study. Autistic adults who have a clinical autism diagnosis and self-reported history of self-harm, suicidal thoughts, or suicidal behaviours within the last 6 months will be invited to take part in the study. Informed consent will be obtained. Participants will be recruited via community and third sector services (including community settings, autism charities, and mental health charities). They may also "self-refer" into the study through social media recruitment and word of mouth. Ninety participants will be randomised to either develop an AASP or receive their usual care in a 1:1 ratio. DISCUSSION The present study will provide an evaluation of the suitability of the processes that would be undertaken in a larger definitive study, including recruitment, randomisation, methods, questionnaires, outcome measures, treatment, and follow-up assessments. TRIAL REGISTRATION ISRCTN70594445, Protocol v4: 8/2/22.
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Affiliation(s)
- Jacqui Rodgers
- grid.1006.70000 0001 0462 7212Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Jane Goodwin
- grid.1006.70000 0001 0462 7212Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Emma Nielsen
- grid.4563.40000 0004 1936 8868School of Psychology, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Nawaraj Bhattarai
- grid.1006.70000 0001 0462 7212Health Economics Group, Population Health Science Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Phil Heslop
- grid.42629.3b0000000121965555Social Work, Education and Community Wellbeing, Northumbria University, Newcastle Upon Tyne, UK
| | - Ehsan Kharatikoopaei
- grid.8250.f0000 0000 8700 0572Department of Anthropology, Durham University, Durham, UK
| | - Rory C. O’Connor
- grid.8756.c0000 0001 2193 314XSuicidal Behaviour Research Lab, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Emmanuel Ogundimu
- grid.8250.f0000 0000 8700 0572Department of Mathematical Sciences, Durham University, Durham, UK
| | - Sheena E. Ramsay
- grid.1006.70000 0001 0462 7212Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Katie Steele
- grid.1006.70000 0001 0462 7212School of Psychology, Newcastle University, Newcastle Upon Tyne, UK
| | - Ellen Townsend
- grid.4563.40000 0004 1936 8868School of Psychology, University of Nottingham, Nottingham, UK
| | - Luke Vale
- grid.1006.70000 0001 0462 7212Health Economics Group, Population Health Science Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Emily Walton
- grid.1006.70000 0001 0462 7212School of Psychology, Newcastle University, Newcastle Upon Tyne, UK
| | - Colin Wilson
- grid.1006.70000 0001 0462 7212Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Sarah Cassidy
- grid.4563.40000 0004 1936 8868School of Psychology, University of Nottingham, Nottingham, UK
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12
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Kimble R, Papacosta AO, Lennon LT, Whincup PH, Weyant RJ, Mathers JC, Wannamethee SG, Ramsay SE. The Relationships of Dentition, Use of Dental Prothesis and Oral Health Problems with Frailty, Disability and Diet Quality: Results from Population-Based Studies of Older Adults from the UK and USA. J Nutr Health Aging 2023; 27:663-672. [PMID: 37702340 DOI: 10.1007/s12603-023-1951-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/16/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVES This study examined the relationships of dental status, use and types of dental prothesis and oral health problems, individually and combined, with diet quality, frailty and disability in two population-based studies of older adults. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Men form the British Regional Heart Study (BRHS) (aged 85±4 years in 2018; n=1013) and Men and Women from the Health, Aging, and Body Composition (HABC) Study (aged 75±3 years in 1998-99; n=1975). MEASUREMENTS Physical and dental examinations and questionnaires were collected with data available for dental status, oral problems related to eating, diet quality, Fried frailty phenotype, disability based on mobility limitations, and activities of daily living (ADL). The associations of dental status and oral health problems, individually and combined, with risk of frailty and disability were quantified. The relationship with diet quality was also assessed. RESULTS In the BRHS, but not HABC Study, impaired natural dentition without the use of dentures was associated with frailty independently. This relationship was only established in the same group in those with oral problems (OR=3.24; 95% CI: 1.30-8.03). In the HABC Study, functional dentition with oral health problems was associated with greater risk of frailty (OR=2.21; 95% CI: 1.18-4.15). In both studies those who wore a full or partial denture in one or more jaw who reported oral problems were more likely to have disability. There was no association with diet quality in these groups. CONCLUSION Older adults with impaired dentition even who use dentures who experience self-report oral problems related to eating may be at increased risk of frailty and disability. Further research is needed to establish whether improving oral problems could potentially reduce the occurrence of frailty and disability.
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Affiliation(s)
- R Kimble
- Dr. Rachel Kimble, Institute of Health and Society, University of the West of Scotland, Technology Ave, Blantyre, Glasgow G72 0LH, United Kingdom, E-mail:
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13
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Yu G, Vale L, McMeekin P, Ramsay SE, Fu Y. Investigating changes in mental health services utilisation in England and their impact on health outcomes and wellbeing during the COVID-19 pandemic: Protocol for a health data-linkage study. PLoS One 2023; 18:e0283986. [PMID: 37023005 PMCID: PMC10079107 DOI: 10.1371/journal.pone.0283986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/21/2023] [Indexed: 04/07/2023] Open
Abstract
INTRODUCTION Linking routinely collected health care system data records for the same individual across different services and over time has enormous potential for the NHS and its patients. The aims of this data linkage study are to quantify the changes to mental health services utilisation in responses to the COVID-19 pandemic and determine whether these changes were associated with health-related outcomes and wellbeing among people living in the most deprived communities in North East and North Cumbria, England. METHODS AND ANALYSIS We will assemble a retrospective cohort of people having referred or self-referred to NHS-funded mental health services or Improving Access to Psychological Therapies (IAPT) services between 23rd March 2019 and 22nd March 2020 in the most deprived areas in England. We will link together data from retrospective routinely collected healthcare data including local general practitioner (GP) practice data, Hospital Episode Statistics admitted patient care outpatients, and A&E, Community Services Data Set, Mental Health Services Data Set, and Improving Access to Psychological Therapies Data Set. We will use these linked patient-level data to 1) describe the characteristics of the cohort prior to the lockdown; 2) investigate changes to mental health services utilised between multiple time periods of the COVID-19 lockdown including out of lockdown; 3) explore the relationship between these changes and health outcomes/wellbeing and factors that confound and mediate this relationship among this cohort. STRENGTHS AND LIMITATIONS OF THIS STUDY This study comprises a deprived population-based cohort of people having referred or self-referred to NHS-funded secondary mental health services or Improving Access to Psychological Therapies (IAPT) services over an extended period of the lockdown in England (2019-2022).This study will utilise a new longitudinal data resource that will link together detailed data from a cohort of individual participants and retrospective administrative data relating to the use of primary, secondary, and community care services.The study period covers pre-lockdown, different lockdown and post-lockdown, and out of lockdown periods up to March 2022.Routinely collected administrative data contain limited contextual information and represent an underestimate of total health outcomes for these individuals.Routinely collected datasets can often been incomplete or contain missing data, which can make it difficult to accurately analyse the data and draw meaningful conclusions.Intervention and treatment for mental health conditions are not wholly captured across these data sources and may impact health outcomes.
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Affiliation(s)
- Ge Yu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- NIHR Applied Research Collaboration North East and North Cumbria, St Nicholas' Hospital, Gosforth, Newcastle Upon Tyne, United Kingdom
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- NIHR Applied Research Collaboration North East and North Cumbria, St Nicholas' Hospital, Gosforth, Newcastle Upon Tyne, United Kingdom
| | - Peter McMeekin
- Faculty of Health and Life Science, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Yu Fu
- Department of Health Services Research, University of Liverpool, Liverpool, United Kingdom
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Thomson K, Rice S, Arisa O, Johnson E, Tanner L, Marshall C, Sotire T, Richmond C, O'Keefe H, Mohammed W, Gosney M, Raffle A, Hanratty B, McEvoy CT, Craig D, Ramsay SE. Oral nutritional interventions in frail older people who are malnourished or at risk of malnutrition: a systematic review. Health Technol Assess 2022; 26:1-112. [PMID: 36541454 PMCID: PMC9791461 DOI: 10.3310/ccqf1608] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Malnutrition worsens the health of frail older adults. Current treatments for malnutrition may include prescribed oral nutritional supplements, which are multinutrient products containing macronutrients and micronutrients. OBJECTIVE To assess the effectiveness and cost-effectiveness of oral nutritional supplements (with or without other dietary interventions) in frail older people who are malnourished or at risk of malnutrition. DATA SOURCES MEDLINE, EMBASE, Cochrane Library, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and grey literature were searched from inception to 13 September 2021. REVIEW METHODS A systematic review and meta-analysis was conducted to evaluate the effectiveness and cost-effectiveness of oral nutritional supplements in frail older people (aged ≥ 65 years) who are malnourished or at risk of malnutrition (defined as undernutrition as per National Institute for Health and Care Excellence guidelines). Meta-analysis and network meta-analysis were undertaken, where feasible, along with a narrative synthesis. A cost-effectiveness review was reported narratively. A de novo model was developed using effectiveness evidence identified in the systematic review to estimate the cost-effectiveness of oral nutritional supplements. RESULTS Eleven studies (n = 822 participants) were included in the effectiveness review, six of which were fully or partly funded by industry. Meta-analyses suggested positive effects of oral nutritional supplements compared with standard care for energy intake (kcal) (standardised mean difference 1.02, 95% confidence interval 0.15 to 1.88; very low quality evidence) and poor mobility (mean difference 0.03, p < 0.00001, 95% confidence interval 0.02 to 0.04; very low quality evidence) but no evidence of an effect for body weight (mean difference 1.31, 95% confidence interval -0.05 to 2.66; very low quality evidence) and body mass index (mean difference 0.54, 95% confidence interval -0.03 to 1.11; very low quality evidence). Pooled results for other outcomes were statistically non-significant. There was mixed narrative evidence regarding the effect of oral nutritional supplements on quality of life. Network meta-analysis could be conducted only for body weight and grip strength; there was evidence of an effect for oral nutritional supplements compared with standard care for body weight only. Study quality was mixed; the randomisation method was typically poorly reported. One economic evaluation, in a care home setting, was included. This was a well-conducted study showing that oral nutritional supplements could be cost-effective. Cost-effectiveness analysis suggested that oral nutritional supplements may only be cost-effective for people with lower body mass index (< 21 kg/m2) using cheaper oral nutritional supplements products that require minimal staff time to administer. LIMITATIONS The review scope was narrow in focus as few primary studies used frailty measures (or our proxy criteria). This resulted in only 11 included studies. The small evidence base and varied quality of evidence meant that it was not possible to determine accurate estimates of the effectiveness or cost-effectiveness of oral nutritional supplements. Furthermore, only English-language publications were considered. CONCLUSIONS Overall, the review found little evidence of oral nutritional supplements having significant effects on reducing malnutrition or its adverse outcomes in frail older adults. FUTURE WORK Future research should focus on independent, high-quality, adequately powered studies to investigate oral nutritional supplements alongside other nutritional interventions, with longer-term follow-up and detailed analysis of determinants, intervention components and cost-effectiveness. STUDY REGISTRATION This study is registered as PROSPERO CRD42020170906. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 51. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Katie Thomson
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Rice
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Oluwatomi Arisa
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eugenie Johnson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Tanner
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Marshall
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tumi Sotire
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Richmond
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hannah O'Keefe
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Wael Mohammed
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Anne Raffle
- Elders Council of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire T McEvoy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Institute for Global Food Security, Queen's University Belfast, Belfast, UK
| | - Dawn Craig
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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15
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Kimble R, McLellan G, Lennon LT, Papacosta AO, Weyant RJ, Kapila Y, Mathers JC, Wannamathee SG, Whincup PH, Ramsay SE. Association between oral health markers and decline in muscle strength and physical performance in later life: longitudinal analyses of two prospective cohorts from the UK and the USA. Lancet Healthy Longev 2022; 3:e777-e788. [PMID: 36356627 PMCID: PMC10397540 DOI: 10.1016/s2666-7568(22)00222-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Poor oral health could be associated with changes in musculoskeletal health over time. This aim of this study was to investigate the longitudinal relationship between oral health and decline in physical function in later life. METHODS We did a prospective analysis of two cohorts of older adults (aged 70 years or older) including men from the British Regional Heart Study (BRHS; n=612), and men and women from the Health, Aging and Body Composition (Health ABC) Study (n=1572), followed up for about 8 years. Data were available for clinical or self-reported oral health measures, muscle (grip) strength, and physical performance (chair stand and gait speed). ANCOVA models were used to assess the association between oral health and follow-up physical function scores. Multivariate logistic regression models were used to examine the associations between oral health and decline in physical function over the follow-up period. In the BRHS, changes in oral health and physical function were also assessed. All models were adjusted for relevant sociodemographic, behavioural, and health-related factors. FINDINGS In the BRHS, complete tooth loss and difficulty eating were associated with weaker grip strength at follow-up, and periodontal status was associated with decline in gait speed. In the Health ABC Study, complete tooth loss, poor self-rated oral health, and the presence of one oral health problem were associated with slower gait speed at follow-up. In both studies, dry mouth was associated with declines in physical function. In the BRHS, deterioration of dentition (tooth loss) over the follow-up period was associated with decline in chair stand speed (adjusted odds ratio 2·34 [95% CI 1·20-4·46]), as was deterioration in difficulty eating (2·41 [1·04-5·60]). INTERPRETATION Oral health problems are associated with poorer physical function and greater decline in physical function in older adults, and could be an indicator of individuals at risk of reduced physical capacity and subsequent frailty and disability in later life. FUNDING The Dunhill Medical Trust and the US National Institutes of Health-National Institute of Dental and Craniofacial Research.
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Affiliation(s)
- Rachel Kimble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Division of Sport and Exercise Science, School of Health and Life Sciences, University of the West of Scotland, Blantyre, UK.
| | - Gillian McLellan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Lucy T Lennon
- Department of Primary Care and Population Health, University College London, London, UK
| | - Anna Olia Papacosta
- Department of Primary Care and Population Health, University College London, London, UK
| | - Robert J Weyant
- Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yvonne Kapila
- School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA
| | - John C Mathers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, London, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Brennan-Tovey K, Aquino MRJ, Flanagan S, Kaner E, Wearn A, Bigirumurame T, Fong M, Todd A, Aveyard P, Jolly K, Damery S, Attwood A, Robson D, West J, Bridges S, Armitage CJ, Russell S, Strong S, Ramsay SE. Implementation of the NHS-funded tobacco dependence services in England: a qualitative study to understand the contexts of implementation. Lancet 2022; 400 Suppl 1:S24. [PMID: 36929967 DOI: 10.1016/s0140-6736(22)02234-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The National Health Service (NHS) Long Term Plan is a national policy that offers a package of treatment and support, called the NHS-funded tobacco dependence service, to help people stop smoking. It will be offered to people who smoke and are admitted to hospital by 2023-24. We present preliminary findings from our study, aiming to describe the contexts that the NHS-funded tobacco dependence services is being implemented in, including current service provisions. METHODS We did a qualitative study in five regions across England to understand the current provision and context implementing the NHS-funded tobacco dependence services, including current barriers to a quality service, and challenges of implementing the new service. We used key informant technique and document analysis. We interviewed those involved in the planning, commissioning, or delivery of NHS-funded tobacco dependence services. Documents analysed included implementation plans. Interviews and documents were analysed thematically. Ethical approval was obtained from Newcastle University. FINDINGS At time of writing (May 25, 2022), 11 interviews had been done, conducted by KBT and SF, and 12 documents analysed (Integrated Care System implementation plans, hospital trust polices, and protocols). Preliminary findings show that pre-existing services were patchy across regions, trusts, and patient pathways, whereas referrals to Local Authority Stop Smoking Services and community pharmacies differed between regions. Current practices to identify smokers within NHS settings were inadequate, with many smokers being discharged with no nicotine replacement therapy. Barriers to implementing the NHS Long Term Plan included funding issues, engagement of trusts, and a hesitancy to change. Participants identified anticipated changes being a reduction in health inequalities, reducing stigma, and a change in staff perception of smoking. INTERPRETATION Our findings show how funding, trust interest and systems, current services, infrastructure, and attitudes and culture of staff pose challenges and barriers to the successful implementation of the NHS Long Term Plan, locally and nationally. These findings will provide a detailed insight into the plans implementation challenges to policy and practice partners, as well as hopefully guide them on how to overcome these challenges. FUNDING NIHR's National Priority Areas Research Programme 2020-23 via the Prevention Including Behavioural Risk Factors Applied Research Collaboration (ARC) Consortium.
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Affiliation(s)
- Kerry Brennan-Tovey
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
| | - Maria Raisa Jessica Aquino
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Flanagan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Angela Wearn
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Theophile Bigirumurame
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Mackenzie Fong
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Adam Todd
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sarah Damery
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Angela Attwood
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Debbie Robson
- National Addiction Centre, Kings College London, London, UK
| | - Jane West
- Bradford institute for Health Research, Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Sally Bridges
- Bradford institute for Health Research, Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Samantha Russell
- National Institute for Health and Care Research Applied Research Collaboration North East and North Cumbria Tobacco Evaluation Public Advisory Group, Newcastle, UK
| | - Steve Strong
- National Institute for Health and Care Research Applied Research Collaboration North East and North Cumbria Tobacco Evaluation Public Advisory Group, Newcastle, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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17
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Thomson KH, Rice S, Arisa O, Johnson E, Tanner L, Marshall C, Sotire T, Richmond C, O'Keefe H, Mohammed W, Raffle A, Hanratty B, McEvoy CT, Craig D, Ramsay SE. Effectiveness and cost-effectiveness of oral nutritional supplements in frail older people who are malnourished or at risk of malnutrition: a systematic review and meta-analysis. Lancet Healthy Longev 2022; 3:e654-e666. [PMID: 36116457 DOI: 10.1016/s2666-7568(22)00171-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Current management of malnutrition can include prescribed oral nutritional supplements (ONS); however, there is uncertainty whether these supplements are effective in people who are older (≥65 years) and frail. We assessed the effectiveness, cost-effectiveness, and adherence and acceptability of ONS in frail older people who are malnourished or at risk of malnutrition. METHODS In this systematic review and meta-analysis, five bibliographic databases (MEDLINE, EMBASE, Cochrane Library, Scopus, and CINAHL) and grey literature sources were searched from inception to Sept 13, 2021, to identify studies assessing the effectiveness and cost-effectiveness of ONS (with or without other dietary interventions) in frail older people who are malnourished or at risk of malnutrition. Multiple reviewers independently did study screening, data extraction, and risk of bias assessment. Quality was assessed using version 1.0 of the Cochrane risk of bias tool for randomised controlled trials (RCTs), and the BMJ Drummond checklist was used to assess the quality of the included cost-effectiveness study. A meta-analysis was done for the effectiveness review; for the other reviews, a narrative synthesis approach was used. This systematic review and meta-analysis was registered on PROSPERO, CRD42020170906. FINDINGS Of 8492 records retrieved and screened, we included 11 RCTs involving 822 participants, six of which were fully or partly funded by industry. For the majority of the outcomes for which meta-analyses were possible (11/12), Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessments suggested that the evidence was of very low certainty. Results suggested that ONS might have a slightly positive effect on energy (kcal) intake (standardised mean difference 1·02 [95% CI 0·15 to 1·88]; I2=87%; four studies), protein intake (standardised mean difference 1·67 [-0·03 to 3·37; I2=97%; four studies), and mobility (mean difference 0·03 [0·02 to 0·04]; I2=0%; four studies), compared with standard care. Narrative syntheses suggested that the effect of ONS on quality of life, compared with standard care, was mixed. In the identified studies, there was very little information related to active components, determinants, or acceptability of interventions. One economic evaluation, done in a care home setting, showed that ONS could be cost-effective. INTERPRETATION We found little evidence of ONS reducing malnutrition or its associated adverse outcomes in older people who are frail. High-quality, non-industry-funded, adequately powered studies reporting on short-term and long-term health outcomes, determinants, and participant characteristics are needed. FUNDING UK National Institute of Health and Care Research (NIHR) Health Technology Assessment (NIHR128729).
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Affiliation(s)
- Katie H Thomson
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, The Catalyst, 3 Science Square, Newcastle Helix, Newcastle Upon Tyne, UK
| | - Stephen Rice
- Population Health Sciences Institute, Baddiley-Clark Building, Newcastle University, Newcastle Upon Tyne, UK
| | - Oluwatomi Arisa
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, The Catalyst, 3 Science Square, Newcastle Helix, Newcastle Upon Tyne, UK
| | - Eugenie Johnson
- Population Health Sciences Institute, Baddiley-Clark Building, Newcastle University, Newcastle Upon Tyne, UK
| | - Louise Tanner
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, The Catalyst, 3 Science Square, Newcastle Helix, Newcastle Upon Tyne, UK
| | - Christopher Marshall
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, The Catalyst, 3 Science Square, Newcastle Helix, Newcastle Upon Tyne, UK; York Health Economics Consortium, Enterprise House, Innovation Way, University of York, York, UK
| | - Tumi Sotire
- Population Health Sciences Institute, Baddiley-Clark Building, Newcastle University, Newcastle Upon Tyne, UK
| | - Catherine Richmond
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, The Catalyst, 3 Science Square, Newcastle Helix, Newcastle Upon Tyne, UK
| | - Hannah O'Keefe
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, The Catalyst, 3 Science Square, Newcastle Helix, Newcastle Upon Tyne, UK
| | - Wael Mohammed
- Population Health Sciences Institute, Baddiley-Clark Building, Newcastle University, Newcastle Upon Tyne, UK; School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anne Raffle
- Elders Council of Newcastle Upon Tyne, Campus for Aging and Vitality, Newcastle Upon Tyne, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Baddiley-Clark Building, Newcastle University, Newcastle Upon Tyne, UK
| | - Claire T McEvoy
- Centre for Public Health, Institute for Global Food Security, Institute of Clinical Sciences A, Belfast, Northern Ireland
| | - Dawn Craig
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, The Catalyst, 3 Science Square, Newcastle Helix, Newcastle Upon Tyne, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Baddiley-Clark Building, Newcastle University, Newcastle Upon Tyne, UK.
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18
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Kotronia E, Brown H, Papacosta O, Lennon LT, Weyant RJ, Whincup PH, Wannamethee SG, Ramsay SE. Oral health problems and risk of incident disability in two studies of older adults in the United Kingdom and the United States. J Am Geriatr Soc 2022; 70:2080-2092. [PMID: 35437751 PMCID: PMC9283258 DOI: 10.1111/jgs.17792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 02/08/2022] [Accepted: 03/11/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Preventing oral health problems can be crucial for maintaining physical independence in older adults. We aimed to examine the associations of a range of oral health problems with incidence of disability in older adults. METHODS We used prospective data from the British Regional Health Study (BRHS) (N = 2147, 71-92 years), and the Health, Aging and Body Composition (HABC) study (USA) (N = 3075, 71-80 years). Oral health measures included tooth loss, periodontal disease, self-rated oral health, and self-reported dry mouth. Participants were followed for onset of disability over a follow-up period of 3 years. Onset of disability was assessed through new cases of mobility limitations, activities of daily living (ADL), and instrumental activities of daily living (IADL). Logistic regression was performed to calculate the odds of incident disability. RESULTS In the BRHS, tooth loss was associated with greater odds of mobility limitations and ADL difficulties. Periodontal disease was associated with greater incidence of mobility limitations. Self-report of ≥3 dry mouth symptoms was associated with increased odds of incident mobility limitations and ADL difficulties (OR = 2.08, 95% CI 1.27-3.42; OR = 1.73, 95% CI 1.03-2.90). Fair/poor self-rated oral health was associated with greater incidence of IADL difficulties. In the HABC study, complete tooth loss was associated with greater incidence of mobility limitations (OR = 1.86, 95% CI 1.13-3.06), and fair/poor self-rated oral health was associated with increased odds of incident ADL difficulties (OR = 1.42, 95% CI 1.04-1.94). CONCLUSIONS Oral health problems in older adults, particularly tooth loss, self-reported dry mouth and self-rated oral health were associated with greater incidence of disability. Poor oral health plays a potentially important role in the development of disability in older populations, which in turn is an essential part of quality of life and healthy aging.
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Affiliation(s)
- Eftychia Kotronia
- Population Health Sciences InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Heather Brown
- Population Health Sciences InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Olia Papacosta
- Department of Primary Care & Population HealthInstitute of Epidemiology and Health Care, University College LondonLondonUK
| | - Lucy T. Lennon
- Department of Primary Care & Population HealthInstitute of Epidemiology and Health Care, University College LondonLondonUK
| | - Robert J. Weyant
- Department of Dental Public Health, School of Dental MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Peter H. Whincup
- Population Health Research InstituteSt George's University of LondonLondonUK
| | - Sasiwarang Goya Wannamethee
- Department of Primary Care & Population HealthInstitute of Epidemiology and Health Care, University College LondonLondonUK
| | - Sheena E. Ramsay
- Population Health Sciences InstituteNewcastle UniversityNewcastle Upon TyneUK
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19
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McKechnie DGJ, Patel M, Papacosta AO, Lennon LT, Ellins EA, Halcox JPJ, Ramsay SE, Whincup PH, Wannamethee SG. Associations between inflammation, coagulation, cardiac strain and injury, and subclinical vascular disease with frailty in older men: a cross-sectional study. BMC Geriatr 2022; 22:405. [PMID: 35527242 PMCID: PMC9082861 DOI: 10.1186/s12877-022-03106-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 04/27/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Inflammation, coagulation activation, endothelial dysfunction and subclinical vascular disease are cross-sectionally associated with frailty. Cardiac-specific biomarkers are less-well characterised. We assessed associations between these and frailty, in men with, and without, cardiovascular disease (CVD). METHODS Cross-sectional analysis of 1096 men without, and 303 with, CVD, aged 71-92, from the British Regional Heart Study. Multinominal logistic regression was performed to examine the associations between frailty status (robust/pre-frail/frail) and, separately, C-reactive protein (CRP), interleukin-6 (IL-6), tissue plasminogen activator (tPA), D-dimer, von Willebrand factor (vWF), high-sensitivity cardiac troponin-T (hs-cTnT), N-terminal pro B-type natriuretic peptide (NT-proBNP) (all natural log-transformed), and, in men without CVD, carotid intima-media thickness (CIMT), carotid-femoral pulse wave velocity (cfPWV), carotid distensibility coefficient (DC), and ankle-brachial pressure index (ABPI), adjusted for age, renal function, BMI, social class, smoking, polypharmacy, cognition, multimorbidity and systolic blood pressure. Explanatory variables with p < 0.05 were carried forward into mutually-adjusted analysis. RESULTS In men without CVD, higher CRP, IL-6, vWF, tPA, hs-cTnT, NT-proBNP, cfPWV, and lower DC were significantly associated with frailty; mutually-adjusted, log IL-6 (OR for frailty = 2.02, 95%CI 1.38-2.95), log hs-cTnT (OR = 1.95, 95%CI 1.24-3.05) and DC (OR = 0.92, 95%CI 0.86-0.99) retained associations. In men with CVD, higher CRP, IL-6, and hs-cTnT, but not vWF, tPA, NT-proBNP or D-dimer, were significantly associated with frailty; mutually-adjusted, log hs-cTnT (OR 3.82, 95%CI 1.84-7.95) retained a significant association. CONCLUSIONS In older men, biomarkers of myocardial injury are associated with frailty. Inflammation is associated with frailty in men without CVD. Carotid artery stiffness is associated with frailty in men without CVD, independently of these biomarkers.
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Affiliation(s)
- Douglas G J McKechnie
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK.
| | - Meera Patel
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK
| | - A Olia Papacosta
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK
| | - Lucy T Lennon
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK
| | | | | | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - S Goya Wannamethee
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK
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20
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Adams EA, Parker J, Jablonski T, Kennedy J, Tasker F, Hunter D, Denham K, Smiles C, Muir C, O’Donnell A, Widnall E, Dotsikas K, Kaner E, Ramsay SE. A Qualitative Study Exploring Access to Mental Health and Substance Use Support among Individuals Experiencing Homelessness during COVID-19. Int J Environ Res Public Health 2022; 19:ijerph19063459. [PMID: 35329147 PMCID: PMC8950841 DOI: 10.3390/ijerph19063459] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 11/16/2022]
Abstract
People experiencing homelessness have higher rates of mental ill-health and substance use and lower access to health services compared to the general population. The COVID-19 pandemic led to changes in service delivery across health and social care services, with many adopting virtual or telephone support for service users. This paper explores the experiences of access to community-based mental health and substance use support for people experiencing homelessness during the COVID-19 pandemic. Qualitative telephone interviews were conducted with 10 women and 16 men (ages 25 to 71) who self-identified as experiencing homelessness in North East England between February and May 2021. With five individuals with lived experience, results were analysed using inductive reflexive thematic analysis. Reactive changes to support provision often led to inadvertent exclusion. Barriers to access included: physical locations, repetition of recovery stories, individual readiness, and limited availability. Participants suggested creating services reflective of need and opportunities for choice and empowerment. Community mental health and substance use support for people experiencing homelessness should ensure the support is personalised, responsive to need, inclusive, and trauma-informed. The findings of this research have important implications for mental health and substance use policy and practice for individuals who experience homelessness during a public health crisis.
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Affiliation(s)
- Emma A. Adams
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (C.S.); (C.M.); (A.O.); (E.K.); (S.E.R.)
- Correspondence:
| | - Jeff Parker
- HeathNow, Crisis, City House 1 City Road, Newcastle upon Tyne NE1 2AF, UK
- Pathway, 4th Floor East, 250 Euston Road, London NW1 2PG, UK
- Crisis Pie Team, 66 Commercial Street, London E1 6LT, UK
| | - Tony Jablonski
- HeathNow, Crisis, City House 1 City Road, Newcastle upon Tyne NE1 2AF, UK
- Pathway, 4th Floor East, 250 Euston Road, London NW1 2PG, UK
- Crisis Pie Team, 66 Commercial Street, London E1 6LT, UK
| | - Joanne Kennedy
- Expert by Experience Network, Fulfilling Lives Newcastle Gateshead, Gateshead NE8 4DY, UK
| | - Fiona Tasker
- Expert by Experience Network, Fulfilling Lives Newcastle Gateshead, Gateshead NE8 4DY, UK
| | - Desmond Hunter
- HeathNow, Crisis, City House 1 City Road, Newcastle upon Tyne NE1 2AF, UK
- Expert by Experience Network, Fulfilling Lives Newcastle Gateshead, Gateshead NE8 4DY, UK
| | - Katy Denham
- Newcastle University Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK;
| | - Claire Smiles
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (C.S.); (C.M.); (A.O.); (E.K.); (S.E.R.)
| | - Cassey Muir
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (C.S.); (C.M.); (A.O.); (E.K.); (S.E.R.)
| | - Amy O’Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (C.S.); (C.M.); (A.O.); (E.K.); (S.E.R.)
| | - Emily Widnall
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK;
| | | | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (C.S.); (C.M.); (A.O.); (E.K.); (S.E.R.)
| | - Sheena E. Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (C.S.); (C.M.); (A.O.); (E.K.); (S.E.R.)
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21
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McKechnie DGJ, Papacosta AO, Lennon LT, Ramsay SE, Whincup PH, Wannamethee SG. Associations between inflammation, cardiovascular biomarkers and incident frailty: the British Regional Heart Study. Age Ageing 2021; 50:1979-1987. [PMID: 34254997 PMCID: PMC8675445 DOI: 10.1093/ageing/afab143] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction cardiovascular disease (CVD) and chronic inflammation are implicated in the development of
frailty. Longitudinal analyses of inflammatory markers, biomarkers of cardiac dysfunction and
incidence of frailty are limited. Methods in the British Regional Heart Study, 1,225 robust or pre-frail men aged 71–92 years
underwent a baseline examination, with questionnaire-based frailty assessment after 3 years.
Frailty definitions were based on the Fried phenotype. Associations between incident frailty
and biomarkers of cardiac dysfunction (high-sensitivity cardiac troponin T (hs-cTnT),
N-terminal pro B-type natriuretic peptide (NT-proBNP)) and inflammation (C-reactive protein
(CRP) and interleukin-6 (IL-6)) were examined, by tertile, with the lowest as reference. Results follow-up data were available for 981 men. Ninety one became frail. Adjusted for age,
pre-frailty, prevalent and incident CVD, comorbidity, polypharmacy and socioeconomic status,
IL-6 (third tertile OR 2.36, 95% CI 1.07–5.17) and hs-cTnT (third tertile OR 2.24, 95% CI
1.03–4.90) were associated with increased odds of frailty. CRP (third tertile OR 1.83, 95% CI
0.97–4.08) and NT-proBNP (second tertile OR 0.48, 95% CI 0.23–1.01) showed no significant
association with incident frailty. The top tertiles of CRP, IL-6, hscTnT and NT-proBNP were
strongly associated with mortality prior to follow-up. Conclusion IL-6 is associated with incident frailty, supporting the prevailing argument that
inflammation is involved in the pathogenesis of frailty. Cardiomyocyte injury may be
associated with frailty risk. Associations between elevated CRP and frailty cannot be fully
discounted; NT-proBNP may have a non-linear relationship with incident frailty. CRP, IL-6,
hs-cTnT and NT-proBNP are vulnerable to survivorship bias.
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Affiliation(s)
- Douglas G J McKechnie
- Department of Primary Care and Population Health, University College London, London, UK
| | - A Olia Papacosta
- Department of Primary Care and Population Health, University College London, London, UK
| | - Lucy T Lennon
- Department of Primary Care and Population Health, University College London, London, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter H Whincup
- Population Health Research Institute, St George’s University of London, London, UK
| | - S Goya Wannamethee
- Department of Primary Care and Population Health, University College London, London, UK
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Joyes EC, McGowan LJ, Adams EA, Paisi M, Burrows M, Shabaninejad H, Beyer F, Haddow K, Coyte A, Landes D, Moffatt S, Watt RG, Sniehotta FF, Bambra C, Craig D, Kaner E, Ramsay SE. Exploring Interventions to Improve the Oral Health and Related Health Behaviours of Adults Experiencing Severe and Multiple Disadvantage: Protocol for a Qualitative Study with Stakeholders. Int J Environ Res Public Health 2021; 18:ijerph182211755. [PMID: 34831509 PMCID: PMC8624319 DOI: 10.3390/ijerph182211755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/28/2021] [Accepted: 11/04/2021] [Indexed: 11/27/2022]
Abstract
The number of individuals in England experiencing homelessness, substance use, and involvement with the criminal justice system is increasing. These issues, referred to as severe and multiple disadvantage (SMD), are often interlinked and co-occur. Health inequalities, particularly poor oral health, persist for those facing these inter-related issues and are closely linked with high levels of substance use, smoking, and poor diet. However, evidence for interventions that can improve these health outcomes for those experiencing these issues is limited. This paper outlines the design of a qualitative study which aims to explore the perspectives of stakeholders to understand what interventions can help to support SMD groups with their oral health and related health behaviours (i.e., substance use, smoking, diet). Interviews and focus groups will be undertaken with stakeholders comprising two groups: (1) individuals with experience of SMD, and (2) service providers (staff and volunteers), policy makers, and commissioners who support such individuals. Public involvement and engagement is central to the project. For example, stakeholders and research partners in policy and practice and people with lived experience of SMD will provide input at all stages of this study. Findings from the study will inform an ‘evidence for practice’ briefing outlining recommendations for policy. Dissemination will occur through presentations to a range of practice, policy and academic beneficiaries, and through peer-reviewed publications.
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Affiliation(s)
- Emma C. Joyes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (H.S.); (F.B.); (A.C.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Laura J. McGowan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (H.S.); (F.B.); (A.C.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
- Correspondence:
| | - Emma A. Adams
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (H.S.); (F.B.); (A.C.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Martha Paisi
- Peninsula Dental School, University of Plymouth, Plymouth PL4 8AA, UK;
| | | | - Hosein Shabaninejad
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (H.S.); (F.B.); (A.C.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Fiona Beyer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (H.S.); (F.B.); (A.C.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Kate Haddow
- Fulfilling Lives Newcastle/Gateshead, Gateshead NE8 4DY, UK;
| | - Aishah Coyte
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (H.S.); (F.B.); (A.C.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - David Landes
- Public Health England, Newcastle Upon Tyne NE15 8NY, UK;
| | - Suzanne Moffatt
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (H.S.); (F.B.); (A.C.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Richard G. Watt
- Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK;
| | - Falko F. Sniehotta
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (H.S.); (F.B.); (A.C.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (H.S.); (F.B.); (A.C.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (H.S.); (F.B.); (A.C.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (H.S.); (F.B.); (A.C.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Sheena E. Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (H.S.); (F.B.); (A.C.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
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23
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McGowan LJ, Joyes EC, Adams EA, Coyte A, Gavin R, Richmond C, Shabaninejad H, Beyer F, Broadbridge A, Dobson K, Landes D, Moffatt S, Watt RG, Sniehotta FF, Freeman R, Paisi M, Bambra C, Craig D, Kaner E, Ramsay SE. Investigating the Effectiveness and Acceptability of Oral Health and Related Health Behaviour Interventions in Adults with Severe and Multiple Disadvantage: Protocol for a Mixed-Methods Systematic Review. Int J Environ Res Public Health 2021; 18:11554. [PMID: 34770066 PMCID: PMC8582803 DOI: 10.3390/ijerph182111554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/27/2021] [Accepted: 10/30/2021] [Indexed: 11/17/2022]
Abstract
Increasing numbers of people in England experience homelessness, substance use, and repeated offending (known as 'severe and multiple disadvantage'; SMD). Populations experiencing SMD often have extremely poor oral health, which is closely inter-linked with high levels of substance use, smoking, and poor diet. This study aims to undertake an evidence synthesis to identify the effectiveness, resource requirements, and factors influencing the implementation and acceptability of oral health and related health behaviour interventions in adults experiencing SMD. Two systematic reviews will be conducted using mixed-methods. Review 1 will investigate the effectiveness and resource implications of oral health and related health behaviours (substance use, smoking, diet) interventions; Review 2 will investigate factors influencing the implementation of such interventions. The population includes adults (≥18 years) experiencing SMD. Standard review methods in terms of searches, screening, data extraction, and quality appraisal will be conducted. Narrative syntheses will be conducted. If feasible, a meta-analysis will be conducted for Review 1 and a thematic synthesis for Review 2. Evidence from the two reviews will then be synthesised together. Input from people with experience of SMD will be sought throughout to inform the reviews. An initial logic model will be iteratively refined during the review.
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Affiliation(s)
- Laura J. McGowan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Emma C. Joyes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Emma A. Adams
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Aishah Coyte
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Richard Gavin
- Northumbria Healthcare, NHS Foundation Trust, Newcastle upon Tyne NE27 0QG, UK;
| | - Catherine Richmond
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Hosein Shabaninejad
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Fiona Beyer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Angela Broadbridge
- Fulfilling Lives Newcastle/Gateshead, Gateshead NE8 4DY, UK; (A.B.); (K.D.)
| | - Kevin Dobson
- Fulfilling Lives Newcastle/Gateshead, Gateshead NE8 4DY, UK; (A.B.); (K.D.)
| | | | - Suzanne Moffatt
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Richard G. Watt
- Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK;
| | - Falko F. Sniehotta
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Ruth Freeman
- Dental Health Services Research Unit, University of Dundee, Dundee DD1 4HN, UK;
| | - Martha Paisi
- School of Nursing and Midwifery, University of Plymouth, Plymouth PL4 8AA, UK;
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
| | - Sheena E. Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.C.J.); (E.A.A.); (A.C.); (C.R.); (H.S.); (F.B.); (S.M.); (F.F.S.); (C.B.); (D.C.); (E.K.); (S.E.R.)
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Adams EA, Parker J, Jablonski T, Kennedy J, Hunter D, Tasker F, Smiles C, Muir C, Widnall E, Dotsikas K, Reed C, Burrows M, O'Donnell A, Kaner E, Ramsay SE. “It's been up and down”—perspectives on living through COVID-19 for individuals who experience homelessness: a qualitative study. Lancet 2021. [PMID: 34227988 PMCID: PMC8617349 DOI: 10.1016/s0140-6736(21)02549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background The UN describes the COVID-19 pandemic as the greatest public health crisis for the current generation. However, individuals who experienced austerity, adversity, and disadvantage prior to the pandemic have been disproportionately affected with every turn the pandemic has taken, from transmission risk to vaccination take-up. One such population is individuals who experience homelessness. As the UK begins to transition to a stage of post-pandemic recovery, it is imperative to understand the perceived impact COVID-19 has had on the day-to-day lives of individuals who experience homelessness, to ensure they are not left behind and recovery planning can be better targeted to their specific needs. Methods Between February and May, 2021, 26 individuals (10 women and 16 men) who self-identified as experiencing homelessness within the Newcastle Gateshead area took part in telephone interviews of 20–80 min in length. Participants provided written or verbal informed consent prior to participating. Recruitment took place through existing networks, housing providers, charities, word of mouth, and snowball sampling. Analysis was co-produced with five individuals with lived experience using interpretative phenomenological analysis. NVivo release 1·5 was used to organise quotes. Ethics approval was granted by the Faculty of Medical Sciences Research Ethics Committee, part of Newcastle University's Research Ethics Committee (ref 2034/6698/2020.) Findings Experiences shared depicted unique stories with commonalities across the findings through five main themes: (1) surreality of day-to-day life—searching for understanding and lost autonomy; (2) an emotional rollercoaster—confronting negative emotions; (3) loneliness is my best friend—learning from being alone; (4) adversity is the only consistency—recognising past and present hardship, violence, and loss; and (5) coping with uncertainty—using drugs, mindfulness, and technology to survive. Interpretation The pandemic has affected the daily lives of people who experience homelessness in a variety of ways, including personal growth, no change, and regression. This study is limited by its localised recruitment in Newcastle and Gateshead in the UK; however, this local focus and involvement of individuals with lived experience has strengthened the study's implications for policy and practice in the region. Initiatives or policies developed to support post-pandemic recovery should reflect the array of impacts, while giving special recognition to loneliness, adversity, and resiliency among individuals who experience homelessness. Funding National Institute for Health Research School for Public Health Research.
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25
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McKechnie DGJ, Papacosta AO, Lennon LT, Ellins EA, Halcox JPJ, Ramsay SE, Whincup PH, Wannamethee SG. Subclinical cardiovascular disease and risk of incident frailty: The British Regional Heart Study. Exp Gerontol 2021; 154:111522. [PMID: 34428478 DOI: 10.1016/j.exger.2021.111522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/03/2021] [Accepted: 08/16/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND/OBJECTIVES Subclinical cardiovascular disease (CVD) is cross-sectionally associated with frailty, but the relationship between subclinical CVD and incident frailty has not been reported. We aimed to assess this prospective association. DESIGN Longitudinal analysis of data from the British Regional Heart Study, a prospective cohort study. PARTICIPANTS 1057 men, aged 71-92 years, robust or pre-frail at baseline, and without a clinical diagnosis of CVD. MEASUREMENTS Participants underwent baseline measurement of carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (CIMT), carotid distensibility coefficient (DC), and ankle-brachial pressure index (ABPI), and had questionnaire-based frailty assessment after three years. Frailty status was based on the Fried phenotype. Multivariate logistic regressions examined associations between incident frailty and tertile of cfPWV, CIMT, DC, and ABPI group (<0.9, 0.9-1.4, ≥1.4). RESULTS 865 men were examined and completed the 3 year follow-up questionnaire, of whom 78 became frail. Adjusted for age, prefrailty, body mass index, diabetes, smoking, atrial fibrillation, blood pressure, renal function, and incident CVD, higher CIMT was associated with greater odds of incident frailty (2nd tertile OR 1.62, 95% CI 0.78-3.35, 3rd tertile OR 2.61, 95% CI 1.30-5.23, p = 0.007, trend p = 0.006). cfPWV showed a weaker, non-significant association (2nd tertile OR 1.79, 95% CI 0.85-3.78, 3rd tertile OR 1.73, OR 0.81-3.72, p = 0.16, trend p = 0.20). There was no clear association between incident frailty and DC or ABPI. In subgroup analyses, CIMT was significantly associated with incident frailty in men ≥80 years (3rd tertile OR 6.99, 95%CI 1.42-34.5), but not in men aged 75-80 or < 75 years. CONCLUSION Subclinical CVD, as measured by CIMT, is associated with greater risk of incident frailty in older men over three year follow-up, independent of the development of clinically-apparent stroke, heart failure, or myocardial infarction, and may be a modifiable risk factor for frailty. This association may be stronger in very old age.
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Affiliation(s)
- Douglas G J McKechnie
- Department of Primary Care and Population Health, University College London, London, UK.
| | - A Olia Papacosta
- Department of Primary Care and Population Health, University College London, London, UK
| | - Lucy T Lennon
- Department of Primary Care and Population Health, University College London, London, UK
| | | | | | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - S Goya Wannamethee
- Department of Primary Care and Population Health, University College London, London, UK
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26
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Spiers GF, Liddle J, Kunonga TP, Whitehead IO, Beyer F, Stow D, Welsh C, Ramsay SE, Craig D, Hanratty B. What are the consequences of caring for older people and what interventions are effective for supporting unpaid carers? A rapid review of systematic reviews. BMJ Open 2021; 11:e046187. [PMID: 34588234 PMCID: PMC8483048 DOI: 10.1136/bmjopen-2020-046187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 08/26/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To identify and map evidence about the consequences of unpaid caring for all carers of older people, and effective interventions to support this carer population. DESIGN A rapid review of systematic reviews, focused on the consequences for carers of unpaid caring for older people, and interventions to support this heterogeneous group of carers. Reviews of carers of all ages were eligible, with any outcome measures relating to carers' health, and social and financial well-being. Searches were conducted in MEDLINE, PsycInfo and Epistemonikos (January 2000 to January 2020). Records were screened, and included systematic reviews were quality appraised. Summary data were extracted and a narrative synthesis produced. RESULTS Twelve systematic reviews reporting evidence about the consequences of caring for carers (n=6) and assessing the effectiveness of carer interventions (n=6) were included. The review evidence typically focused on mental health outcomes, with little information identified about carers' physical, social and financial well-being. Clear estimates of the prevalence and severity of carer outcomes, and how these differ between carers and non-carers, were absent. A range of interventions were identified, but there was no strong evidence of effectiveness. In some studies, the choice of outcome measure may underestimate the full impact of an intervention. CONCLUSIONS Current evidence fails to fully quantify the impacts that caring for older people has on carers' health and well-being. Information on social patterning of the consequences of caring is absent. Systematic measurement of a broad range of outcomes, with comparison to the general population, is needed to better understand the true consequences of caring. Classification of unpaid caring as a social determinant of health could be an effective lever to bring greater focus and support to this population. Further work is needed to develop and identify suitable interventions in order to support evidence-based policymaking and practice.
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Affiliation(s)
- Gemma F Spiers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jennifer Liddle
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Applied Research Collaboration North East & North Cumbria, Newcastle upon Tyne, UK
| | | | | | - Fiona Beyer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel Stow
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Welsh
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Applied Research Collaboration North East & North Cumbria, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Applied Research Collaboration North East & North Cumbria, Newcastle upon Tyne, UK
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27
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Abstract
Aging is associated with the development of disease. Periodontal disease is one of the many diseases and conditions that increase in prevalence with age. In addition to the traditional focus on individual age-related conditions, there is now a greater recognition that multisystem conditions such as frailty play an important role in the health of older populations. Frailty is a clinical condition in older adults that increases the risk of adverse health outcomes. Both frailty and periodontal disease are common chronic conditions in older populations and share several risk factors. There is likely a bidirectional relationship between periodontal disease and frailty. Comorbid systemic diseases, poor physical functioning, and limited ability to self-care in frail older people have been implicated as underlying the association between frailty and periodontal disease. In addition, both frailty and periodontal disease also have strong associations with inflammatory dysregulation and other age-related pathophysiologic changes that may similarly underlie their development and progression. Investigating age-related changes in immune cells that regulate inflammation may lead to a better understanding of age-related disease and could lead to therapeutic targets for the improved management of frailty and periodontal disease.
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Affiliation(s)
- Daniel Clark
- Department of Orofacial Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Eftychia Kotronia
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
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28
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Harland JM, Adams EA, Boobis S, Cheetham M, Wiseman A, Ramsay SE. Understanding the life experiences of people with multiple complex needs: peer research in a health needs assessment. Eur J Public Health 2021; 32:176-190. [PMID: 34436575 PMCID: PMC8975534 DOI: 10.1093/eurpub/ckab142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Multiple complex needs (MCN) describe a population experiencing a combination of homelessness, substance use, offending and/or mental ill-health. Using peer researchers, this study aimed to explore the perspectives of individuals with lived experience of MCN with regards to (i) issues leading to MCN and (ii) key intervention opportunities. METHODS As part of a health needs assessment in Gateshead (North East England), trained peer researchers interviewed 27 adults (aged ≥18 years) with experience of MCN, identified using purposive sampling methods. Peer researchers designed a topic guide for interviews which were audio recorded and thematically analyzed. RESULTS Interviewees reported adverse childhood experiences leading to MCN including abuse, bereavement, parental imprisonment, family break-up and inadequate support. Mental ill-health, substance use, poverty, early experiences of unstable housing and acute homelessness were identified as major precedents for adulthood experiences of MCN. Between 16 and 20 years, access to housing, social and mental health support was perceived as having the potential to prevent circumstances worsening. Individuals perceived removing barriers to mental health, housing and welfare and financial supports could help. CONCLUSIONS This study highlights the perceived role austerity, adverse childhood events and current service provision have in current and future experiences of MCN. Individuals expressed a need for future interventions and support to be judgement free and provided by workers who are educated about MCN and related adversity. Involving peer researchers and individuals with experience of MCN in future research and service provision could ensure appropriate measures and supports are put in place.
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Affiliation(s)
- Jill M Harland
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Emma A Adams
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Mandy Cheetham
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Alice Wiseman
- Public Health Department, Gateshead Council, Gateshead, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
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29
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Kotronia E, Brown H, Papacosta AO, Lennon LT, Weyant RJ, Whincup PH, Wannamethee SG, Ramsay SE. Oral health and all-cause, cardiovascular disease, and respiratory mortality in older people in the UK and USA. Sci Rep 2021; 11:16452. [PMID: 34385519 PMCID: PMC8361186 DOI: 10.1038/s41598-021-95865-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/02/2021] [Indexed: 11/09/2022] Open
Abstract
Preventing deterioration of oral health in older age can be crucial for survival. We aimed to examine associations of oral health problems with all-cause, cardiovascular disease (CVD), and respiratory mortality in older people. We used cohort data from the British Regional Health Study (BRHS) (N = 2147, 71-92 years), and the Health, Aging and Body Composition (HABC) Study (USA) (N = 3075, 71-80 years). Follow-up was 9 years (BRHS) and 15 years (HABC Study). Oral health comprised tooth loss, periodontal disease, dry mouth, and self-rated oral health. Cox regression was performed for all-cause mortality, competing risks for CVD mortality, and accelerated failure time models for respiratory mortality. In the BRHS, tooth loss was associated with all-cause mortality (hazard ratio (HR) = 1.59, 95% CI 1.09, 2.31). In the HABC Study, tooth loss, dry mouth, and having ≥ 3 oral problems were associated with all-cause mortality; periodontal disease was associated with increased CVD mortality (subdistribution hazard ratio (SHR) = 1.49, 95% CI 1.01, 2.20); tooth loss, and accumulation of oral problems were associated with high respiratory mortality (tooth loss, time ratio (TR) = 0.73, 95% CI 0.54, 0.98). Findings suggest that poor oral health is associated with mortality. Results highlight the importance of improving oral health to lengthen survival in older age.
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Affiliation(s)
- Eftychia Kotronia
- Population Health Sciences Institute, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
| | - Heather Brown
- Population Health Sciences Institute, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - A Olia Papacosta
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Lucy T Lennon
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Robert J Weyant
- Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - S Goya Wannamethee
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
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Kotronia E, Brown H, Papacosta AO, Lennon LT, Weyant RJ, Whincup PH, Wannamethee SG, Ramsay SE. Poor oral health and the association with diet quality and intake in older people in two studies in the UK and USA. Br J Nutr 2021; 126:118-130. [PMID: 33468264 PMCID: PMC8187263 DOI: 10.1017/s0007114521000180] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We aimed to investigate the associations of poor oral health cross-sectionally with diet quality and intake in older people. We also examined whether change in diet quality is associated with oral health problems. Data from the British Regional Heart Study (BRHS) comprising British males aged 71-92 years and the Health, Aging and Body Composition (HABC) Study comprising American males and females aged 71-80 years were used. Dental data included tooth loss, periodontal disease, dry mouth and self-rated oral health. Dietary data included diet quality (based on Elderly Dietary Index (BRHS) and Healthy Eating Score (HABC Study)) and several nutrients. In the BRHS, change in diet quality over 10 years (1998-2000 to 2010-2012) was also assessed. In the BRHS, tooth loss, fair/poor self-rated oral health and accumulation of oral health problems were associated with poor diet quality, after adjustment. Similar associations were reported for high intake of processed meat. Poor oral health was associated with the top quartile of percentage of energy content from saturated fat (self-rated oral health, OR 1·34, 95 % CI 1·02, 1·77). In the HABC Study, no significant associations were observed for diet quality after adjustment. Periodontal disease was associated with the top quartile of percentage of energy content from saturated fat (OR 1·48, 95 % CI 1·09, 2·01). In the BRHS, persistent low diet quality was associated with higher risk of tooth loss and accumulation of oral health problems. Older individuals with oral health problems had poorer diets and consumed fewer nutrient-rich foods. Persistent poor diet quality was associated with oral health problems later in life.
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Affiliation(s)
- Eftychia Kotronia
- Population Health Sciences Institute, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle Upon Tyne NE2 4AX, UK
| | - Heather Brown
- Population Health Sciences Institute, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle Upon Tyne NE2 4AX, UK
| | - A. Olia Papacosta
- Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Lucy T. Lennon
- Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Robert J. Weyant
- Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Peter H. Whincup
- Population Health Research Institute, St George’s University of London, London, UK
| | - S. Goya Wannamethee
- Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Sheena E. Ramsay
- Population Health Sciences Institute, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle Upon Tyne NE2 4AX, UK
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Ni Lochlainn M, Cox NJ, Wilson T, Hayhoe RPG, Ramsay SE, Granic A, Isanejad M, Roberts HC, Wilson D, Welch C, Hurst C, Atkins JL, Mendonça N, Horner K, Tuttiett ER, Morgan Y, Heslop P, Williams EA, Steves CJ, Greig C, Draper J, Corish CA, Welch A, Witham MD, Sayer AA, Robinson S. Nutrition and Frailty: Opportunities for Prevention and Treatment. Nutrients 2021; 13:2349. [PMID: 34371858 PMCID: PMC8308545 DOI: 10.3390/nu13072349] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/28/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023] Open
Abstract
Frailty is a syndrome of growing importance given the global ageing population. While frailty is a multifactorial process, poor nutritional status is considered a key contributor to its pathophysiology. As nutrition is a modifiable risk factor for frailty, strategies to prevent and treat frailty should consider dietary change. Observational evidence linking nutrition with frailty appears most robust for dietary quality: for example, dietary patterns such as the Mediterranean diet appear to be protective. In addition, research on specific foods, such as a higher consumption of fruit and vegetables and lower consumption of ultra-processed foods are consistent, with healthier profiles linked to lower frailty risk. Few dietary intervention studies have been conducted to date, although a growing number of trials that combine supplementation with exercise training suggest a multi-domain approach may be more effective. This review is based on an interdisciplinary workshop, held in November 2020, and synthesises current understanding of dietary influences on frailty, focusing on opportunities for prevention and treatment. Longer term prospective studies and well-designed trials are needed to determine the causal effects of nutrition on frailty risk and progression and how dietary change can be used to prevent and/or treat frailty in the future.
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Affiliation(s)
- Mary Ni Lochlainn
- Department of Twin Research and Genetics, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK;
| | - Natalie J. Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO17 1BJ, UK; (N.J.C.); (H.C.R.)
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Thomas Wilson
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Aberystwyth SY23 3DA, UK; (T.W.); (J.D.)
| | - Richard P. G. Hayhoe
- Department of Epidemiology & Public Health, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (R.P.G.H.); (A.W.)
- School of Allied Health, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford CM1 1SQ, UK
| | - Sheena E. Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (S.E.R.); (N.M.)
| | - Antoneta Granic
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (A.G.); (C.H.); (P.H.); (M.D.W.); (A.A.S.)
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Masoud Isanejad
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK;
| | - Helen C. Roberts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO17 1BJ, UK; (N.J.C.); (H.C.R.)
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Daisy Wilson
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (D.W.); (C.W.)
| | - Carly Welch
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (D.W.); (C.W.)
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham B15 2TT, UK;
| | - Christopher Hurst
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (A.G.); (C.H.); (P.H.); (M.D.W.); (A.A.S.)
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Janice L. Atkins
- Epidemiology & Public Health Group, University of Exeter Medical School, Exeter EX1 2LU, UK;
| | - Nuno Mendonça
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (S.E.R.); (N.M.)
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, 1150-082 Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
| | - Katy Horner
- School of Public Health, Physiotherapy and Sport Science and UCD Institute of Food and Health, University College Dublin, Belfield, Dublin 4, Ireland; (K.H.); (C.A.C.)
| | - Esme R. Tuttiett
- The Medical Research Council Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing and The Department of Oncology and Metabolism, The University of Sheffield, Sheffield S10 2RX, UK; (E.R.T.); (E.A.W.)
| | - Yvie Morgan
- EDESIA PhD Programme, University of East Anglia Norwich Research Park, Norwich NR4 7TJ, UK;
| | - Phil Heslop
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (A.G.); (C.H.); (P.H.); (M.D.W.); (A.A.S.)
| | - Elizabeth A. Williams
- The Medical Research Council Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing and The Department of Oncology and Metabolism, The University of Sheffield, Sheffield S10 2RX, UK; (E.R.T.); (E.A.W.)
| | - Claire J. Steves
- Department of Twin Research and Genetics, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK;
| | - Carolyn Greig
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham B15 2TT, UK;
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham and NIHR Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham B15 2TT, UK
| | - John Draper
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Aberystwyth SY23 3DA, UK; (T.W.); (J.D.)
| | - Clare A. Corish
- School of Public Health, Physiotherapy and Sport Science and UCD Institute of Food and Health, University College Dublin, Belfield, Dublin 4, Ireland; (K.H.); (C.A.C.)
| | - Ailsa Welch
- Department of Epidemiology & Public Health, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (R.P.G.H.); (A.W.)
| | - Miles D. Witham
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (A.G.); (C.H.); (P.H.); (M.D.W.); (A.A.S.)
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Avan A. Sayer
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (A.G.); (C.H.); (P.H.); (M.D.W.); (A.A.S.)
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Sian Robinson
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (A.G.); (C.H.); (P.H.); (M.D.W.); (A.A.S.)
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne NE4 5PL, UK
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McKechnie DGJ, Papacosta AO, Lennon LT, Ramsay SE, Whincup PH, Wannamethee SG. Frailty and incident heart failure in older men: the British Regional Heart Study. Open Heart 2021; 8:openhrt-2021-001571. [PMID: 34088788 PMCID: PMC8183233 DOI: 10.1136/openhrt-2021-001571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/16/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Frailty and heart failure (HF) are cross-sectionally associated. Published longitudinal data are very limited. We sought to investigate associations between frailty and incident HF. METHODS Prospective study of 1722 men, examined at age 72-91 years. Scores based on the Fried phenotype, Gill index and a novel frailty score, based on the Health Ageing and Body Composition Battery, incorporating slow walking speed, low chair-stand time and subjective difficulty with balance, were calculated. Associations between these scores and incident HF were analysed with Cox proportional hazard modelling. RESULTS 1445 men with frailty data and without prevalent HF were included. 99 developed HF (mean follow-up 6.1 years). Men scoring 3/3 on our novel frailty score had elevated risk of incident HF (HR 2.77, 95% CI 1.25 to 6.15), which persisted after adjustment for established risk factors and interleukin-6 (HR 3.14, 95% CI 1.35 to 7.31). This risk remained increased, although attenuated, after excluding HF events within 2 years of baseline (HR 2.05, 95% CI 0.61 to 6.92). The frailty phenotype showed a non-significant association with HF (age-adjusted HR 1.92, 95% CI 0.99 to 3.73), which was further attenuated after adjustment for prevalent coronary heart disease and Body mass index (HR 1.60, 95% CI 0.81 to 3.15). Gill-type scores were weakly associated with HF risk after these adjustments (HR 1.31, 95% CI 0.47 to 3.70). CONCLUSION In these older men, the combination of slow walk speed, low sit-stand time and balance problems were associated with high risk of incident HF, independent of established risk factors and inflammatory markers. However, undiagnosed HF at baseline may still be a confounder. There is a differential association between aspects of the frailty phenotype and incident HF.
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Affiliation(s)
- Douglas GJ McKechnie
- Department of Primary Care and Population Health, University College London, London, UK
| | - A Olia Papacosta
- Department of Primary Care and Population Health, University College London, London, UK
| | - Lucy T Lennon
- Department of Primary Care and Population Health, University College London, London, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - S Goya Wannamethee
- Department of Primary Care and Population Health, University College London, London, UK
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Perry R, Adams EA, Harland J, Broadbridge A, Giles EL, McGeechan GJ, O'Donnell A, Ramsay SE. Exploring high mortality rates among people with multiple and complex needs: a qualitative study using peer research methods. BMJ Open 2021; 11:e044634. [PMID: 34083333 PMCID: PMC8183219 DOI: 10.1136/bmjopen-2020-044634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 05/20/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore the perceived reasons underlying high mortality rates among people with multiple and complex needs. DESIGN Qualitative study using peer research. SETTING North East of England. PARTICIPANTS Three focus group discussions were held involving (1) people with lived experience of multiple and complex needs (n=5); (2) front-line staff from health, social care and voluntary organisations that support multiple and complex needs groups (n=7); and (3) managers and commissioners of these organisations (n=9). RESULTS Findings from this study provide valuable perspectives of people with multiple complex needs and those that provide them with support on what may be perceived factors underlying premature mortality. Mental ill health and substance misuse (often co-occurring dual diagnosis) were perceived as influencing premature mortality among multiple and complex needs groups. Perceptions of opportunities to identify people at risk included critical life events (eg, bereavement, relationship breakdown) and transitions (eg, release from prison, completion of drug treatment). Early prevention, particularly supporting young people experiencing adverse childhood experiences, was also highlighted as a priority. CONCLUSION High mortality in multiple and complex needs groups may be reduced by addressing dual diagnosis, providing more support at critical life events and investing in early prevention efforts. Future interventions could take into consideration the intricate nature of multiple and complex needs and improve service access and navigation.
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Affiliation(s)
- Rachel Perry
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma A Adams
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jill Harland
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Emma L Giles
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Grant J McGeechan
- Centre for Applied Psychological Science, Teesside University, Middlesbrough, UK
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Barker RO, Hanratty B, Kingston A, Ramsay SE, Matthews FE. Changes in health and functioning of care home residents over two decades: what can we learn from population-based studies? Age Ageing 2021; 50:921-927. [PMID: 33951152 PMCID: PMC8099147 DOI: 10.1093/ageing/afaa227] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Indexed: 11/16/2022] Open
Abstract
Background Care home residents have complex care and support needs. There is a perception that the needs of residents have increased, but the evidence is limited. We investigated changes in health and functioning of care home residents over two decades in England and Wales. Methods We conducted a repeated cross-sectional analysis over a 24 year period (1992–2016), using data from three longitudinal studies, the Cognitive Function and Ageing Studies (CFAS) I and II and the English Longitudinal Study of Ageing (ELSA). To adjust for ageing of respondents over time results are presented for the 75–84 age group. Results Analysis of 2,280 observations from 1,745 care home residents demonstrated increases in severe disability (difficulty in at least two from washing, dressing and toileting). The prevalence of severe disability increased from 63% in 1992 to 87% in 2014 (subsequent fall in 2016 although wide confidence intervals). The prevalence of complex multimorbidity (problems in at least three out of six body systems) increased within studies over time, from 33% to 54% in CFAS I/II between 1992 and 2012, and 26% to 54% in ELSA between 2006 and 2016. Conclusion Over two decades, there has been an increase in disability and the complexity of health problems amongst care home residents in England and Wales. A rise in support needs for residents places increasing demands on care home staff and health professionals, and should be an important consideration for policymakers and service commissioners.
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Affiliation(s)
- Robert O Barker
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Andrew Kingston
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
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Albani V, Nishio K, Ito T, Kotronia E, Moynihan P, Robinson L, Hanratty B, Kingston A, Abe Y, Takayama M, Iinuma T, Arai Y, Ramsay SE. Associations of poor oral health with frailty and physical functioning in the oldest old: results from two studies in England and Japan. BMC Geriatr 2021; 21:187. [PMID: 33736595 PMCID: PMC7977173 DOI: 10.1186/s12877-021-02081-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/11/2021] [Indexed: 12/19/2022] Open
Abstract
Background Very few studies have examined the relationship of oral health with physical functioning and frailty in the oldest old (> 85 years). We examined the association of poor oral health with markers of disability, physical function and frailty in studies of oldest old in England and Japan. Methods The Newcastle 85+ Study in England (n = 853) and the Tokyo Oldest Old Survey on Total Health (TOOTH; n = 542) comprise random samples of people aged > 85 years. Oral health markers included tooth loss, dryness of mouth, difficulty swallowing and difficulty eating due to dental problems. Physical functioning was based on grip strength and gait speed; disability was assessed as mobility limitations. Frailty was ascertained using the Fried frailty phenotype. Cross-sectional analyses were undertaken using logistic regression. Results In the Newcastle 85+ Study, dry mouth symptoms, difficulty swallowing, difficulty eating, and tooth loss were associated with increased risks of mobility limitations after adjustment for sex, socioeconomic position, behavioural factors and co-morbidities [odds ratios (95%CIs) were 1.76 (1.26–2.46); 2.52 (1.56–4.08); 2.89 (1.52–5.50); 2.59 (1.44–4.65) respectively]. Similar results were observed for slow gait speed. Difficulty eating was associated with weak grip strength and frailty on full adjustment. In the TOOTH Study, difficulty eating was associated with increased risks of frailty, mobility limitations and slow gait speed; and complete tooth loss was associated with increased risk of frailty. Conclusion Different markers of poor oral health are independently associated with worse physical functioning and frailty in the oldest old age groups. Research to understand the underlying pathways is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02081-5.
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Affiliation(s)
- Viviana Albani
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
| | - Kensuke Nishio
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry, Tokyo, Japan
| | - Tomoka Ito
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry, Tokyo, Japan
| | - Eftychia Kotronia
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Paula Moynihan
- Adelaide Dental School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Kingston
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Yukiko Abe
- Centre for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Michiyo Takayama
- Centre for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Toshimitsu Iinuma
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry, Tokyo, Japan
| | - Yasumichi Arai
- Centre for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Sheena E Ramsay
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Kotronia E, Wannamethee SG, Papacosta AO, Whincup PH, Lennon LT, Visser M, Kapila YL, Weyant RJ, Ramsay SE. Poor Oral Health and Inflammatory, Hemostatic, and Cardiac Biomarkers in Older Age: Results From Two Studies in the UK and USA. J Gerontol A Biol Sci Med Sci 2021; 76:346-351. [PMID: 32306041 PMCID: PMC7812424 DOI: 10.1093/gerona/glaa096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND We examined the association of objective and subjective oral health markers with inflammatory, hemostatic, and cardiac biomarkers in older age. METHODS Cross-sectional analyses were based on the British Regional Heart Study (BRHS) comprising British men aged 71-92 years (n = 2,147), and the Health, Aging and Body Composition (HABC) Study comprising American men and women aged 71-80 years (n = 3,075). Oral health markers included periodontal disease, tooth count, dry mouth. Inflammatory biomarkers included C-reactive protein (CRP), interleukin-6 (IL-6) in both studies, and tissue plasminogen activator (t-PA), von Willebrand Factor (vWF), fibrin D-dimer, high-sensitivity Troponin T (hsTnT), and N-terminal pro-brain natriuretic peptide (NTproBNP) only in the BRHS. RESULTS In both studies, tooth loss, was associated with the top tertile of CRP-odds ratios (ORs) (95% confidence interval [CI]) are 1.31 (1.02-1.68) in BRHS; and 1.40 (1.13-1.75) in the HABC Study, after adjusting for confounders. In the HABC Study, cumulative (≥3) oral health problems were associated with higher levels of CRP (OR [95% CI] =1.42 [1.01-1.99]). In the BRHS, complete and partial tooth loss was associated with hemostatic factors, in particular with the top tertile of fibrin D-dimer (OR [95% CI] = 1.64 [1.16-2.30] and 1.37 [1.05-1.77], respectively). Tooth loss and periodontal disease were associated with increased levels of hsTnT. CONCLUSIONS Poor oral health in older age, particularly tooth loss, was consistently associated with some inflammatory, hemostatic, and cardiac biomarkers. Prospective studies and intervention trials could help understand better if poor oral health is causally linked to inflammatory, hemostatic, and cardiac biomarkers.
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Affiliation(s)
- Eftychia Kotronia
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - S Goya Wannamethee
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, UK
| | - A Olia Papacosta
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, UK
| | - Peter H Whincup
- Faculty of Medical Sciences, Population Health Research Institute, St George’s University of London, UK
| | - Lucy T Lennon
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, UK
| | - Marjolein Visser
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit, the Netherlands
| | - Yvonne L Kapila
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco
| | - Robert J Weyant
- Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh, Pennsylvania
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
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Gilani A, Ramsay SE, Welsh P, Papacosta O, Lennon LT, Whincup PH, Wannamethee SG. Vitamin D deficiency is associated with orthostatic hypotension in older men: a cross-sectional analysis from the British Regional Heart Study. Age Ageing 2021; 50:198-204. [PMID: 32902636 PMCID: PMC7793603 DOI: 10.1093/ageing/afaa146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Indexed: 01/27/2023] Open
Abstract
Background orthostatic hypotension (OH) that occurs within, or at, 1 minute of standing is associated with higher risk of falls, myocardial infarction, syncope and mortality, compared to OH that occurs after 1 minute of standing. Whether vitamin D deficiency increases the risk of OH is controversial. Methods this was a cross-sectional analysis of 3,620 older, community-dwelling men. Multinomial, multiple logistic regression models were used to calculate the risk of OH across categories of vitamin D status (deficient [<25 nmol/l], insufficient [≥25–<50 nmol/l] and sufficient [≥50 nmol/l]) and parathyroid hormone quintile. Results men with vitamin D deficiency were more likely to have OH that occurred within 1 minute of standing in univariate logistic regression (OR 1.88, 95% CI 1.40–2.53) and multinomial, multiple logistic regression (OR 1.51, 95% CI 1.06–2.15), compared to men with sufficient levels of vitamin D. Vitamin D insufficiency was not associated with the risk of OH. Elevated parathyroid hormone was not associated with risk of OH. Conclusion the absence of an association between vitamin D insufficiency and risk of OH and the presence of an association between vitamin D deficiency and risk of OH suggest that there may be a threshold effect; it is only below a particular level of vitamin D that risk of OH is increased. In this cohort, the threshold was <25 nmol/l. Future work should investigate whether treating vitamin D deficiency can improve postural blood pressure or if preventing vitamin D deficiency reduces the incidence of OH.
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Affiliation(s)
- Artaza Gilani
- Research Department of Primary Care and Population Health, University College London, Royal Free Campus, London NW3 2PF, UK
- Address correspondence to: Dr Artaza Gilani. Tel: 02080168021.
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow G12 8TA, UK
| | - Olia Papacosta
- Research Department of Primary Care and Population Health, University College London, Royal Free Campus, London NW3 2PF, UK
| | - Lucy T Lennon
- Research Department of Primary Care and Population Health, University College London, Royal Free Campus, London NW3 2PF, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, London SW17 0RE, UK
| | - S Goya Wannamethee
- Research Department of Primary Care and Population Health, University College London, Royal Free Campus, London NW3 2PF, UK
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Gilani A, Ramsay SE, Juraschek SP, Papacosta O, Lennon LT, Whincup PH, Wannamethee SG. Associations of the systolic and diastolic components of orthostatic hypotension with markers of cardiovascular risk in older men: A cross-sectional analysis from The British Regional Heart Study. J Clin Hypertens (Greenwich) 2020; 22:1892-1901. [PMID: 33231377 PMCID: PMC8029713 DOI: 10.1111/jch.13996] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/09/2020] [Accepted: 06/28/2020] [Indexed: 12/14/2022]
Abstract
The mechanisms underlying the association between orthostatic hypotension (OH) and cardiovascular disease are unclear. We investigated whether OH is associated with circulating cardiovascular risk markers. This was a cross-sectional analysis of 3857 older, community-dwelling men. "Consensus OH" was defined as a sitting-to-standing decrease in systolic blood pressure ≥20 mm Hg and/or diastolic blood pressure ≥10 mm Hg that occurred within three minutes of standing. Multiple generalized linear regression and logistic models were used to examine the association between cardiovascular risk markers and OH. Consensus OH was present in 20.2%, consisting of isolated systolic OH in 12.6%, isolated diastolic OH in 4.6%, and combined systolic and diastolic OH in 3.0%. Concentration of von Willebrand factor, a marker of endothelial dysfunction, was positively associated with isolated systolic OH (OR 1.35, 95% CI 1.05-1.73) and combined systolic and diastolic OH (OR 2.27, 95% CI 1.35-3.83); high circulating phosphate concentration, which may reflect vascular calcification, was associated with isolated diastolic OH (OR 1.53, 95% CI 1.04-2.25) and combined systolic and diastolic OH (OR 2.12, 95% CI 1.31-3.44), high-sensitivity troponin T, a marker of myocardial injury, was positively associated with isolated diastolic OH (OR 1.69, 95% CI 1.07-2.65) and N-terminal pro-brain natriuretic peptide, a marker of cardiac stress, was positively associated with combined systolic and diastolic OH (OR 2.14, 95% CI 1.14-4.03). In conclusion, OH is associated with some cardiovascular risk markers implicated in endothelial dysfunction, vascular calcification, myocardial injury, and cardiac stress. Clinicians should consider assessing cardiovascular risk in patients with OH.
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Affiliation(s)
- Artaza Gilani
- Research Department of Primary Care & Population Health, Royal Free Campus, University College London, London, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen P Juraschek
- Division of General Medicine, Section for Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Olia Papacosta
- Research Department of Primary Care & Population Health, Royal Free Campus, University College London, London, UK
| | - Lucy T Lennon
- Research Department of Primary Care & Population Health, Royal Free Campus, University College London, London, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, London, UK
| | - Sasiwarang Goya Wannamethee
- Research Department of Primary Care & Population Health, Royal Free Campus, University College London, London, UK
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Oyebode O, Ramsay SE, Brayne C. Public health research in the UK to understand and mitigate the impact of COVID-19 and COVID-19 response measures. J Epidemiol Community Health 2020; 75:209-212. [PMID: 33028615 DOI: 10.1136/jech-2020-214997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 11/03/2022]
Abstract
This paper reflects concerns that funding and attention should be expanded from the important focus on those suffering and dying from COVID-19, and the safety and resources of healthcare professionals, to address wider questions on the (unequal) health and well-being impacts of COVID-19 and associated response measures. While immediate priorities such as those outlined in the WHO research agenda are undoubtedly important, additional urgent questions must be addressed. These include questions focused on (1) the non-virus impacts of preparing health and social care systems to cope with COVID-19 and (2) the health effects mediated by the educational, economic and social injuries sustained during the pandemic. Long-term, sustained and co-ordinated interdisciplinary research funding will be needed to address the long-lasting impacts of COVID-19 and its response measures.
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Affiliation(s)
| | - Sheena E Ramsay
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Carol Brayne
- Institute of Public Health, University of Cambridge, Cambridge, UK
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Kotronia E, Wannamethee SG, Papacosta OA, Whincup PH, Lennon LT, Visser M, Weyant RJ, Ramsay SE. Poor oral health and incidence of disability: results from studies of older people in the UK and USA. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
To examine the association between oral health markers and disability 4 years later in two population-based studies of older people in the UK and USA.
Methods
Analyses were conducted in the British Regional Heart Study (BRHS) comprising older men (n = 2147) and the Health, Aging and Body Composition (HABC) Study comprising American older men and women (n = 3075). Data from a 4-year follow up period were used. Oral health measures included tooth loss, periodontal disease, dry mouth, and self-rated oral health. Mobility limitations and Activities of Daily Living (ADL) were markers of disability. Logistic regression was performed and analyses were adjusted for confounders (age, socioeconomic position, lifestyle factors, and chronic diseases).
Results
Over a 4-year follow-up, 15% of subjects in the BRHS and 19% in the HABC Study developed mobility limitations. In both studies, 12% of participants developed ADL problems. In the BRHS, tooth loss (complete and partial), periodontal disease, dry mouth and accumulation of oral health problems were associated with an increased risk of developing mobility limitations after adjustment for confounders (partial tooth loss, OR = 1.86, 95% CI 1.18-2.94, ≥3 dry mouth symptoms, OR = 1.97, 95%CI 1.25-3.09). Similar results were observed for the risk of developing ADL problems. In the HABC Study, complete tooth loss and accumulation of oral health problems were associated with greater risk of incident mobility limitations (OR = 1.77, 95%CI 1.13-2.76; OR = 1.18, 95% CI 1.02-1.37, respectively). Moreover, self-rated oral health was associated with increased risk of ADL problems, after adjustment for confounders.
Conclusions
Poor oral health was associated with increased risk of developing disability in community-dwelling older people. Screening tools of oral health may be helpful in identifying oral health problems, improving oral health status and promoting health and good quality of life.
Key messages
Poor oral health is associated with a higher risk of developing disability in later life. This highlights the importance of oral health on maintaining independence in older people.
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Affiliation(s)
- E Kotronia
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - S G Wannamethee
- Department of Primary Care and Population Health, University College London, London, UK
| | - O A Papacosta
- Department of Primary Care and Population Health, University College London, London, UK
| | - P H Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - L T Lennon
- Department of Primary Care and Population Health, University College London, London, UK
| | - M Visser
- Department of Health Sciences, Vrije Universiteit, Amsterdam, Netherlands
| | - R J Weyant
- Department of Dental Public Health, University of Pittsburgh, Pittsburgh, USA
| | - S E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
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Watson S, McMullan J, Brocklehurst P, Tsakos G, Watt RG, Wassall RR, Sherriff A, Ramsay SE, Karki AJ, Tada S, Lappin C, Donaldson M, McKenna G. Development of a core outcome set for oral health services research involving dependent older adults (DECADE): a study protocol. Trials 2020; 21:599. [PMID: 32611443 PMCID: PMC7329504 DOI: 10.1186/s13063-020-04531-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/18/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Oral healthcare service provision for dependent older adults is often poor. For dental services to provide more responsive and equitable care, evidence-based approaches are needed. To facilitate future research, the development and application of a core outcome set would be beneficial. The aim of this study is to develop a core outcome set for oral health services research involving dependent older adults. METHODS A multi-step process involving consensus methods and including key stakeholders will be undertaken. This will involve identifying potentially relevant outcomes through a systematic review of previous studies examining the effectiveness of strategies to prevent oral disease in dependent older adults, combined with semi-structured interviews with key stakeholders. Stakeholders will include dependent older adults, family members, carers, care-home managers, health professionals, researchers, dental commissioners and policymakers. To condense and prioritise the long list of outcomes generated by the systematic review and semi-structured interviews, a Delphi survey consisting of several rounds with key stakeholders, as mentioned above, will be undertaken. The 9-point Likert scale proposed by the GRADE Working Group will facilitate this consensus process. Following the Delphi survey, a face-to-face consensus meeting with key stakeholders will be conducted where the stakeholders will anonymously vote and decide on what outcomes should be included in the finalised core outcome set. DISCUSSION Developing a core set of outcomes that are clinically and patient-centred will help improve the design, conduct and reporting of oral health services research involving dependent older adults, and ultimately strengthen the evidence base for high-quality oral health care for dependent older adults. TRIAL REGISTRATION The study was registered with the COMET initiative on 9 January 2018 http://www.cometinitiative.org/studies/details/1081?result=true .
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Affiliation(s)
- Sinead Watson
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Julie McMullan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | | | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Richard G. Watt
- Department of Epidemiology and Public Health, University College London, London, UK
| | | | | | - Sheena E. Ramsay
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | | | - Sayaka Tada
- Discipline of Endodontics, Operative Dentistry and Prosthodontics, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Caroline Lappin
- Community Dental Service, South Eastern Health and Social Care Trust, Dundonald, UK
| | | | - Gerald McKenna
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
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Ahmed A, Ramsay SE, Papacosta O, Lennon L, Whincup PH, Wannamethee SG. 84 Circulating Vitamin D Levels and Frailty in the British Regional Heart Study: Cross Sectional and Prospective Associations. Age Ageing 2020. [DOI: 10.1093/ageing/afz192.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Whether Vitamin D deficiency is linked to development of frailty, independent of other health conditions, is inconclusive. In the British Regional Heart Study we aimed to examine (1) cross sectional (CS) and prospective (PS) associations between Vitamin D levels and frailty; and (2) if these are mediated by conditions linked to low Vitamin D (diabetes, chronic obstructive pulmonary disease and inflammatory markers C-reactive protein & Interleukin-6).
Methods
Baseline (2010-2012) Vitamin D in men (71-92y) was categorised as deficiency (<12 ng/ml), insufficiency (12 - < 20 ng/ml) and sufficiency (≥20 ng/ml) states. Frailty, assessed at baseline and follow up (2014) was classified as robust, pre-frail or frail (score 0, 1-2, or ≥3 out of 5 Fried Frailty components respectively). Multinomial regression determined CS & PS relative risk ratios (RRR) of being pre-frail or frail, relative to robust. Adjustments were made for age, BMI, season, smoking, drinking habits, social class, Vitamin D/calcium supplements, mental/physical health and potential mediators.
Results
At baseline, 20% of 1494 men were frail and 25% deficient in Vitamin D. Unadjusted RRR of being frail (vs robust) was 3.16 [95% CI 2.16, 4.62] in men with Vitamin D<12ng/ml (reference ≥20ng/ml). Higher RRR persisted even after adjusting for covariates and potential mediating factors, [2.74; 95% CI 1.60, 4.69]. Of 977 men non-frail at baseline, 10% became frail. Men with Vitamin D <12ng/ml (reference ≥20ng/ml) had higher unadjusted RRR of becoming pre-frail [1.47; 95% CI 1.04, 2.09] and frail [2.14 95% CI 1.29, 3.56] (vs robust). While the PS association with pre-frailty was completely attenuated with covariate adjustment, higher RRR for frailty remained even in the fully adjusted model [2.07 95% CI 1.07, 4.00].
Conclusions
Vitamin D <12ng/ml was associated with prevalent & incident frailty in older British men, independent of disease/inflammatory states. Further research exploring Vit D therapy for improving frailty outcomes is needed.
Reference
1. Parry SW. JAGS;2016;64(11):2368–2373.
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Affiliation(s)
- A Ahmed
- British Regional Heart Study, Department of Primary Care and Population Health, UCL institute of Epidemiology and Health Care
| | - S E Ramsay
- British Regional Heart Study, Department of Primary Care and Population Health, UCL institute of Epidemiology and Health Care
| | - O Papacosta
- British Regional Heart Study, Department of Primary Care and Population Health, UCL institute of Epidemiology and Health Care
| | - L Lennon
- British Regional Heart Study, Department of Primary Care and Population Health, UCL institute of Epidemiology and Health Care
| | - P H Whincup
- British Regional Heart Study, Department of Primary Care and Population Health, UCL institute of Epidemiology and Health Care
| | - S G Wannamethee
- British Regional Heart Study, Department of Primary Care and Population Health, UCL institute of Epidemiology and Health Care
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Ramsay SE, Papachristou E, Watt RG, Lennon LT, Papacosta AO, Whincup PH, Wannamethee SG. Socioeconomic disadvantage across the life-course and oral health in older age: findings from a longitudinal study of older British men. J Public Health (Oxf) 2019; 40:e423-e430. [PMID: 29684223 DOI: 10.1093/pubmed/fdy068] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/04/2018] [Indexed: 12/16/2022] Open
Abstract
Background The influence of life-course socioeconomic disadvantage on oral health at older ages is not well-established. We examined the influence of socioeconomic factors in childhood, middle-age and older age on oral health at older ages, and tested conceptual life-course models (sensitive period, accumulation of risk, social mobility) to determine which best described observed associations. Methods A representative cohort of British men aged 71-92 in 2010-12 included socioeconomic factors in childhood, middle-age and older age. Oral health assessment at 71-92 years (n = 1622) included tooth count, periodontal disease and self-rated oral health (excellent/good, fair/poor) (n = 2147). Life-course models (adjusted for age and town of residence) were compared with a saturated model using Likelihood-ratio tests. Results Socioeconomic disadvantage in childhood, middle-age and older age was associated with complete tooth loss at 71-92 years-age and town adjusted odds ratios (95% CI) were 1.39 (1.02-1.90), 2.26 (1.70-3.01), 1.83 (1.35-2.49), respectively. Socioeconomic disadvantage in childhood and middle-age was associated with poor self-rated oral health; adjusted odds ratios (95% CI) were 1.48 (1.19-1.85) and 1.45 (1.18-1.78), respectively. A sensitive period for socioeconomic disadvantage in middle-age provided the best model fit for tooth loss, while accumulation of risk model was the strongest for poor self-rated oral health. None of the life-course models were significant for periodontal disease measures. Conclusion Socioeconomic disadvantage in middle-age has a particularly strong influence on tooth loss in older age. Poor self-rated oral health in older age is influenced by socioeconomic disadvantage across the life-course. Addressing socioeconomic factors in middle and older ages are likely to be important for better oral health in later life.
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Affiliation(s)
- Sheena E Ramsay
- Institute of Health & Society, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, UK.,Institute of Epidemiology and Health Care, UCL, London, UK
| | | | - Richard G Watt
- Department of Epidemiology & Public Health UCL, London, UK
| | - Lucy T Lennon
- Institute of Epidemiology and Health Care, UCL, London, UK
| | | | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, UK
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Kotronia E, Wannamethee SG, Papacosta AO, Whincup PH, Lennon LT, Visser M, Weyant RJ, Harris TB, Ramsay SE. Oral Health, Disability and Physical Function: Results From Studies of Older People in the United Kingdom and United States of America. J Am Med Dir Assoc 2019; 20:1654.e1-1654.e9. [PMID: 31409558 DOI: 10.1016/j.jamda.2019.06.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/05/2019] [Accepted: 06/13/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Studies examining the associations between oral health and disability have limited oral health measures. We investigated the association of a range of objectively and subjectively assessed oral health markers with disability and physical function in older age. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analyses were based on the British Regional Heart Study (BRHS) comprising men aged 71 to 92 years (n = 2147) from 24 British towns, and the Health, Aging, and Body Composition (HABC) Study comprising men and women aged 71 to 80 years (n = 3075) from the United States. Assessments included oral health (periodontal disease, tooth count, dry mouth, and self-rated oral health), disability, and physical function (grip strength, gait speed, and chair stand test). RESULTS In the BRHS, dry mouth, tooth loss, and cumulative oral health problems (≥3 problems) were associated with mobility limitations and problems with activities of daily living and instrumental activities of daily living; these remained significant after adjustment for confounding variables (for ≥3 dry mouth symptoms, odds ratio (OR) 2.68, 95% confidence interval (CI) 1.94-3.69; OR 1.76, 95% CI 1.15-2.69; OR 2.90, 95% CI 2.01, 4.18, respectively). Similar results were observed in the HABC Study. Dry mouth was associated with the slowest gait speed in the BRHS, and the weakest grip strength in the HABC Study (OR 1.75, 95% CI 1.22, 2.50; OR 2.43, 95% CI 1.47-4.01, respectively). CONCLUSIONS AND IMPLICATIONS Markers of poor oral health, particularly dry mouth, poor self-rated oral health, and the presence of more than 1 oral health problem, were associated with disability and poor physical function in older populations. Prospective investigations of these associations and underlying pathways are needed.
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Affiliation(s)
- Eftychia Kotronia
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, United Kingdom.
| | - S Goya Wannamethee
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - A Olia Papacosta
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, United Kingdom
| | - Lucy T Lennon
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Earth and Life Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, the Netherlands
| | - Robert J Weyant
- Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD
| | - Sheena E Ramsay
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, United Kingdom; Department of Primary Care and Population Health, University College London, London, United Kingdom
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Parsons TJ, Papachristou E, Atkins JL, Papacosta O, Ash S, Lennon LT, Whincup PH, Ramsay SE, Wannamethee SG. Physical frailty in older men: prospective associations with diet quality and patterns. Age Ageing 2019; 48:355-360. [PMID: 30668624 PMCID: PMC6503938 DOI: 10.1093/ageing/afy216] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/15/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND increasing numbers of older adults are living with frailty and its adverse consequences. We investigated relationships between diet quality or patterns and incident physical frailty in older British men and whether any associations were influenced by inflammation. METHODS prospective study of 945 men from the British Regional Heart Study aged 70-92 years with no prevalent frailty. Incident frailty was assessed by questionnaire after 3 years of follow-up. Frailty was defined as having at least three of: low grip strength, low physical activity, slow walking speed, unintentional weight loss and feeling of low energy, all based on self-report. The Healthy Diet Indicator (HDI) based on WHO dietary guidelines and the Elderly Dietary Index (EDI) based on a Mediterranean-style dietary intake were computed from questionnaire data and three dietary patterns were identified using principal components analysis: prudent, high fat/low fibre and high sugar. RESULTS men in the highest EDI category and those who followed a prudent diet were less likely to become frail [top vs bottom category odds ratio (OR) (95% CI) 0.49 (0.30, 0.82) and 0.53 (0.30, 0.92) respectively] after adjustment for potential confounders including BMI and prevalent cardiovascular disease. No significant association was seen for the HDI. By contrast those who had a high fat low fibre diet pattern were more likely to become frail [OR (95% CI) 2.54 (1.46, 4.40)]. These associations were not mediated by C-reactive protein (marker of inflammation). CONCLUSIONS the findings suggest adherence to a Mediterranean-style diet is associated with reduced risk of developing frailty in older people.
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Affiliation(s)
- Tessa J Parsons
- UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, UK
| | | | - Janice L Atkins
- Epidemiology and Public Health Group, Medical School, University of Exeter, RILD Building, Barrack Road, Exeter, UK
| | - Olia Papacosta
- UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, UK
| | - Sarah Ash
- UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, UK
| | - Lucy T Lennon
- UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, UK
| | - Peter H Whincup
- Population Health Research Institute, St George’s University of London, Cranmer Terrace, London, UK
| | - Sheena E Ramsay
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, UK
| | - S Goya Wannamethee
- UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, UK,Address correspondence to: P S. Goya Wannamethee. Tel: +44 20 7830 2335; Fax: +44 20 7472 6871.
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46
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Zonoozi S, Ramsay SE, Papacosta O, Lennon LT, Ellins EA, Halcox JPJ, Whincup P, Wannamethee SG. Chronic kidney disease, cardiovascular risk markers and total mortality in older men: cystatin C versus creatinine. J Epidemiol Community Health 2019; 73:645-651. [DOI: 10.1136/jech-2018-211719] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/26/2019] [Accepted: 03/02/2019] [Indexed: 11/04/2022]
Abstract
BackgroundIt remains uncertain whether cystatin C is a superior marker of renal function than creatinine in older adults. We have investigated the association between estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations based on creatinine (CKD-EPIcr) and cystatin C (CKD-EPIcys), and cardiovascular risk markers and mortality in older adults.MethodsThis is a cross-sectional and prospective study of 1639 British men aged 71–92 years followed up for an average of 5 years for mortality. Cox survival model and receiving operating characteristic analysis were used to assess the associations.ResultsThe prevalence of chronic kidney disease (CKD) was similar using the two CKD-EPI equations, although cystatin C reclassified 43.9% of those with stage 3a CKD (eGFR 45–59 mL/min/1.732, moderate damage) to no CKD. However, CKD stages assessed using both CKD-EPIcr and CKD-EPIcys were significantly associated with vascular risk markers and with all-cause and cardiovascular disease mortality. In all men with CKD (eGFR <60 mL/min/1.732), the HRs (95% CI) for all-cause mortality after adjustment for cardiovascular risk factors compared with those with no CKD were 1.53 (1.20 to 1.96) and 1.74 (1.35 to 2.23) using CKD-EPIcr and CKD-EPIcys, respectively. Comparisons of the two CKD equations showed no significant difference in their predictive ability for mortality (difference in area under the curve p=0.46).ConclusionDespite reclassification of CKD stages, assessment of CKD using CKD-EPIcys did not improve prediction of mortality in older British men >70 years. Our data do not support the routine use of CKD-EPIcys for identifying CKD in the elderly British male population.
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Liljas AEM, Walters K, de Oliveira C, Wannamethee SG, Ramsay SE, Carvalho LA. Self-Reported Sensory Impairments and Changes in Cognitive Performance: A Longitudinal 6-Year Follow-Up Study of English Community-Dwelling Adults Aged ⩾50 Years. J Aging Health 2018; 32:243-251. [PMID: 30522390 PMCID: PMC7221867 DOI: 10.1177/0898264318815391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective: To investigate the influence of single and dual sensory impairments prospectively on cognition in adults aged ⩾50 years. Method: Community-dwelling English adults (n = 4,621) were followed up from 2008 to 2014. Self-reported hearing and vision were collected in 2008. Change in cognitive performance on working memory and executive function between 2008 and 2014 was evaluated. Results: Compared with good hearing and good vision, respectively, poor hearing and poor vision were associated with worse cognitive function (hearing: unstandardized coefficient B = 0.83, 95% Confidence Interval [CI] = [0.29, 1.37]; vision: B = 1.61, 95% CI = [0.92, 2.29] adjusted for age, sex, baseline cognition). Compared with no sensory impairment, dual sensory impairment was associated with worse cognition (B = 2.30, 95% CI = [1.21, 3.39] adjusted for age, sex, baseline cognition). All associations remained after further adjustment for sociodemographic characteristics, lifestyle factors, chronic conditions, falls, mobility, depression, and lack of companionship. Discussion: The findings are important as age-related sensory impairments are often preventable or modifiable, which may prevent or delay cognitive impairment.
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Parsons TJ, Papachristou E, Atkins JL, Papacosta O, Ash S, Lennon LT, Whincup PH, Ramsay SE, Wannamethee SG. Healthier diet quality and dietary patterns are associated with lower risk of mobility limitation in older men. Eur J Nutr 2018; 58:2335-2343. [PMID: 30039434 PMCID: PMC6689276 DOI: 10.1007/s00394-018-1786-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 07/17/2018] [Indexed: 11/16/2022]
Abstract
Purpose To investigate associations between diet quality, dietary patterns and mobility limitation 15 years later in a population-based sample of older British men. Methods We used longitudinal data from 1234 men from the British Regional Heart Study, mean age 66 years at baseline. Mobility limitation was defined as difficulty going up- or downstairs or walking 400 yards as a result of a long-term health problem. Dietary intake was measured using a food frequency questionnaire data from which the Healthy Diet Indicator (HDI), the Elderly Dietary Index (EDI), and three a posteriori dietary patterns were derived. The a posteriori dietary patterns were identified using principal components analysis: (1) high fat/low fibre, (2) prudent and (3) high sugar. Results Men with greater adherence to the EDI or HDI were less likely to have mobility limitation at follow-up, top vs bottom category odds ratio for the EDI OR 0.50, 95% CI 0.34, 0.75, and for the HDI OR 0.55, 95% CI 0.35, 0.85, after adjusting for age, social class, region of residence, smoking, alcohol consumption and energy intake. Men with a higher score for the high-fat/low-fibre pattern at baseline were more likely to have mobility limitation at follow-up, top vs bottom quartile odds ratio OR 3.28 95% CI 2.05, 5.24. These associations were little changed by adjusting for BMI and physical activity. Conclusion Our study provides evidence that healthier eating patterns could contribute to prevention or delay of mobility limitation in older British men. Electronic supplementary material The online version of this article (10.1007/s00394-018-1786-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tessa J Parsons
- UCL Department of Primary Care and Population Health, UCL Medical School, Rowland Hill Street, London, NW3 2PF, UK.
| | - Efstathios Papachristou
- Psychology and Human Development, UCL Institute of Education, 25 Woburn Square, London, WC1H 0AA, UK
| | - Janice L Atkins
- Epidemiology and Public Health Group, Medical School, University of Exeter, RILD Building, Barrack Road, Exeter, EX2 5DW, UK
| | - Olia Papacosta
- UCL Department of Primary Care and Population Health, UCL Medical School, Rowland Hill Street, London, NW3 2PF, UK
| | - Sarah Ash
- UCL Department of Primary Care and Population Health, UCL Medical School, Rowland Hill Street, London, NW3 2PF, UK
| | - Lucy T Lennon
- UCL Department of Primary Care and Population Health, UCL Medical School, Rowland Hill Street, London, NW3 2PF, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Sheena E Ramsay
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, UK
| | - S Goya Wannamethee
- UCL Department of Primary Care and Population Health, UCL Medical School, Rowland Hill Street, London, NW3 2PF, UK
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49
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Ramsay SE, Papachristou E, Watt RG, Tsakos G, Lennon LT, Papacosta AO, Moynihan P, Sayer AA, Whincup PH, Wannamethee SG. Influence of Poor Oral Health on Physical Frailty: A Population-Based Cohort Study of Older British Men. J Am Geriatr Soc 2017; 66:473-479. [PMID: 29266166 PMCID: PMC5887899 DOI: 10.1111/jgs.15175] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objectives To investigate the associations between objective and subjective measures of oral health and incident physical frailty. Design Cross‐sectional and longitudinal study with 3 years of follow‐up using data from the British Regional Heart Study. Setting General practices in 24 British towns. Participants Community‐dwelling men aged 71 to 92 (N = 1,622). Measurements Objective assessments of oral health included tooth count and periodontal disease. Self‐reported oral health measures included overall self‐rated oral health; dry mouth symptoms; sensitivity to hot, cold, and sweet; and perceived difficulty eating. Frailty was defined using the Fried phenotype as having 3 or more of weight loss, grip strength, exhaustion, slow walking speed, and low physical activity. Incident frailty was assessed after 3 years of follow‐up in 2014. Results Three hundred three (19%) men were frail at baseline (aged 71–92). Having fewer than 21 teeth, complete tooth loss, fair to poor self‐rated oral health, difficulty eating, dry mouth, and more oral health problems were associated with greater likelihood of being frail. Of 1,284 men followed for 3 years, 107 (10%) became frail. The risk of incident frailty was higher in participants who were edentulous (odds ratio (OR) = 1.90, 95% confidence interval (CI) = 1.03–3.52); had 3 or more dry mouth symptoms (OR = 2.03, 95% CI = 1.18–3.48); and had 1 (OR = 2.34, 95% CI = 1.18–4.64), 2 (OR = 2.30, 95% CI = 1.09–4.84), or 3 or more (OR = 2.72, 95% CI = 1.11–6.64) oral health problems after adjustment for age, smoking, social class, history of cardiovascular disease or diabetes mellitus, and medications related to dry mouth. Conclusion The presence of oral health problems was associated with greater risks of being frail and developing frailty in older age. The identification and management of poor oral health in older people could be important in preventing frailty. See related editorial by https://doi.org/10.1111/jgs.15253.
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Affiliation(s)
- Sheena E Ramsay
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom.,Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College of London, London, United Kingdom
| | - Efstathios Papachristou
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College of London, London, United Kingdom.,Institute of Education, University College of London, London, United Kingdom
| | - Richard G Watt
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College of London, London, United Kingdom
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College of London, London, United Kingdom
| | - Lucy T Lennon
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College of London, London, United Kingdom
| | - A Olia Papacosta
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College of London, London, United Kingdom
| | - Paula Moynihan
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom.,Centre for Oral Health Research and School of Dental Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Avan A Sayer
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom.,Biomedical Research Centre, National Institute for Health Research, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, United Kingdom
| | - S Goya Wannamethee
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College of London, London, United Kingdom
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50
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Hawkesworth S, Silverwood RJ, Armstrong B, Pliakas T, Nanchalal K, Jefferis BJ, Sartini C, Amuzu AA, Wannamethee SG, Ramsay SE, Casas JP, Morris RW, Whincup PH, Lock K. Investigating associations between the built environment and physical activity among older people in 20 UK towns. J Epidemiol Community Health 2017; 72:121-131. [PMID: 29175864 PMCID: PMC5800350 DOI: 10.1136/jech-2017-209440] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/25/2017] [Accepted: 10/29/2017] [Indexed: 12/23/2022]
Abstract
Background Policy initiatives such as WHO Age Friendly Cities recognise the importance of the urban environment for improving health of older people, who have both low physical activity (PA) levels and greater dependence on local neighbourhoods. Previous research in this age group is limited and rarely uses objective measures of either PA or the environment. Methods We investigated the association between objectively measured PA (Actigraph GT3x accelerometers) and multiple dimensions of the built environment, using a cross-sectional multilevel linear regression analysis. Exposures were captured by a novel foot-based audit tool that recorded fine-detail neighbourhood features relevant to PA in older adults, and routine data. Results 795 men and 638 women aged 69–92 years from two national cohorts, covering 20 British towns, were included in the analysis. Median time in moderate to vigorous PA (MVPA) was 27.9 (lower quartile: 13.8, upper quartile: 50.4) minutes per day. There was little evidence of associations between any of the physical environmental domains (eg, road and path quality defined by latent class analysis; number of bus stops; area aesthetics; density of shops and services; amount of green space) and MVPA. However, analysis of area-level income deprivation suggests that the social environment may be associated with PA in this age group. Conclusions Although small effect sizes cannot be discounted, this study suggests that older individuals are less affected by their local physical environment and more by social environmental factors, reflecting both the functional heterogeneity of this age group and the varying nature of their activity spaces.
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Affiliation(s)
- Sophie Hawkesworth
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard J Silverwood
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ben Armstrong
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Triantafyllos Pliakas
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Kiran Nanchalal
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Barbara J Jefferis
- UCL Department of Primary Care & Population Health, UCL Medical School, London, UK.,UCL Physical Activity Research Group, London, UK
| | - Claudio Sartini
- UCL Department of Primary Care & Population Health, UCL Medical School, London, UK.,UCL Physical Activity Research Group, London, UK
| | - Antoinette A Amuzu
- Farr Institute of Health Informatics, Faculty of Population Health Sciences, London, UK
| | - S Goya Wannamethee
- UCL Department of Primary Care & Population Health, UCL Medical School, London, UK
| | - Sheena E Ramsay
- UCL Department of Primary Care & Population Health, UCL Medical School, London, UK
| | - Juan-Pablo Casas
- Farr Institute of Health Informatics, Faculty of Population Health Sciences, London, UK
| | - Richard W Morris
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, London, UK
| | - Karen Lock
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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