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Cooper A.J.M.,University of Cambridge | Simmons R.K.,University of Cambridge | Kuh D.,University College London | Brage S.,University of Cambridge | And 73 more authors.
PLoS ONE | Year: 2015

Purpose: To investigate the associations of time spent sedentary, in moderate-to-vigorous-intensity physical activity (MVPA) and physical activity energy expenditure (PAEE) with physical capability measures at age 60-64 years. Methods: Time spent sedentary and in MVPA and, PAEE were assessed using individually calibrated combined heart rate and movement sensing among 1727 participants from the MRC National Survey of Health and Development in England, Scotland and Wales as part of a detailed clinical assessment undertaken in 2006-2010. Multivariable linear regression models were used to examine the cross-sectional associations between standardised measures of each of these behavioural variables with grip strength, chair rise and timed up-&-go (TUG) speed and standing balance time. Results: Greater time spent in MVPA was associated with higher levels of physical capability; adjusted mean differences in each capability measure per 1standard deviation increase in MVPA time were: grip strength (0.477 kg, 95% confidence interval (CI): 0.015 to 0.939), chair rise speed (0.429 stands/min, 95% CI: 0.093 to 0.764), standing balance time (0.028 s, 95% CI: 0.003 to 0.053) and TUG speed (0.019 m/s, 95% CI: 0.011 to 0.026). In contrast, time spent sedentary was associated with lower grip strength (-0.540 kg, 95% CI: -1.013 to -0.066) and TUG speed (-0.011 m/s, 95% CI: -0.019 to -0.004). Associations for PAEE were similar to those for MVPA. Conclusion: Higher levels of MVPA and overall physical activity (PAEE) are associated with greater levels of physical capability whereas time spent sedentary is associated with lower levels of capability. Future intervention studies in older adults should focus on both the promotion of physical activity and reduction in time spent sedentary. © 2015 Cooper et al.

Calem M.,King's College London | Bisla J.,King's College London | Begum A.,King's College London | Dewey M.,King's College London | And 10 more authors.
Sleep | Year: 2012

Study Objectives: To investigate changes over 15 years in the prevalence of insomnia and its association with demographic characteristics and hypnotic medication use. Design: Analysis of 3 cross-sectional national mental health surveys carried out in 1993, 2000, and 2007, which used comparable sampling methods and identical insomnia assessments. Setting: Adults living in private households in England. Patients or Participants: 20,503 people aged 16-64 years. Measurements and Results: Insomnia was defined according to 4 different criteria, using relevant questions from the revised Clinical Interview Schedule. Modest increases in insomnia prevalence were found over the survey periods (any symptoms increasing from 35.0% in 1993 to 38.6% in 2007; insomnia diagnosis from 3.1% to 5.8%, respectively). In all 3 surveys, similar strengths of association in relation to all criteria were found, with female gender, increased age, lower educational attainment, depression, unemployment, economic inactivity, and widowed, divorced, or separated status. Prevalence of hypnotic use was double in 2000 (0.8%) compared to 1993 (0.4%); from limited information on selected medications, there was no such increase between 2000 and 2007. The reasons reported for any sleep disturbance over the last month were generally similar across surveys, the most marked change being illness/discomfort increasing as an explanation from 14.3% to 17.4% to 19.0%. Conclusions: In the English general population, insomnia (by any definition) showed a modest but steady increase in prevalence over a 15-year period. Strengths of associations with demographic factors and self-reported reasons for sleep disturbance remained reasonably stable over this period.

Raleigh V.S.,Kings Fund | Hussey D.,NatCen | Seccombe I.,Care Quality Commission
Journal of the Royal Society of Medicine | Year: 2010

Objective: To examine ethnic and social inequalities in women's experience of maternity care in England. Design: A 2007 national survey of women (16 years or over) about their experience of maternity care. Multiple logistic regression analysis, controlling for several maternal characteristics, was used to examine inequalities by ethnicity, partner status and education. Setting: Sample of records of 149 NHS acute trusts and two primary care trusts (PCTs) providing maternity services in England. Results: A total of 26,325 women responded to the survey (response rate 59%). Ethnic minority women were more likely thanWhite British women to access services late, not have a scan by 20 weeks, and experience complications during pregnancy and birth. They were more likely to initiate breastfeeding and say they were treated with respect and dignity. Single women responded more negatively to almost all questions than women with a husband/partner. They were less likely to access care within 12 weeks of pregnancy (OR 0.45, 95% CI 0.39-0.52), have a scan at 20 weeks (OR 0.49, 95% CI 0.39-0.63), attend NHS antenatal classes (OR 0.56, 95% CI 0.49-0.65), have a postnatal check-up (OR 0.67, 95% CI 0.60-0.75), and initiate breastfeeding (OR 0.57, 95% CI 0.51-0.62), and were more likely to experience complications. Women completing education at 19+ years were more likely to access services early (OR 1.21, 95% CI 1.04-1.40), attend antenatal classes (OR 1.48, 95% CI 1.31-1.67), have a postnatal check-up (OR 1.19, 95% CI 1.07-1.32) and initiate breastfeeding (OR 3.88, 95% CI 3.56-4.22) than those completing education at 16 years or younger, and were less likely to experience complications. Conclusions: Ethnic minority women, single mothers, and those with an earlier age at completing education access maternity services late, have poorer outcomes, and report poorer experiences across some - though not all - dimensions of maternity care. Ethnic differences were absent or inconsistent between groups for some aspects of care.We recommend these findings are used by commissioners, trusts and healthcare professionals to inform improvements in maternity services for high-risk groups and reduce inequalities.

Cooper C.,University College London | Bebbington P.,University College London | McManus S.,NatCen | Meltzer H.,University of Leicester | And 5 more authors.
Journal of Affective Disorders | Year: 2010

Background: We investigated for the first time in a national survey whether older people were less likely than younger adults with the same symptom severity to receive treatment for Common Mental Disorders (CMD). Method: We analysed data from the 2007 English Adult Psychiatric Morbidity Survey, representative of people living in private homes. 7461 (57%) people approached took part. We used the revised Clinical Interview Schedule to measure CMD symptom severity. Results: Older participants were less likely than younger adults to receive talking therapy and to have seen their GP in the last year about mental health, and more likely to receive benzodiazepines, after adjusting for CMD symptoms. Adults aged 35-74 were the most likely to take antidepressants. There was also preliminary evidence that people from non-white ethnicities were less likely to be taking antidepressants and to have seen their GP in the last year about their mental health. Limitations: We only recorded current treatment, and it is possible that older adults were less likely to be receiving treatments they had found unhelpful earlier in their lives. We asked people whether they had seen their GP about a mental health problem in the last year, but this question may not have detected those who attended for somatic manifestations of their anxieties. Conclusions: Older people are less likely to receive evidence-based treatment for CMD. Managers and clinicians should prioritise reducing this inequality. © 2010 Elsevier B.V. All rights reserved.

Taylor-Gooby P.,University of Kent | Cebulla A.,NatCen
Journal of Risk Research | Year: 2010

This paper seeks to test the influential 'risk society' thesis using quantitative data from the major UK longitudinal surveys. Two hypotheses are derived from the thesis: distanciation (the claim that more recent generations understand and manage their social lives in relation to risk and uncertainty in substantially different ways from those of their parents' generation) and reflexivity (the view that individuals are increasingly aware of their status in a detraditionalised social order and of their responsibility to manage their own life course). Empirical testing shows that greater distanciation and reflexivity can be identified in a comparison of the education, employment and partnership experience of earlier and later cohorts, but that these factors vary substantially for different social groups. Success in planning one's life and attaining the occupational status to which one initially aspired is increasingly associated with greater satisfaction and, with respect to career objectives, repeated change in jobs. But these outcomes are least likely to be available to those from the manual working class, especially those whose aspirations remain within that group. Risk society increasingly offers opportunities to 'write one's own biography', but it is important to be clear that success in doing so is socially structured. © 2010 Taylor & Francis.

News Article | February 21, 2017

Problem gambling experts have criticised rival factions of the betting industry for waging a “selfish” war of words to protect their own interests amid the threat of tighter regulation. The UK’s leading gambling charity also warned that a “narrow” focus on controversial fixed-odds betting terminals (FOBTs), potentially ignoring online betting and fruit machines in pubs, amusement arcades and casinos, risks undermining efforts to help addicts. The government is conducting a review of gaming machines that industry figures fear will lead to tighter curbs on betting machines and reduced profits. The review has seen amusement arcades and casinos go on the offensive against bookmakers by highlighting the addictive nature of FOBTs, which make up more than half of bookies’ revenues at about £1.7bn last year. The machines have been publicly reviled as the “crack cocaine of gambling”, a phrase thought to have been coined by President Donald Trump when he was running casinos to draw attention to video game bingo, which posed a threat to his business. GambleAware chief executive Marc Etches said that while attention should be paid to FOBTs, which allow punters to stake £100 every 20 seconds, ignoring other types of gambling was a “disservice” to problem gamblers. “There’s a particular focus on machines in bookmakers but I’ve observed the industry for the best part of two decades and in my experience it’s always been the same,” he said. “When the National Lottery was introduced, elements of the industry didn’t care for that. “When there was discussion of expanding casinos, there were businesses within the industry that campaigned against it. Such is the case around machines in bookmakers.” He added that it was “problematic” that a cross-party group of MPs, which has recommended slashing the maximum FOBT stake to £2, is backed by firms that profit from rival forms of gambling. Groups that fund the MPs’ efforts include amusement arcade body Bacta, pub chain JD Wetherspoon, which operates fruit machines, and Hippodrome casinos. The Association of British Bookmakers recently fought back against criticism of FOBTs, latching on to research published by industry regulator the Gambling Commission. Using data compiled from real betting sessions, the commission found there was “no consistent evidence that particular gambling activities are predictive of problem gambling”. The ABB also pointed to figures suggesting that on average gamblers lost more money and spent more time on amusement arcade-style games. ABB chief executive Malcolm George warned of the danger that “adult gaming centres and other forms of gambling escape proper scrutiny.” “The arcade industry and elements within the casino industry, which are commercial competitors of the bookmakers, have unfairly used FOBTs as the whipping boy for far too long when it comes to problem gambling. “In particular arcades, with vastly more machines, need to wake up to their responsibility to help problem gamblers, in the same way as the bookmaking industry has.” Bacta accuses the ABB of cherry-picking data that suits its own argument, focusing on averages rather than the extreme losses that can affect higher-stakes FOBT players. The two sides have also drawn opposing conclusions about whether studies suggest that reducing the maximum stake on FOBTs would stem players’ losses. Etches said the back-and-forth between competing firms in the same industry suggested that they were losing sight of the need to address problem gambling. “The industry needs to think more carefully about that bigger reputational issue and recognise that those who are thoughtful can see through some of this selfish behaviour,” he said. “There are a lot of people who have a problem so we need to have a better discourse. A narrow focus that gets very shouty between campaign groups puts people off having a more grown-up more mature discussion.” The row over the role that FOBTs play in addiction reflects the limited amount of hard evidence on problem gambling. One of the most comprehensive studies, by research group NatCen, looked at whether people who hold loyalty cards with bookmakers changed their behaviour over time, in an attempt to show whether FOBTs coincide with a slide into addiction. It found a correlation between the use of machines in bookmakers and a descent into problem gambling, with the unemployed and ethnic minority groups worst affected. But NatCen associate research director Heather Wardle, who sits on the Responsible Gambling Strategy Board, is wary of drawing too many conclusions from this. “It shows an association, we just don’t know what’s driving that association. In all likelihood there are some people for whom the machines are causing them difficulties. “Others have immense problems with all types of gambling and happen to play machines.” She points out that similar research has not been done into amusement arcades, fruit machines or online betting, so it is difficult to compare the risk of addiction. This raises the possibility that while FOBTs do pose a risk, a blinkered focus on them could allow other forms of betting – whether it’s amusement arcades or online poker – to escape scrutiny. Like Etches, Wardle is concerned by the tendency of the warring factions to highlight data that suits their cause. “There is a lot of energy expended on different interest groups trying to make a case that one activity versus another is the most harmful thing,” she said. “You end up with a polarised debate that misses the complexity of what’s causing people harm and what you do about it. “I can perfectly understand why different stakeholders do that but it’s not particularly helpful. I’d like to see people combine their energies into really thinking about how we help people and stop the horrendous problems they experience.”

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