ctDNA guided adjuvant chemotherapy versus standard of care adjuvant chemotherapy after curative surgery in patients with high risk stage II or stage III colorectal cancer: a multi-centre, prospective, randomised control trial (TRACC Part C).

BACKGROUND: Circulating tumour DNA (ctDNA) to detect minimal residual disease (MRD) is emerging as a biomarker to predict recurrence in patients with curatively treated early stage colorectal cancer (CRC). ctDNA risk stratifies patients to guide adjuvant treatment decisions. We are conducting the UK's first multi-centre, prospective, randomised study to determine whether a de-escalation strategy using ctDNA to guide adjuvant chemotherapy (ACT) decisions is non-inferior to standard of care (SOC) chemotherapy, as measured by 3-year disease free survival (DFS) in patients with resected CRC with no evidence of MRD (ctDNA negative post-operatively). In doing so we may be able to spare patients unnecessary chemotherapy and associated toxicity and achieve significant cost savings for the National Health Service (NHS). METHODS: We are recruiting patients with fully resected high risk stage II and stage III CRC who are being considered for ACT into the study which uses results from a plasma-only ctDNA assay to guide treatment decisions. Eligible patients are randomised 1:1 to receive ctDNA-guided chemotherapy versus SOC chemotherapy. The primary endpoint is the difference in DFS at 3 years between the trial arms. Secondary endpoints include the proportion of patients in the ctDNA-guided arm who are ctDNA negative post-operatively and receive de-escalated ACT compared to the standard arm, the difference in overall survival (OS), neurotoxicity and quality of life between the arms, and the cost-effectiveness of ctDNA-guided therapy compared to SOC treatment. We hypothesise that using a ctDNA-guided approach to ACT decisions is non-inferior to SOC. Target accrual is 1621 patients over 4 years, which will provide a power of 80% with an alpha of 0.1 to demonstrate non-inferiority with a margin of 1.25 in survival of the ctDNA-guided approach compared to SOC. We anticipate approximately 50 UK centres will participate. The study opened with the Guardant Reveal plasma-only ctDNA assay in August 2022. DISCUSSION: The trial will determine whether ctDNA guided ACT is non-inferior to SOC ACT in patients with fully resected high risk stage II and stage III resected CRC, with the potential to significantly reduce unnecessary ACT and the toxicity associated with it. TRIAL REGISTRATION: NCT04050345.

SARS-CoV-2 Vaccine Immunogenicity in Patients with Gastrointestinal Cancer Receiving Systemic Anti-Cancer Therapy.

INTRODUCTION: Patients with gastrointestinal (GI) cancers have an increased risk of serious complications and death from SARS-CoV-2 infection. The immunogenicity of vaccines in patients with GI cancers receiving anti-cancer therapies is unclear. We conducted a prospective study to evaluate the prevalence of neutralizing antibodies in a cohort of GI cancer patients receiving chemotherapy following SARS-CoV-2 vaccination. MATERIALS AND METHODS: Between September 2020 and April 2021, patients with cancer undergoing chemotherapy were enrolled. At baseline (day 0), days 28, 56, and 84, we assessed serum antibodies to SARS-CoV-2 spike (anti-S) and anti-nucleocapsid (anti-NP) and concomitantly assessed virus neutralization using a pseudovirus neutralization assay. Patients received either the Pfizer/BioNTech BNT162b2, or the Oxford/AstraZeneca ChAdOx1 vaccine. RESULTS: All 152 patients enrolled had a prior diagnosis of cancer; colorectal (n = 80, 52.6%), oesophagogastric (n = 38, 25.0%), and hepato pancreatic biliary (n = 22, 12.5%). Nearly all were receiving systemic anti-cancer therapy (99.3%). Of the 51 patients who did not receive a vaccination prior to, or during the study, 5 patients had detectable anti-NP antibodies. Ninety-nine patients received at least one dose of vaccine prior to, or during the study. Within 19 days following the first dose of vaccine, 30.0% had anti-S detected in serum which increased to 70.2% at days 20-39. In the 19 days following a second dose, anti-S positivity was 84.2% (32/38). However, pseudovirus neutralization titers (pVNT80) decreased from days 20 to 39. CONCLUSION: Despite the immunosuppressive effects of chemotherapy, 2 doses of SARS-CoV-2 vaccines are able to elicit a protective immune response in patients' ongoing treatment for gastrointestinal cancers. Decreases in pseudoviral neutralization were observed after 20-39 days, re-affirming the current recommendation for vaccine booster doses. CLINICAL TRIAL REGISTRATION NUMBER: NCT04427280.

Ibrutinib in c-MYC and HER2 Amplified Oesophagogastric Carcinoma: Results of the Proof-of-Concept iMYC Study.

Oesophagogastric (OG) cancer is a highly lethal disease requiring novel treatment options. c-MYC and/or HER-2 amplified oesophageal cancer models have demonstrated sensitivity to BTK inhibition with ibrutinib. We evaluated the safety and efficacy of ibrutinib in patients with c-MYC and/or HER2 amplified pre-treated advanced OG cancer. c-MYC and HER2 amplification status were determined by FISH. The primary endpoint was overall response rate (ORR). Secondary endpoints were disease control rate (DC) at 8 weeks, safety, progression-free survival (PFS) and overall survival (OS). Eleven patients were enrolled. Eight patients had c-MYC amplified tumours, six were HER2 amplified and three were c-MYC and HER2 co-amplified. Grade ≥ 3 adverse events were fever, neutropenia, and vomiting. Grade ≥ 3 gastrointestinal haemorrhage occurred in three patients and was fatal in two cases. Among seven evaluable patients, three patients (43%) achieved a best response of SD at 8 weeks. No PR or CR was observed. Disease control was achieved for 32 weeks in one patient with a dual c-MYC and HER2 highly co-amplified tumour. The median PFS and OS were 1.5 (95% CI: 0.8-5.1) and 5.1 (95% CI: 0.8-14.5) months, respectively. Ibrutinib had limited clinical efficacy in patients with c-MYC and/or HER2 amplified OG cancer. Unexpected gastrointestinal bleeding was observed in 3 out of 8 treated patients which was considered a new safety finding for ibrutinib in this population.

Gene-diet quality interactions on haemoglobin A1c and type 2 diabetes risk: The Airwave Health Monitoring Study.

INTRODUCTION: Type 2 diabetes (T2D) is multifactorial involving lifestyle, environmental and genetic risk factors. This study aims to investigate the impact of genetic interactions with alcohol and diet quality on glycated haemoglobin A1c (HbA1c) independent of obesity, in a British population. METHODS: Cross-sectional study of 14 089 white British participants from Airwave Health Monitoring Study and a subsample of 3733 participants with dietary data. A T2D genetic risk score (GRS) was constructed, and its interactions with diet on HbA1c were assessed. RESULTS: GRS was associated with a higher HbA1c% (ß = 0.03, P < 0.0001) and a higher risk of prediabetes (OR = 1.09, P < 0.0001) and T2D (OR = 1.14, P = 0.006). The genetic effect on HbA1c% was significantly higher in obese participants (ß = 1.88, P interaction = 0.03). A high intake of wholegrain attenuated the effect on HbA1c% in high-risk individuals P interaction = 0.04. CONCLUSION: The genetic effect on HbA1c was almost doubled in obese individuals, compared with those with a healthy weight, and independent of weight, there was a modest offset on HbA1c in high-genetic-risk individuals consuming a diet high in wholegrain. This supports the importance of a healthy diet high in wholegrains and along with maintaining a healthy weight in controlling HbA1c among high-genetic-risk groups.

Intakes and Food Sources of Dietary Fibre and Their Associations with Measures of Body Composition and Inflammation in UK Adults: Cross-Sectional Analysis of the Airwave Health Monitoring Study.

The purpose of this study was to investigate the associations between intakes of fibre from the main food sources of fibre in the UK diet with body mass index (BMI), percentage body fat (%BF), waist circumference (WC) and C-reactive protein (CRP). Participants enrolled in the Airwave Health Monitoring Study (2007-2012) with 7-day food records (n = 6898; 61% men) were included for cross-sectional analyses. General linear models evaluated associations across fifths of fibre intakes (total, vegetable, fruit, potato, whole grain and non-whole grain cereal) with BMI, %BF, WC and CRP. Fully adjusted analyses showed inverse linear trends across fifths of total fibre and fibre from fruit with all outcome measures (ptrend < 0.0001). Vegetable fibre intake showed an inverse association with WC (ptrend 0.0156) and CRP (ptrend 0.0005). Fibre from whole grain sources showed an inverse association with BMI (ptrend 0.0002), %BF (ptrend 0.0007) and WC (ptrend 0.0004). Non-whole grain cereal fibre showed an inverse association with BMI (Ptrend 0.0095). Direct associations observed between potato fibre intake and measures of body composition and inflammation were attenuated in fully adjusted analyses controlling for fried potato intake. Higher fibre intake has a beneficial association on body composition, however, there are differential associations based on the food source.

Use of TETRA personal radios and sickness absence in the Airwave Health Monitoring Study of the British police forces.

BACKGROUND: Terrestrial Trunked Radio (TETRA) is used for radiocommunications among the British police forces. OBJECTIVES: To investigate association of personal radio use and sickness absence among police officers and staff from the Airwave Health Monitoring Study. METHODS: Participant-level sickness absence records for 26 forces were linked with personal radio use for 32,102 participants. We used multivariable logistic regression to analyse TETRA usage in year prior to enrolment and sickness absence (lasting more than 7 or 28 consecutive days) in the following year and a zero-inflated negative binomial model for analyses of number of sickness absence episodes of any duration ('spells') over the same period. In secondary analyses, we looked at an extended period of observation among a sub-cohort with linked data over time, using Cox proportional hazards regression. RESULTS: Median personal radio use (year prior to enrolment) was 29.7 min per month (interquartile range 7.5, 64.7) among users. In the year following enrolment there were 25,655 sickness absence spells among 15,248 participants. There were similar risks of sickness absence lasting more than seven days among users and non-users, although among users risk was higher with greater use, odds ratio = 1.04 (95% confidence interval [CI] 1.02 to 1.06) per doubling of radio use. There was no association for sickness absence of more than 28 days. For sickness absence spells, risk was lower among users than non-users (incidence rate ratio = 0.91; 95% CI 0.75 to 1.11), again with higher risk among users for greater radio use. There was no association between radio use and sickness absence in secondary analyses. DISCUSSION: There were similar or lower risks of sickness absence in TETRA radio users compared with non-users. Among users, the higher risk of sickness absence with greater radio use may reflect working pattern differences among police personnel rather than effects of radiofrequency exposure.

Personal radio use and cancer risks among 48,518 British police officers and staff from the Airwave Health Monitoring Study.

BACKGROUND: Radiofrequency electromagnetic fields (RF-EMF) from mobile phones have been classified as potentially carcinogenic. No study has investigated use of Terrestrial Trunked Radio (TETRA), a source of RF-EMF with wide occupational use, and cancer risks. METHODS: We investigated association of monthly personal radio use and risk of cancer using Cox proportional hazards regression among 48,518 police officers and staff of the Airwave Health Monitoring Study in Great Britain. RESULTS: During median follow-up of 5.9 years, 716 incident cancer cases were identified. Among users, the median of the average monthly duration of use in the year prior to enrolment was 30.5 min (inter-quartile range 8.1, 68.1). Overall, there was no association between personal radio use and risk of all cancers (hazard ratio [HR] = 0.98, 95% confidence interval [CI]: 0.93, 1.03). For head and neck cancers HR = 0.72 (95% CI: 0.30, 1.70) among personal radio users vs non-users, and among users it was 1.06 (95% CI: 0.91, 1.23) per doubling of minutes of personal radio use. CONCLUSIONS: With the limited follow-up to date, we found no evidence of association of personal radio use with cancer risk. Continued follow-up of the cohort is warranted.

Estimation of TETRA radio use in the Airwave Health Monitoring Study of the British police forces.

BACKGROUND: The Airwave Health Monitoring Study aims to investigate the possible long-term health effects of Terrestrial Trunked Radio (TETRA) use among the police forces in Great Britain. Here, we investigate whether objective data from the network operator could be used to correct for misreporting in self-reported data and expand the radio usage availability in our cohort. METHODS: We estimated average monthly usage of personal radio in the 12 months prior to enrolment from a missing value imputation model and evaluated its performance against objective and self-reported data. Factors associated with TETRA radio usage variables were investigated using Chi-square tests and analysis of variance. RESULTS: The imputed data were better correlated with objective than self-reported usage (Spearman correlation coefficient = 0.72 vs. 0. 52 and kappa 0.56 [95% confidence interval 0.55, 0.56] vs. 0.46 [0.45, 0.47]), although the imputation model tended to under-estimate use for higher users. Participants with higher personal radio usage were more likely to be younger, men vs. women and officer vs. staff. The median average monthly usage level for the entire cohort was estimated to be 29.3 min (95% CI: [7.2, 66.6]). CONCLUSION: The availability of objective personal radio records for a large proportion of users allowed us to develop a robust imputation model and hence obtain personal radio usage estimates for ~50,000 participants. This substantially reduced exposure misclassification compared to using self-reported data and will allow us to carry out analyses of TETRA usage for the entire cohort in future work.

Nutrient profiling and adherence to components of the UK national dietary guidelines association with metabolic risk factors for CVD and diabetes: Airwave Health Monitoring Study.

CVD is the leading cause of death worldwide. Diet is a key modifiable component in the development of CVD. No official UK diet quality index exists for use in UK nutritional epidemiological studies. The aims of this study are to: (i) develop a diet quality index based on components of UK dietary reference values (DRV) and (ii) determine the association between the index, the existing UK nutrient profile (NP) model and a comprehensive range of cardiometabolic risk markers among a British adult population. A cross-sectional analysis was conducted using data from the Airwave Health Monitoring Study (n 5848). Dietary intake was measured by 7-d food diary and metabolic risk using waist circumference, BMI, blood lipid profile, glycated Hb (HbA1c) and blood pressure measurements. Diet quality was assessed using the novel DRV index and NP model. Associations between diet and cardiometabolic risk were analysed via multivariate linear models and logistic regression. A two-point increase in NP score was associated with total cholesterol (ß -0·33 mmol/l, P<0·0001) and HbA1c (ß -0·01 %, P<0·0001). A two-point increase in DRV score was associated with waist circumference (ß -0·56 cm, P<0·0001), BMI (ß -0·15 kg/m2, P<0·0001), total cholesterol (ß -0·06 mmol/l, P<0·0001) and HbA1c (ß -0·02 %, P=0·002). A one-point increase in DRV score was associated with type 2 diabetes (T2D) (OR 0·94, P=0·01) and obesity (OR 0·95, P<0·0001). The DRV index is associated with overall diet quality and risk factors for CVD and T2D, supporting its application in nutritional epidemiological studies investigating CVD risk in a UK population.

Can routine data be used to support cancer clinical trials? A historical baseline on which to build: retrospective linkage of data from the TACT (CRUK 01/001) breast cancer trial and the National Cancer Data Repository.

BACKGROUND: Randomised clinical trials (RCTs) are the gold standard for evaluating new cancer treatments. They are, however, expensive to conduct, particularly where long-term follow-up of participants is required. Tracking participants via routine datasets could provide a cost-effective alternative for ascertaining follow-up information required to evaluate disease outcomes. This project explores the potential for routine data to inform cancer trials, using, the historical National Cancer Data Repository (NCDR) for English NHS sites and, for validation, mature data available from the TACT trial. METHODS: Datasets were matched using patients' NHS number, date of birth (dob) and name/initials. Demographics, clinical characteristics and outcomes were assessed for agreement and completeness. Overall survival was compared between NCDR and TACT. RESULTS: A total of 3151 patients underwent linkage; 3047 (96.7%) of which had matched records. Extensive cleaning was required for some registry data fields, e.g. cause of death, whilst others had large amounts of missing data, e.g. tumour size (22.1%). Other data had high levels of matching such as dob (99.6%) and date of death (89.6%). There was no evidence of differential survival rates (8-year survival: TACT = 75% (95% CI 73, 76); NCDR = 76% (95% CI 74, 77)). CONCLUSIONS: Data quality and completeness requires improvement before routine data could be used for RCTs. Introduction of new routine datasets, including COSD, is welcomed although reporting of disease-recurrence events remains a concern. Prospective validation of such datasets is required before RCTs can confidently switch patient follow-up to utilise routinely collected NHS-based data. TACT TRIAL REGISTRATION: Clinicaltrials.gov NCT00033683 , registered on 9 April 2002; ISRCTN79718493 , registered on 1 July 2001.

Dietary assessment of British police force employees: a description of diet record coding procedures and cross-sectional evaluation of dietary energy intake reporting (The Airwave Health Monitoring Study).

OBJECTIVES: Dietary intake is a key aspect of occupational health. To capture the characteristics of dietary behaviour that is affected by occupational environment that may affect disease risk, a collection of prospective multiday dietary records is required. The aims of this paper are to: (1) collect multiday dietary data in the Airwave Health Monitoring Study, (2) describe the dietary coding procedures applied and (3) investigate the plausibility of dietary reporting in this occupational cohort. DESIGN: A dietary coding protocol for this large-scale study was developed to minimise coding error rate. Participants (n 4412) who completed 7-day food records were included for cross-sectional analyses. Energy intake (EI) misreporting was estimated using the Goldberg method. Multivariate logistic regression models were applied to determine participant characteristics associated with EI misreporting. SETTING: British police force employees enrolled (2007-2012) into the Airwave Health Monitoring Study. RESULTS: The mean code error rate per food diary was 3.7% (SD 3.2%). The strongest predictors of EI under-reporting were body mass index (BMI) and physical activity. Compared with participants with BMI<25 kg/m2, those with BMI>30 kg/m2 had increased odds of being classified as under-reporting EI (men OR 5.20 95% CI 3.92 to 6.89; women OR 2.66 95% CI 1.85 to 3.83). Men and women in the highest physical activity category compared with the lowest were also more likely to be classified as under-reporting (men OR 3.33 95% CI 2.46 to 4.50; women OR 4.34 95% CI 2.91 to 6.55). CONCLUSIONS: A reproducible dietary record coding procedure has been developed to minimise coding error in complex 7-day diet diaries. The prevalence of EI under-reporting is comparable with existing national UK cohorts and, in agreement with previous studies, classification of under-reporting was biased towards specific subgroups of participants.

Validation of objective records and misreporting of personal radio use in a cohort of British Police forces (the Airwave Health Monitoring Study).

BACKGROUND: Terrestrial Trunked Radio (TETRA) is a digital communication system progressively adopted by Police Forces in Great Britain since 2001. In 2000, the UK Independent Expert Group on Mobile Phones suggested that exposure to TETRA-like signal modulation might have adverse effects on health. The Airwave Health Monitoring Study was established to investigate possible long-term effects of TETRA use on health. This requires estimation of TETRA use among Police Force employees participating in the study. METHODS: We investigated TETRA usage among 42,112 Police officers and staff. An algorithm was created to link each personal radio user to his/her objective radio usage records for the 26,035 participants with available data. We linked 16,577 personal radio users to their objective radio usage records and compared self-reported usage with data from the TETRA operator for those individuals. RESULTS: For weekly usage, the correlation between self-reported and operator-derived personal radio usage was r=0.69 for number and r=0.59 for the duration of calls. Compared with objective data, participants under-reported the number of calls and over-reported the duration of calls by a factor of around 4 and 1.6 respectively. Correlations were lower and bias higher when looking at daily usage. CONCLUSION: Where both objective and self-reported information were available, our study showed substantial misreporting in self-reported TETRA usage. Successful linkage of large numbers of TETRA users to objective data on their personal radios will allow objective assessment of TETRA radio usage for these participants and development of algorithms to correct bias in self-reported data for the remainder.

Patterns of clustering of six health-compromising behaviours in Saudi adolescents.

BACKGROUND: Clustering of multiple health-compromising behaviours is associated with an increased risk of various chronic diseases. There are few studies on patterns of clustering of multiple health-compromising behaviours in adolescents. Therefore, the aim of this study is to assess how six health-compromising behaviours, namely, low fruit consumption, high sweet consumption, less frequent tooth brushing, low physical activity, physical fighting and smoking, cluster among Saudi male adolescents. METHODS: A representative stratified cluster random sample of 1,335 Saudi Arabian male adolescents living in Riyadh city answered a questionnaire on health-related behaviours. Hierarchical Agglomerative Cluster Analysis (HACA) was used to identify cluster solutions of the six health-compromising behaviours. RESULTS: HACA suggested two broad and stable clusters for the six health-compromising behaviours. The first cluster included low fruit consumption, less frequent tooth brushing and low physical activity. The second cluster included high sweets consumption, smoking and physical fighting. CONCLUSIONS: The six health-compromising behaviours clustered into two conceptually distinct clusters among Saudi Arabian male adolescents, one reflecting non-adherence to preventive behaviours and the second undertaking of risk behaviours. Clustering of health behaviours has important implications for health promotion.

Most older pedestrians are unable to cross the road in time: a cross-sectional study.

OBJECTIVES: to compare walking speed in the UK older population with the speed required to utilise pedestrian crossings (≥1.2 m/s), and determine health and socio-demographic associations with walking impairment. DESIGN: cross-sectional study using Health Survey for England 2005 data. SETTING: private households in England. PARTICIPANTS: random population sample of 3,145 adults (1,444 men) aged ≥65 years. MAIN OUTCOME MEASURES: walking speed was assessed by timing a walk of 8 feet at normal pace. Walking impairment was defined as walking speed <1.2 m/s or non-participation in the test due to being unsafe or unable. RESULTS: the mean walking speed was 0.9 m/s in men and 0.8 m/s in women; 84% of men and 93% of women ≥65 years had walking impairment. Female gender, increasing age, lower socio-economic status, poorer health and lower grip strength were predictors of walking impairment. CONCLUSION: most older adults either cannot walk 8 feet safely or cannot walk fast enough to use a pedestrian crossing in the UK. The health impacts on older adults include limited independence and reduced opportunities for physical activity and social interaction. An assumed normal walking speed for pedestrian crossings of 1.2 m/s is inappropriate for older adults and revision of these timings should be considered.

Development of new demi-span equations from a nationally representative sample of older people to estimate adult height.

OBJECTIVES: To develop new equations for the calculation of body mass index (BMI) of adults aged 65 and older for when an actual height measurement may not be possible or reflect attained height because of loss of height with aging or conditions such as kyphosis or osteoporosis. DESIGN: Cross-sectional, nationally representative samples; data from 1994, 2000 2005, and 2007. SETTING: Adults aged 65 and older living in England. PARTICIPANTS: Two thousand four hundred fifty-four noninstitutitionalized adults aged 65 and older taking part in the Health Survey for England (HSE). MEASUREMENTS: Height and demi-span measurements (defined as the distance between the mid-point of the sternal notch and the finger roots with the arm outstretched laterally) were taken according to standard procedures. RESULTS: Sex- and age-specific regression equations were produced from measured height and demi-span (DEH) using HSE 2005 data to develop new DEH equations (DEH(age)) from people aged 65 and older. The derived DEH(age) equation was applied to the HSE data for 1994, 2000, and 2007 to attempt to test its reliability. Analysis showed that DEH(age) predicts current height better than when using the Bassey equation (DEH(B) (assey)). DEH(age) can be used instead of a height measurement to derive other anthropometric indices such as body mass index (BMI) in older people. CONCLUSION: The new equations developed for predicting current height in older people can be used to calculate BMI more accurately in older people.

Representativeness of participants in a cross-sectional health survey by time of day and day of week of data collection.

BACKGROUND: General population health examination surveys (HESs) provide a reliable source of information to monitor the health of populations. A number of countries across Europe are currently planning their first HES, or the first after a significant gap, and some of these intend offering appointments only during office hours and/or weekdays, raising concerns about representativeness of survey participants. It is important to ascertain whether personal characteristics of participants vary by time of day and day of week of data collection, in order to determine the association between time and day of interview and physical examination on the results of data collected in HES. METHODS: Multivariable regression models were applied to national HES in England to examine socio-demographic and health variations in three combined day-time periods of interview and physical examination: weekday daytime; weekday evening; and weekend. RESULTS: The characteristics of participants interviewed or visited by a nurse varied by both time of day and day of the week for age, ethnicity, marital status, income, socio-economic group, economic activity and deprivation. People seen during weekday working hours had higher rates of poor self-reported health, limiting longstanding illness and obesity, and higher alcohol consumption, BMI and systolic blood pressure; adjustment for socio-demographic characteristics eliminated or substantially reduced these differences. CONCLUSION: People responsible for planning surveys should be aware of participant preference for the timing of data collection and ensure flexibility and choice in times and days offered to optimise participation rates and representativeness.

Improving lipid profiles and increasing use of lipid-lowering therapy in England: results from a national cross-sectional survey - 2006.

OBJECTIVE: To evaluate blood lipid levels in the adult English population in 2006 and to report change in the use and efficacy of lipid-lowering treatment since 2003 after which time the general practitioner contract introduced a 'pay-per-performance' approach. DESIGN: Cross-sectional surveys. PARTICIPANTS: Nationally representative sample of 14,142 noninstitutionalized adults (>16 years) living in England, partaking in the Health Survey for England 2006. MEASUREMENTS: Mean levels of total, HDL, non-HDL and total/HDL cholesterol ratio, prevalence of hypercholesterolaemia, use of lipid lowering agents and lipid levels and control rates among those on treatment. RESULTS: Age-standardized mean cholesterol levels fell from 5·49 mM in men and 5·56 mM in women in 2003 to 5·26 and 5·37 mM, respectively, in 2006. In 2006, 59% of adults had a total cholesterol ≥ 5·0 mM and 11% reported lipid-lowering treatment, of whom 66% had a total cholesterol < 5·0 mM and 22% were < 4·0 mM. The majority of those with established coronary heart disease, stroke or diabetes but fewer than one quarter of those with hypertension or ≥ 20% estimated 10-year cardiovascular risk and no established CVD took lipid-lowering drugs. Lipid lowering treatment rates increased fivefold and control rates among the treated (to < 5·0 mM) more than doubled between 1998 and 2006. About one-third of those with established CVD or diabetes had cholesterol levels of < 4·0 mM. CONCLUSIONS: Previously reported improvements in treatment and control rates between 1998 and 2003 continued between 2003 and 2006, with the biggest increases among those with established CVD and diabetes.

Development of new demi-span equations from a nationally representative sample of adults to estimate maximal adult height.

Various measures have been used to estimate height when assessing nutritional status. Current equations to obtain demi-span equivalent height (DEH(Bassey)) are based on a small sample from a single study. The objectives of this study were to develop more robust DEH equations from a large number of men (n = 591) and women (n = 830) aged 25-45 y from a nationally representative cross-sectional sample (Health Survey for England 2007). Sex-specific regression equations were produced from young adults' (aged 25-45 y) measured height and demi-span to estimate new DEH equations (DEH(new)). DEH in people aged >or= 65 y was calculated using DEH(new). DEH(new) estimated current height in people aged 25-45 y with a mean difference of 0.04 in men (P = 0.80) and -0.29 in women (P = 0.05). Height, demi-span, DEH(new), and DEH(Bassey) declined by age group in both sexes aged >or=65 y (P < 0.05); DEH were larger than the measured height for all age groups (mean difference between DEH(new) and current height was -2.64 in men and -3.16 in women; both P < 0.001). Comparisons of DEH estimates showed good agreement, but DEH(new) was significantly higher than DEH(Bassey) in each age and sex group in older people. The new equations that are based on a large, randomly selected, nationally representative sample of young adults are more robust for predicting current height in young adults when height measurements are unavailable and can be used in the future to predict maximal adult height more accurately in currently young adults as they age.