Imperial College London

DrPetraWark

Faculty of MedicineSchool of Public Health

Honorary Senior Lecturer in eHealth
 
 
 
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Contact

 

p.wark Website

 
 
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Location

 

Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Publication Type
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97 results found

Fadahunsi P, Wark P, Mastellos N, Gallagher J, Majeed F, Car Jet al., 2022, Clinical information quality of digital health technologies: protocol for an international eDelphi study., BMJ Open, ISSN: 2044-6055

Journal article

Fadahunsi P, O'Connor S, Akinlua J, Wark P, Gallagher J, Caroll C, Car J, Majeed A, O'Donoghue Jet al., 2021, Information quality frameworks for digital health technologies: systematic review, Journal of Medical Internet Research, Vol: 23, ISSN: 1438-8871

Background: Digital health technologies (DHTs) generate a large volume of information used in health care for administrative, educational, research, and clinical purposes. The clinical use of digital information for diagnostic, therapeutic, and prognostic purposes has multiple patient safety problems, some of which result from poor information quality (IQ).Objective: This systematic review aims to synthesize an IQ framework that could be used to evaluate the extent to which digital health information is fit for clinical purposes.Methods: The review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We searched Embase, MEDLINE, PubMed, CINAHL, Maternity and Infant Care, PsycINFO, Global Health, ProQuest Dissertations and Theses Global, Scopus, and HMIC (the Health Management Information Consortium) from inception until October 2019. Multidimensional IQ frameworks for assessing DHTs used in the clinical context by health care professionals were included. A thematic synthesis approach was used to synthesize the Clinical Information Quality (CLIQ) framework for digital health.Results: We identified 10 existing IQ frameworks from which we developed the CLIQ framework for digital health with 13 unique dimensions: accessibility, completeness, portability, security, timeliness, accuracy, interpretability, plausibility, provenance, relevance, conformance, consistency, and maintainability, which were categorized into 3 meaningful categories: availability, informativeness, and usability.Conclusions: This systematic review highlights the importance of the IQ of DHTs and its relevance to patient safety. The CLIQ framework for digital health will be useful in evaluating and conceptualizing IQ issues associated with digital health, thus forestalling potential patient safety problems.Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42018097142; https://www.crd.york.ac.uk/pros

Journal article

Bul K, Holliday N, Magee P, Wark Pet al., 2020, From development to exploitation of digital health solutions: lessons learnt through multidisciplinary research and consultancy, JOURNAL OF ENABLING TECHNOLOGIES, Vol: 14, Pages: 273-279, ISSN: 2398-6263

Journal article

Hooson J, Hutchinson J, Warthon-Medina M, Hancock N, Greathead K, Knowles B, Vargas-Garcia E, Gibson LE, Bush LA, Margetts B, Robinson S, Ness A, Alwan NA, Wark PA, Roe M, Finglas P, Steer T, Page P, Johnson L, Roberts K, Amoutzopoulos B, Burley VJ, Greenwood DC, Cade JEet al., 2020, A systematic review of reviews identifying UK validated dietary assessment tools for inclusion on an interactive guided website for researchers: www.nutritools.org, CRITICAL REVIEWS IN FOOD SCIENCE AND NUTRITION, Vol: 60, Pages: 1265-1289, ISSN: 1040-8398

Journal article

Bush LA, Hutchinson J, Hooson J, Warthon-Medina M, Hancock N, Greathead K, Knowles B, Vargas-Garcia EJ, Gibson LE, Margetts B, Robinson S, Ness A, Alwan NA, Wark PA, Roe M, Finglas P, Steer T, Page P, Johnson L, Roberts K, Amoutzopoulos B, Greenwood DC, Cade JEet al., 2019, Measuring energy, macro and micronutrient intake in UK children and adolescents: a comparison of validated dietary assessment tools, BMC NUTRITION, Vol: 5

Journal article

Greenwood DC, Hardie LJ, Frost GS, Alwan NA, Bradbury KE, Carter M, Elliott P, Evans CEL, Ford HE, Hancock N, Key TJ, Liu B, Morris MA, Mulla UZ, Petropoulou K, Potter GDM, Riboli E, Young H, Wark PA, Cade JEet al., 2019, Validation of the Oxford WebQ Online 24-hour dietary questionnaire using biomarkers, American Journal of Epidemiology, Vol: 188, Pages: 1858-1867, ISSN: 1476-6256

Oxford WebQ is an online dietary questionnaire covering 24 hours, appropriate for repeated administration in large-scale prospective studies including UK Biobank and the Million Women Study. We compared performance of the Oxford WebQ and a traditional interviewer-administered multi-pass 24-hour recall against biomarkers for protein, potassium and total sugar intake, and total energy expenditure estimated by accelerometry. 160 participants were recruited between 2014 and 2016 in London, UK, and measured at 3 non-consecutive time-points. The measurement error model simultaneously compared all 3 methods. Attenuation factors for protein, potassium, sugars and total energy intake estimated by the mean of 2 Oxford WebQs were 0.37, 0.42, 0.45, and 0.31 respectively, with performance improving incrementally for the mean of more measures. Correlation between the mean of 2 Oxford WebQs and estimated true intakes, reflecting attenuation when intake is categorised or ranked, was 0.47, 0.39, 0.40, and 0.38 respectively, also improving with repeated administration. These were similar to the more administratively burdensome interviewer-based recall. Using objective biomarkers as the standard, Oxford WebQ performs well across key nutrients in comparison with more administratively burdensome interviewer-based 24-hour recalls. Attenuation improves when the average is taken over repeated administration, reducing measurement error bias in assessment of diet-disease associations.

Journal article

Ward H, McLellan H, Udeh-Momoh C, Giannakopoulou P, Robb C, Wark P, Middleton Let al., 2019, Use of online dietary recalls among older UK adults: A feasibility study of an online dietary assessment tool, Nutrients, Vol: 11, ISSN: 2072-6643

This study examined the feasibility of including myfood24, an online 24-hour dietary recall tool, in a cohort studies of older adults. Participants (n = 319) were recruited during follow-up visits for the CHARIOT-Pro Sub-study, a prospective study of cognitively healthy adults aged 60–85 years at baseline. Email invitations were sent over three consecutive months, with weekly reminders. Multivariable regression models were applied to examine the number of recalls completed in relation to technology readiness (TR) scores and demographic characteristics. Ninety-four percent of people agreed to participate. Among participants, 67% completed at least one recall, and 48% completed two or more. Participants who completed multiple recalls reported higher self-confidence with technology and received a higher TR score than those who did not complete any recalls. A one-point higher TR score was associated with higher odds of completing three recalls compared to zero recalls (OR 1.70, 95% CI 0.96–3.01); this association was further attenuated after adjustment for demographic and other TR-related covariates (OR 1.35, 95% CI 0.63–2.88). This study demonstrates reasonable participation rates for a single myfood24 recall among older adults participating in a cohort study but suggests that further support may be required to obtain multiple recalls in this population.

Journal article

Coleby D, Taub N, Mistri A, Turner A, Coad J, Wark P, Bhatti K, Chahal K, Teo W-Pet al., 2019, Do South Asian Communities ‘Act FAST’?, British Journal of General Practice, Vol: 69, Pages: bjgp19X702989-bjgp19X702989, ISSN: 0960-1643

<jats:sec><jats:title>Background</jats:title><jats:p>Rapid medical assessment and treatment of patients with transient ischemic attack (TIA) or stroke significantly reduces the risk of recurrent stroke. Previous research has shown that delays to initial medical assessment are due to lack of an urgent response to symptoms. In comparison to other communities living within the UK, South Asians have a higher risk of stroke/TIA. Therefore, it is critically important to explore stroke/TIA knowledge and anticipated response to symptoms, within this community.</jats:p></jats:sec><jats:sec><jats:title>Aim</jats:title><jats:p>This study aims to provide preliminary evidence of stroke knowledge and awareness of the relaunched ‘Act FAST’ campaign in the South Asian community and to provide evidence of successful participant recruitment from ‘hard to engage’ groups.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>A pilot mixed methods study, incorporating focus group discussions and a short ‘tick box’ style paper survey, designed to assess and explore participant knowledge of stroke/TIA symptoms, and awareness of the relaunched ‘Act FAST’ campaign. Barriers and facilitators to stroke education and the suitability of mass-media campaigns are also discussed during the focus groups. All participants were recruited from places of worship.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The authors will present highlights from the ‘on-going’ study including; the recruitment strategy, barriers and facilitators to recruitment in Sikh temples and preliminary findings from 68 completed surveys. Highlights from the focus group discussions will be presented, alongside participant suggested methods to improve stroke/TIA knowledge in Indian communities.</jats:p

Journal article

Fadahunsi KP, Akinlua JT, O'Connor S, Wark PA, Gallagher J, Carroll C, Majeed F, O'Donoghue Jet al., 2019, Protocol for a systematic review and qualitative synthesis of information quality frameworks in eHealth, BMJ Open, Vol: 9, ISSN: 2044-6055

Introduction: Electronic health (eHealth) applications have become a very large repository of health information which informs critical decisions relating to the diagnosis, treatment and prognosis of patients. Poor information quality (IQ) within eHealth may compromise patient safety. Evaluation of IQ in eHealth is therefore necessary to promote patient safety. An IQ framework specifies what aspects of information to assess and how to conduct the assessment. This systematic review aims to identify dimensions within existing IQ frameworks in eHealth and develop a new IQ framework for assessment of eHealth.Method and Analysis: We will search EMBASE, Medline, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Maternity and Infant Care, PsycINFO, Global Health, Scopus, ProQuest Dissertations and Theses Global, Health Management Information Consortium and reference lists of relevant publications for articles published in English until November 2018. Studies will be selected by two independent reviewers based on pre-specified eligibility criteria. Two reviewers will independently extract data in each eligible study using a pre-piloted Microsoft Excel data extraction form. Thematic synthesis will be employed to define IQ dimensions and develop a new IQ framework for eHealth. Ethics and Dissemination: Ethical approval is not required for this systematic review as primary data will not be collected. The result of the review will be disseminated through publication in an academic journal and scientific conferences. Keywords: Quality in healthcare, health informatics, telemedicine, systematic review, information qualityReview Registration: PROSPERO CRD42018097142

Journal article

Radha M, Groot KD, Rajani N, Wong CCP, Kobold N, Vos V, Fonseca P, Mastellos N, Wark PA, Velthoven N, Haakma R, Aarts RMet al., 2019, Estimating blood pressure trends and the nocturnal dip from photoplethysmography, Physiological Measurement, Vol: 40, ISSN: 0967-3334

Objective: Evaluate a method for the estimation of the nocturnal systolic blood pressure dip from 24-hour blood pressure trends using a wrist-worn Photoplethysmography (PPG) sensor and a deep neural network in free-living individuals, comparing the deep neural network to traditional machine learning and non-machine learning baselines.Approach: A wrist-worn PPG sensor was worn by 106 healthy individuals for 226 days during which 5111 reference values for blood pressure were obtained with a 24-hour ambulatory blood pressure monitor as ground truth and matched with the PPG sensor data. Features based on heart rate variability and pulse morphology were extracted from the PPG waveforms. Machine learning models (linear regression, random forests, dense neural networks and long- and short-term memory neural networks) were then trained and evaluated in their capability of tracking trends in systolic and diastolic blood pressure, as well as the estimation of the nocturnal systolic blood pressure dip.Main results Best performance was obtained with a deep long- and shortterm memory neural network with a Root Mean Squared Error (RMSE) of 3.12±2.20 ∆mmHg and a correlation of 0.69 (p = 3 ∗ 10−5) with the ground truth Systolic Blood Pressure (SBP) dip. This dip was derived from trend estimates of blood pressure which had an RMSE of 8.22±1.49 mmHg for systolic and 6.55±1.39 mmHg for diastolic blood pressure. The random forest model showed slightly lower average error magnitude for SBP trends (7.86±1.57 mmHg), however Bland-Altmann analysis revealed systematic problems in its predictions that were less present in the long- and short-term memory model.Significance The work provides first evidence for the unobtrusive estimation of the nocturnal blood pressure dip, a highly prognostic clinical parameter. It is also the first to evaluate unobtrusive blood pressure measurement in a large data set of unconstrained 24-hour measurements in free-living i

Journal article

Short CE, DeSmet A, Woods C, Williams SL, Maher C, Middelweerd A, Mueller AM, Wark PA, Vandelanotte C, Poppe L, Hingle MD, Crutzen Ret al., 2018, Measuring Engagement in eHealth and mHealth Behavior Change Interventions: Viewpoint of Methodologies, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 20, ISSN: 1438-8871

Journal article

Wilde LJ, Ward G, Sewell L, Mueller AM, Patel R, Wark PAet al., 2018, Apps and wearables to monitor physical activity and sedentary behaviour: Findings from a qualitative systematic review on barriers and facilitators, Publisher: HUMAN KINETICS PUBL INC, Pages: S244-S244, ISSN: 1543-3080

Conference paper

Wark P, Frost G, Elliott P, Ford HE, Riboli E, Hardie LJ, Alwan NA, Carter M, Hancock N, Morris M, Mulla UZ, Noorwali EA, Petropoulou K, Murphy D, Potter GDM, Greenwood DC, Cade JEet al., 2018, An online 24-hour recall tool (myfood24) is valid for dietary assessment in population studies: comparison with biomarkers and standard interviews., BMC Medicine, Vol: 16, ISSN: 1741-7015

BackgroundOnline dietary assessment tools can reduce administrative costs and facilitate repeated dietary assessment during follow-up in large-scale studies. However, information on bias due to measurement error of such tools is limited. We developed an online 24-h recall (myfood24) and compared its performance with a traditional interviewer-administered multiple-pass 24-h recall, assessing both against biomarkers.MethodsMetabolically stable adults were recruited and completed the new online dietary recall, an interviewer-based multiple pass recall and a suite of reference measures. Longer-term dietary intake was estimated from up to 3 × 24-h recalls taken 2 weeks apart. Estimated intakes of protein, potassium and sodium were compared with urinary biomarker concentrations. Estimated total sugar intake was compared with a predictive biomarker and estimated energy intake compared with energy expenditure measured by accelerometry and calorimetry. Nutrient intakes were also compared to those derived from an interviewer-administered multiple-pass 24-h recall.ResultsBiomarker samples were received from 212 participants on at least one occasion. Both self-reported dietary assessment tools led to attenuation compared to biomarkers. The online tools resulted in attenuation factors of around 0.2–0.3 and partial correlation coefficients, reflecting ranking intakes, of approximately 0.3–0.4. This was broadly similar to the more administratively burdensome interviewer-based tool. Other nutrient estimates derived from myfood24 were around 10–20% lower than those from the interviewer-based tool, with wide limits of agreement. Intraclass correlation coefficients were approximately 0.4–0.5, indicating consistent moderate agreement.ConclusionsOur findings show that, whilst results from both measures of self-reported diet are attenuated compared to biomarker measures, the myfood24 online 24-h recall is comparable to the more time-consuming a

Journal article

Wark PA, Hardie LJ, Frost GS, Alwan NA, Carter M, Elliott P, Ford HE, Hancock N, Morris MA, Mulla UZ, Noorwali EA, Petropoulou K, Murphy D, Potter GDM, Riboli E, Greenwood DC, Cade JEet al., 2018, Validity of an online 24-h recall tool (myfood24) for dietary assessment in population studies: comparison with biomarkers and standard interviews, BMC Medicine, Vol: 16, ISSN: 1741-7015

BackgroundOnline dietary assessment tools can reduce administrative costs and facilitate repeated dietary assessment during follow-up in large-scale studies. However, information on bias due to measurement error of such tools is limited. We developed an online 24-h recall (myfood24) and compared its performance with a traditional interviewer-administered multiple-pass 24-h recall, assessing both against biomarkers.MethodsMetabolically stable adults were recruited and completed the new online dietary recall, an interviewer-based multiple pass recall and a suite of reference measures. Longer-term dietary intake was estimated from up to 3 × 24-h recalls taken 2 weeks apart. Estimated intakes of protein, potassium and sodium were compared with urinary biomarker concentrations. Estimated total sugar intake was compared with a predictive biomarker and estimated energy intake compared with energy expenditure measured by accelerometry and calorimetry. Nutrient intakes were also compared to those derived from an interviewer-administered multiple-pass 24-h recall.ResultsBiomarker samples were received from 212 participants on at least one occasion. Both self-reported dietary assessment tools led to attenuation compared to biomarkers. The online tools resulted in attenuation factors of around 0.2–0.3 and partial correlation coefficients, reflecting ranking intakes, of approximately 0.3–0.4. This was broadly similar to the more administratively burdensome interviewer-based tool. Other nutrient estimates derived from myfood24 were around 10–20% lower than those from the interviewer-based tool, with wide limits of agreement. Intraclass correlation coefficients were approximately 0.4–0.5, indicating consistent moderate agreement.ConclusionsOur findings show that, whilst results from both measures of self-reported diet are attenuated compared to biomarker measures, the myfood24 online 24-h recall is comparable to the more time-consuming a

Journal article

Wilde LJ, Ward G, Sewell L, Muller AM, Wark PAet al., 2018, Apps and wearables for monitoring physical activity and sedentary behaviour: A qualitative systematic review protocol on barriers and facilitators, DIGITAL HEALTH, Vol: 4, ISSN: 2055-2076

Journal article

Muller AM, Maher CA, Vandelanotte C, Hingle M, Middelweerd A, Lopez ML, DeSmet A, Short CE, Nathan N, Hutchesson MJ, Poppe L, Woods CB, Williams SL, Wark PAet al., 2018, Physical Activity, Sedentary Behavior, and Diet-Related eHealth and mHealth Research: Bibliometric Analysis, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 20, ISSN: 1438-8871

Background: Electronic health (eHealth) and mobile health (mHealth) approaches to address low physical activity levels, sedentary behavior, and unhealthy diets have received significant research attention. However, attempts to systematically map the entirety of the research field are lacking. This gap can be filled with a bibliometric study, where publication-specific data such as citations, journals, authors, and keywords are used to provide a systematic overview of a specific field. Such analyses will help researchers better position their work.Objective: The objective of this review was to use bibliometric data to provide an overview of the eHealth and mHealth research field related to physical activity, sedentary behavior, and diet.Methods: The Web of Science (WoS) Core Collection was searched to retrieve all existing and highly cited (as defined by WoS) physical activity, sedentary behavior, and diet related eHealth and mHealth research papers published in English between January 1, 2000 and December 31, 2016. Retrieved titles were screened for eligibility, using the abstract and full-text where needed. We described publication trends over time, which included journals, authors, and countries of eligible papers, as well as their keywords and subject categories. Citations of eligible papers were compared with those expected based on published data. Additionally, we described highly-cited papers of the field (ie, top ranked 1%).Results: The search identified 4805 hits, of which 1712 (including 42 highly-cited papers) were included in the analyses. Publication output increased on an average of 26% per year since 2000, with 49.00% (839/1712) of papers being published between 2014 and 2016. Overall and throughout the years, eHealth and mHealth papers related to physical activity, sedentary behavior, and diet received more citations than expected compared with papers in the same WoS subject categories. The Journal of Medical Internet Research published most papers in

Journal article

Warthon-Medina M, Hooson J, Hancock N, Hutchinson J, Vargas-Garcia E, Gibson LE, Bush LA, Greathead K, Knowles B, Margetts B, Robinson S, Ness A, Alwan NA, Wark PA, Roe M, Finglas P, Steer T, Page P, Key T, Johnson L, Roberts K, Amoutzopoulos B, Burley VJ, Greenwood DC, Cade JEet al., 2018, Nutritools.org an innovative website including a Food Questionnaire Creator for dietary assessment in health research, Publisher: CAMBRIDGE UNIV PRESS, Pages: E125-E125, ISSN: 0029-6651

Conference paper

Warthon-Medina M, Hooson J, Hancock N, Gibson LE, Bush LA, Hutchinson J, Greenwood DC, Robinson S, Burley VJ, Roe M, Steers T, Wark PA, Cade JEet al., 2018, Systematic review and website presentation of validated dietary assessment tools, Publisher: CAMBRIDGE UNIV PRESS, Pages: E202-E202, ISSN: 0029-6651

Conference paper

Noorwali EA, Potter GDM, Ford HE, Mulla UZ, Murphy D, Wark PA, Frost GS, Hardie LJ, Cade JEet al., 2018, Sleep timing and vegetable intakes in UK adults: a cross-sectional study, Publisher: CAMBRIDGE UNIV PRESS, Pages: E132-E132, ISSN: 0029-6651

Conference paper

Cade JE, Warthon-Medina M, Albar S, Alwan NA, Ness A, Roe M, Wark PA, Greathead K, Burley VJ, Finglas P, Johnson L, Page P, Roberts K, Steer T, Hooson J, Greenwood DC, Robinson Set al., 2017, DIET@NET: Best Practice Guidelines for dietary assessment in health research, BMC Medicine, Vol: 15, ISSN: 1741-7015

Background: Dietary assessment is complex, and strategies to select the most appropriate dietary assessment tool(DAT) in epidemiological research are needed. The DIETary Assessment Tool NETwork (DIET@NET) aimed to establishexpert consensus on Best Practice Guidelines (BPGs) for dietary assessment using self-report.Methods: The BPGs were developed using the Delphi technique. Two Delphi rounds were conducted. A total of 131experts were invited, and of these 65 accepted, with 48 completing Delphi round I and 51 completing Delphi round II.In all, a total of 57 experts from North America, Europe, Asia and Australia commented on the 47 suggested guidelines.Results: Forty-three guidelines were generated, grouped into the following four stages: Stage I. Define what is to bemeasured in terms of dietary intake (what? who? and when?); Stage II. Investigate different types of DATs; Stage III.Evaluate existing tools to select the most appropriate DAT by evaluating published validation studies; Stage IV. Thinkthrough the implementation of the chosen DAT and consider sources of potential biases.Conclusions: The Delphi technique consolidated expert views on best practice in assessing dietary intake. The BPGsprovide a valuable guide for health researchers to choose the most appropriate dietary assessment method for theirstudies. These guidelines will be accessible through the Nutritools website, www.nutritools.org.

Journal article

Warthon-Medina M, Hooson J, Hancock N, Alwan NA, Ness A, Wark PA, Margetts B, Robinson S, Steer T, Page P, Finglas P, Key T, Roe M, Amoutzopoulos B, Greenwood DC, Cade JEet al., 2017, Development of Nutritools, an interactive dietary assessment tools website, for use in health research, Public Health Science Conference, Publisher: ELSEVIER SCIENCE INC, Pages: S94-S94, ISSN: 0140-6736

Conference paper

Warthon-Medina M, Hooson J, Hancock N, Alwan NA, Ness A, Wark PA, Margetts B, Robinson S, Page P, Cade JEet al., 2017, A new website to support dietary assessment in health research: Nutritools.org, 10th European Public Health Conference Sustaining resilient and healthy communities, Publisher: Oxford University Press (OUP), ISSN: 1101-1262

Conference paper

Robb C, UdehMomoh CT, Wark PA, Middleton LT, Perneczky Ret al., 2017, [P1–609]: COGNITIVE DECLINE AND AD‐GENETIC RISK: THE ROLE OF PHYSICAL ACTIVITY, Alzheimer's &amp; Dementia, Vol: 13, ISSN: 1552-5260

Journal article

Sawada N, Wark PA, Merritt MA, Tsugane S, Ward HA, Rinaldi S, Weiderpass E, Dartois L, Boutron-Ruault MC, His M, Turzanski-Fortner R, Kaaks R, Overvad K, Redondo ML, Travier N, Molina-Portillo E, Dorronsoro M, Cirera L, Ardanaz E, Perez-Cornago A, Trichopoulou A, Lagiou P, Valanou E, Masala G, Pala V, Peeters PHM, van der Schouw YT, Melander O, Manjer J, da Silva M, Skeie G, Tjonneland A, Olsen A, Gunter MJ, Riboli E, Cross AJet al., 2017, The association between adult attained height and sitting height with mortality in the European Prospective Investigation into Cancer and Nutrition (EPIC), PLOS One, Vol: 12, ISSN: 1932-6203

Adult height and sitting height may reflect genetic and environmental factors, including early life nutrition, physical and social environments. Previous studies have reported divergent associations for height and chronic disease mortality, with positive associations observed for cancer mortality but inverse associations for circulatory disease mortality. Sitting height might be more strongly associated with insulin resistance; however, data on sitting height and mortality is sparse. Using the European Prospective Investigation into Cancer and Nutrition study, a prospective cohort of 409,748 individuals, we examined adult height and sitting height in relation to all-cause and cause-specific mortality. Height was measured in the majority of participants; sitting height was measured in ~253,000 participants. During an average of 12.5 years of follow-up, 29,810 deaths (11,931 from cancer and 7,346 from circulatory disease) were identified. Hazard ratios (HR) with 95% confidence intervals (CI) for death were calculated using multivariable Cox regression within quintiles of height. Height was positively associated with cancer mortality (men: HRQ5 vs. Q1 = 1.11, 95%CI = 1.00–1.24; women: HRQ5 vs. Q1 = 1.17, 95%CI = 1.07–1.28). In contrast, height was inversely associated with circulatory disease mortality (men: HRQ5 vs. Q1 = 0.63, 95%CI = 0.56–0.71; women: HRQ5 vs. Q1 = 0.81, 95%CI = 0.70–0.93). Although sitting height was not associated with cancer mortality, it was inversely associated with circulatory disease (men: HRQ5 vs. Q1 = 0.64, 95%CI = 0.55–0.75; women: HRQ5 vs. Q1 = 0.60, 95%CI = 0.49–0.74) and respiratory disease mortality (men: HRQ5 vs. Q1 = 0.45, 95%CI = 0.28–0.71; women: HRQ5 vs. Q1 = 0.60, 95%CI = 0.40–0.89). We observed opposing effects of height on cancer and circulatory disease mortality. Sitting height was inversely associated with circulatory disease and respiratory disease mortality.

Journal article

Ward HA, Wark PA, Muller DC, Steffen A, Johansson M, Norat T, Gunter MJ, Overvad K, Dahm CC, Halkjaer J, Tjønneland A, Boutron-Ruault MC, Fagherazzi G, Mesrine S, Brennan P, Freisling H, Li K, Kaaks R, Trichopoulou A, Lagiou P, Panico S, Grioni S, Tumino R, Vineis P, Palli D, Peeters PHM, Bueno-de-Mesquita HB, Weiderpass E, Agudo A, Ramon Quiros J, Larrañaga N, Ardanaz E, Huerta JM, Sánchez MJ, Laurell G, Johansson I, Westin U, Wallstrom P, Bradbury KE, Wareham NJ, Khaw KT, Pearson C, Boeing H, Riboli Eet al., 2017, Measured adiposity in relation to head and neck cancer risk in the European Prospective Investigation into Cancer and Nutrition, Cancer Epidemiology Biomarkers & Prevention, Vol: 26, Pages: 895-904, ISSN: 1538-7755

Background: Emerging evidence from cohort studies indicates that adiposity is associated with greater incidence of head and neck cancer (HNC). However, most studies have used self-reported anthropometry which is prone to error. Methods: Among 363 094 participants in the European Prospective Investigation into Cancer and Nutrition study (EPIC) with measured anthropometry, there were 837 incident cases of HNC. HNC risk was examined in relation to body mass index (BMI) [lean: < 22.5 kg/m2, normal weight (reference): 22.5-24.9 kg/m2, overweight 25-29.9 kg/m2, obese: > 30 kg/m2], waist circumference (WC), hip circumference (HC) and waist to hip ratio (WHR) using Cox proportional hazards models. Results: Among men, a BMI < 22.5 kg/m2 was associated with higher HNC risk [hazard ratio (HR) 1.62, 95% confidence interval (CI) 1.23 - 2.12)]; BMI was not associated with HNC among women. WC and WHR were associated with greater risk of HNC among women, (WC per 5 cm: HR 1.08, 95% CI 1.02 - 1.15; WHR per 0.1 unit: HR 1.64, 95% CI 1.38 - 1.93). After stratification by smoking status, the association for WHR was present only among smokers (p interaction 0.004). Among men, WC and WHR were associated with HNC only upon additional adjustment for BMI (WC per 5 cm: HR 1.16, 95% CI 1.07 - 1.26; WHR per 0.1 unit: HR 1.42, 95% CI 1.21 - 1.65). Conclusion: Central adiposity, particularly among women, may have a stronger association with HNC risk than previously estimated. Impact: Strategies to reduce obesity may beneficially impact HNC incidence.

Journal article

Molina-Montes E, Sánchez M, Buckland G, Bueno-de-Mesquita B, Weiderpass E, Amiano P, Wark PA, Kuhn T, Katzke V, Huerta JM, Ardanaz E, Ramón Quirós J, Affret A, His M, Boutron- Ruault M, Peeters PH, Ye W, Sund M, Boeing H, Iqbal K, Ohlsson B, Sonestedt E, Tjonneland A, Petersen KEN, Travis RC, Skeie G, Agnoli C, Agnoli C, Panico S, Palli D, Tumino R, Sacerdote C, Freisling H, Huybrechts I, Overvad K, Trichopoulou A, Bamia C, Vasilopoulou E, Wareham N, Khaw K, Cross AJ, Ward HA, Riboli E, Duell EJet al., 2017, Mediterranean Diet and risk of pancreatic cancer in the European Prospective Investigation into Cancer and Nutrition cohort, British Journal of Cancer, Vol: 116, Pages: 811-820, ISSN: 1532-1827

Background:The Mediterranean Diet (MD) has been proposed as a means for cancer prevention, but little evidence has been accrued regarding its potential to prevent pancreatic cancer. We investigated the association between the adherence to the MD and pancreatic cancer risk within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Methods: Over half a million participants from 10 European countries were followed-up for over11 years, after which 865 newly diagnosed exocrine pancreatic cancer cases were identified. Adherence to the MD was estimated through an adapted score without the alcohol component (arMED) to discount alcohol-related harmful effects. Cox proportional hazards regression models, stratified by age, sex and center, and adjusted for energy intake, body mass index (BMI), smoking status, alcohol intake and diabetes status at recruitment, were used to estimate hazardratios (HRs) associated with pancreatic cancer and their corresponding 95% confidence intervals 16 (CIs) . Results: Adherence to the arMED score was not associated with risk of pancreatic cancer (HR high versus low adherence = 0.99; 95% CI: 0.77-1.26, and HR per increments of 2 units in adherence to arMED = 1.00; 95% CI: 0.94-1.06). There was no convincing evidence for heterogeneity by smoking status, BMI, diabetes or European region. There was also no evidence of significant associations in analyses involving microscopically confirmed cases, plausible reporters of energy intake, or other definitions of the MD pattern.Conclusion: A high adherence to the MD is not associated with pancreatic cancer risk in the EPIC study.

Journal article

Hooson J, Hancock N, Greenwood DC, Robinson S, Burley VJ, Roe M, Steer T, Wark PA, Cade JEet al., 2016, A Systematic Review of Systematic Reviews of Validated Dietary Assessment Tools, Publisher: Cambridge University Press (CUP), Pages: E239-E239, ISSN: 0029-6651

Conference paper

Romieu I, Ferrari P, Chajès V, de Batlle J, Biessy C, Scoccianti C, Dossus L, Boutron MC, Bastide N, Overvad K, Olsen A, Tjønneland A, Kaaks R, Boeing H, Trichopoulou A, Lagiou P, Trichopoulos D, Palli D, Sieri S, Tumino R, Vineis P, Panico S, Bueno-de-Mesquita HB, Gils CH, Peeters PH, Lund E, Skeie G, Weiderpass E, Quirós JR, Chirlaque MD, Ardanaz E, Sánchez MJ, Duell EJ, Amiano Etxezarreta P, Borgquist S, Hallmans G, Johansson I, Nilsson LM, Khaw KT, Wareham N, Key TJ, Travis RC, Murphy N, Wark PA, Riboli Eet al., 2016, Fiber intake modulates the association of alcohol intake with breast cancer, International Journal of Cancer, Vol: 140, Pages: 316-321, ISSN: 1097-0215

Alcohol intake has been related to an increased risk of breast cancer (BC) while dietary fiber intake has been inversely associated to BC risk. A beneficial effect of fibers on ethanol carcinogenesis through their impact on estrogen levels is still controversial. We investigated the role of dietary fiber as a modifying factor of the association of alcohol and breast cancer using data from the European Prospective Investigation into Cancer and Nutrition (EPIC). This study included 334,850 women aged 35-70 years at baseline enrolled in the ten countries of the EPIC study and followed up for 11.0 years on average. Information on fiber and alcohol intake at baseline and average lifetime alcohol intake were calculated from country-specific dietary and lifestyle questionnaires. Hazard ratios (HR) of developing invasive breast cancer according to different levels of alcohol and fiber intake were computed. During 3,670,439 person-years, 11,576 incident breast cancer cases were diagnosed. For subjects with low intake of fiber (<18.5 g/day), the risk of BC per 10g/day of alcohol intake was 1.06 (1.03-1.08) while among subjects with high intake of fiber (>24.2 g/day) the risk of BC was 1.02 (0.99-1.05) (test for interaction p=0.011). This modulating effect was stronger for fiber from vegetables. Our results suggest that fiber intake may modulate the positive association of alcohol intake and BC.

Journal article

Cotic Z, Car J, Wark P, Rees Ret al., 2016, Factors influencing the implementation, adoption, use, sustainability and scalability of eLearning for family medicine specialty training: a systematic review protocol, Systematic Reviews, Vol: 5, ISSN: 2046-4053

BackgroundIn 2013, there was a shortage of approximately 7.2 million health workers worldwide, which is larger among family physicians than among specialists. eLearning could provide a potential solution to some of these global workforce challenges. However, there is little evidence on factors facilitating or hindering implementation, adoption, use, scalability and sustainability of eLearning. This review aims to synthesise results from qualitative and mixed methods studies to provide insight on factors influencing implementation of eLearning for family medicine specialty education and training. Additionally, this review aims to identify the actions needed to increase effectiveness of eLearning and identify the strategies required to improve eLearning implementation, adoption, use, sustainability and scalability for family medicine speciality education and training.MethodsA systematic search will be conducted across a range of databases for qualitative studies focusing on experiences, barriers, facilitators, and other factors related to the implementation, adoption, use, sustainability and scalability of eLearning for family medicine specialty education and training. Studies will be synthesised by using the framework analysis approach.DiscussionThis study will contribute to the evaluation of eLearning implementation, adoption, use, sustainability and scalability for family medicine specialty training and education and the development of eLearning guidelines for postgraduate medical education.

Journal article

Wark PA, Peto J, 2016, Cancer Epidemiology, International Encyclopedia of Public Health, Pages: 339-346, ISBN: 9780128036785

The causes of cancer are reviewed from the perspective of an epidemiologist. We describe the distribution of cancer worldwide, the influence of migration, and the effects of smoking, obesity, diet, reproductive factors, viruses, occupation and environmental carcinogens, as well as genetic factors and their interactions with various causes. Advances in cell and molecular biology have transformed the scope and methods of cancer epidemiology over the last 25. years, giving new insights into cancer etiology and underlying mechanisms.

Book chapter

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