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
Year
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91 results found

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

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

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

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 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

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

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

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

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

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

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

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

Albar S, Robinson S, Alwan N, Burley V, Finglas P, Harvey L, Johnson L, Ness A, Page P, Roberts K, Roe M, Steer T, Wark P, Cade Jet al., 2016, P29 Best practice guidance for dietary assessment in research: DIET@NET Guidelines, Society for Social Medicine, 60th Annual Scientific Meeting, Publisher: BMJ Publishing Group, Pages: A66-A67, ISSN: 0143-005X

Conference paper

Navarrete-Muñoz EM, Wark PA, Romaguera D, Bhoo-Pathy N, Michaud D, Molina-Montes E, Tjønneland A, Olsen A, Overvad K, Boutron-Ruault MC, Clavel-Chapelon F, Fagherazzi G, Katzke VA, Kühn T, Steffen A, Trichopoulou A, Klinaki E, Papatesta EM, Masala G, Krogh V, Tumino R, Naccarati A, Mattiello A, Peeters PH, Rylander C, Parr CL, Skeie G, Weiderpass E, Quirós JR, Duell EJ, Dorronsoro M, Huerta JM, Ardanaz E, Wareham N, Khaw KT, Travis RC, Key T, Stepien M, Freisling H, Riboli E, Bueno-de-Mesquita HBet al., 2016, Sweet-beverage consumption and risk of pancreatic cancer in the European Prospective Investigation into Cancer and Nutrition, American Journal of Clinical Nutrition, ISSN: 1938-3207

BACKGROUND: The consumption of sweet beverages has been associated with greater risk of type 2 diabetes and obesity, which may be involved in the development of pancreatic cancer. Therefore, it has been hypothesized that sweet beverages may increase pancreatic cancer risk as well. OBJECTIVE: We examined the association between sweet-beverage consumption (including total, sugar-sweetened, and artificially sweetened soft drink and juice and nectar consumption) and pancreatic cancer risk. DESIGN: The study was conducted within the European Prospective Investigation into Cancer and Nutrition cohort. A total of 477,199 participants (70.2% women) with a mean age of 51 y at baseline were included, and 865 exocrine pancreatic cancers were diagnosed after a median follow-up of 11.60 y (IQR: 10.10-12.60 y). Sweet-beverage consumption was assessed with the use of validated dietary questionnaires at baseline. HRs and 95% CIs were obtained with the use of multivariable Cox regression models that were stratified by age, sex, and center and adjusted for educational level, physical activity, smoking status, and alcohol consumption. Associations with total soft-drink consumption were adjusted for juice and nectar consumption and vice versa. RESULTS: Total soft-drink consumption (HR per 100 g/d: 1.03; 95% CI: 0.99, 1.07), sugar-sweetened soft-drink consumption (HR per 100 g/d: 1.02; 95% CI: 0.97, 1.08), and artificially sweetened soft-drink consumption (HR per 100 g/d: 1.04; 95% CI: 0.98, 1.10) were not associated with pancreatic cancer risk. Juice and nectar consumption was inversely associated with pancreatic cancer risk (HR per 100 g/d: 0.91; 95% CI: 0.84, 0.99); this association remained statistically significant after adjustment for body size, type 2 diabetes, and energy intake. CONCLUSIONS: Soft-drink consumption does not seem to be associated with pancreatic cancer risk. Juice and nectar consumption might be associated with a modest decreased pancreatic cancer risk. Additional

Journal article

Carter MC, Hancock N, Albar SA, Brown H, Greenwood DC, Hardie LJ, Frost GS, Wark PA, Cade JEet al., 2016, Development of a New Branded UK Food Composition Database for an Online Dietary Assessment Tool, Nutrients, Vol: 8, ISSN: 2072-6643

The current UK food composition tables are limited, containing ~3300 mostly generic food and drink items. To reflect the wide range of food products available to British consumers and to potentially improve accuracy of dietary assessment, a large UK specific electronic food composition database (FCDB) has been developed. A mapping exercise has been conducted that matched micronutrient data from generic food codes to "Back of Pack" data from branded food products using a semi-automated process. After cleaning and processing, version 1.0 of the new FCDB contains 40,274 generic and branded items with associated 120 macronutrient and micronutrient data and 5669 items with portion images. Over 50% of food and drink items were individually mapped to within 10% agreement with the generic food item for energy. Several quality checking procedures were applied after mapping including; identifying foods above and below the expected range for a particular nutrient within that food group and cross-checking the mapping of items such as concentrated and raw/dried products. The new electronic FCDB has substantially increased the size of the current, publically available, UK food tables. The FCDB has been incorporated into myfood24, a new fully automated online dietary assessment tool and, a smartphone application for weight loss.

Journal article

Greenfield R, Busink E, Wong CP, Riboli-Sasco E, Greenfield G, Majeed A, Car J, Wark PAet al., 2016, Truck drivers' perceptions on wearable devices and health promotion: a qualitative study., BMC Public Health, Vol: 16, ISSN: 1471-2458

BACKGROUND: Professional truck drivers, as other shift workers, have been identified as a high-risk group for various health conditions including cardiovascular disease, obesity, diabetes, sleep apnoea and stress. Mobile health technologies can potentially improve the health and wellbeing of people with a sedentary lifestyle such as truck drivers. Yet, only a few studies on health promotion interventions related to mobile health technologies for truck drivers have been conducted. We aimed to explore professional truck drivers' views on health promotion delivered via mobile health technologies such as wearable devices. METHODS: We conducted a phenomenological qualitative study, consisting of four semi-structured focus groups with 34 full-time professional truck drivers in the UK. The focus groups were audio-taped, transcribed verbatim and analysed using thematic content analysis. We discussed drivers' perceptions of their health, lifestyle and work environment, and their past experience and expectations from mobile health technologies. RESULTS: The participants viewed their lifestyle as unhealthy and were aware of possible consequences. They expressed the need and wish to change their lifestyle, yet perceived it as an inherent, unavoidable outcome of their occupation. Current health improvement initiatives were not always aligned with their working conditions. The participants were generally willing to use mobile health technologies such as wearable devices, as a preventive measure to avoid prospect morbidity, particularly cardiovascular diseases. They were ambivalent about privacy and the risk of their employer's monitoring their clinical data. CONCLUSIONS: Wearable devices may offer new possibilities for improving the health and wellbeing of truck drivers. Drivers were aware of their unhealthy lifestyle. They were interested in changing their lifestyle and health. Drivers raised concerns regarding being continuously monitored by their employer. Health improvement i

Journal article

Molina-Montes E, Sánchez MJ, Zamora-Ros R, Bueno-de-Mesquita HB, Wark PA, Obon-Santacana M, Kühn T, Katzke V, Travis RC, Ye W, Sund M, Naccarati A, Mattiello A, Krogh V, Martorana C, Masala G, Amiano P, Huerta JM, Barricarte A, Quirós JR, Weiderpass E, Åsli LA, Skeie G, Ericson U, Sonestedt E, Peeters PH, Romieu I, Scalbert A, Overvad K, Clemens M, Boeing H, Trichopoulou A, Peppa E, Vidalis P, Khaw KT, Wareham N, Olsen A, Tjønneland A, Boutroun-Rualt MC, Clavel-Chapelon F, Cross AJ, Lu Y, Riboli E, Duell EJet al., 2016, Flavonoid and lignan intake and pancreatic cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, International Journal of Cancer, Vol: 139, Pages: 1480-1492, ISSN: 1097-0215

Despite the potential cancer preventive effects of flavonoids and lignans, their ability to reduce pancreatic cancer risk has not been demonstrated in epidemiological studies. Our aim was to examine the association between dietary intakes of flavonoids and lignans and pancreatic cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. A total of 865 exocrine pancreatic cancer cases occurred after 11.3 years of follow-up of 477,309 cohort members. Dietary flavonoid and lignan intake was estimated through validated dietary questionnaires and the U.S. Department of Agriculture (USDA) and Phenol Explorer databases. Hazard ratios (HR) and 95% confidence intervals (CIs) were calculated using age, sex and center-stratified Cox proportional hazards models, adjusted for energy intake, body mass index (BMI), smoking, alcohol and diabetes status. Our results showed that neither overall dietary intake of flavonoids nor of lignans were associated with pancreatic cancer risk (multivariable-adjusted HR for a doubling of intake = 1.03, 95% CI: 0.95-1.11 and 1.02; 95% CI: 0.89-1.17, respectively). Statistically significant associations were also not observed by flavonoid subclasses. An inverse association between intake of flavanones and pancreatic cancer risk was apparent, without reaching statistical significance, in microscopically confirmed cases (HR for a doubling of intake = 0.96, 95% CI: 0.91-1.00). In conclusion, we did not observe an association between intake of flavonoids, flavonoid subclasses or lignans and pancreatic cancer risk in the EPIC cohort. This article is protected by copyright. All rights reserved.

Journal article

Gallo V, Vanacore N, Bueno-de-Mesquita HB, Vermeulen R, Brayne C, Pearce N, Wark PA, Ward HA, Ferrari P, Jenab M, Andersen PM, Wennberg P, Wareham N, Katzke V, Kaaks R, Weiderpass E, Peeters PH, Mattiello A, Pala V, Barricante A, Chirlaque M-D, Travier N, Travis RC, Sanchez M-J, Pessah-Rasmussen H, Petersson J, Tjonneland A, Tumino R, Ramon Quiros J, Trichopoulou A, Kyrozis A, Oikonomidou D, Masala G, Sacerdote C, Arriola L, Boeing H, Vigl M, Claver-Chapelon F, Middleton L, Riboli E, Vineis Pet al., 2016, Physical activity and risk of Amyotrophic Lateral Sclerosis in a prospective cohort study, European Journal of Epidemiology, Vol: 31, Pages: 255-266, ISSN: 1573-7284

Previous case–control studies have suggested a possible increased risk of Amyotrophic Lateral Sclerosis (ALS) with physical activity (PA), but this association has never been studied in prospective cohort studies. We therefore assessed the association between PA and risk of death from ALS in the European Prospective Investigation into Cancer and Nutrition. A total of 472,100 individuals were included in the analysis, yielding 219 ALS deaths. At recruitment, information on PA was collected thorough standardised questionnaires. Total PA was expressed by the Cambridge Physical Activity Index (CPAI) and analysed in relation to ALS mortality, using Cox hazard models. Interactions with age, sex, and anthropometric measures were assessed. Total PA was weakly inversely associated with ALS mortality with a borderline statistically significant trend across categories (p = 0.042), with those physically active being 33 % less likely to die from ALS compared to those inactive: HR = 0.67 (95 % CI 0.42–1.06). Anthropometric measures, sex, and age did not modify the association with CPAI. The present study shows a slightly decreased—not increased like in case–control studies—risk of dying from ALS in those with high levels of total PA at enrolment. This association does not appear confounded by age, gender, anthropometry, smoking, and education. Ours was the first prospective cohort study on ALS and physical activity.

Journal article

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