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Peter Williams


Statistics Consultant
+44 (0)1483 683948
06A AB 04
12 noon - 8pm: 3 days per weeks (specific days subject to random variation

Biography

Research interests

Medical statistics. Statistical computing. Epidemiology. Modelling.

Research collaborations

EARNEST

My publications

Publications

Gage H, Erdal E, Saigal P, Qiao Y, Williams P, Raats MM (2012) Recognition and management of overweight and obese children: A questionnaire survey of general practitioners and parents in England., Journal of Paediatrics and Child Health 48 (2) pp. 146-152 Wiley-Blackwell
Aims:? To (i) compare the views of general practitioners (GPs) and parents about the causes, consequences and management of childhood overweight/obesity; and (ii) explore the extent to which they can identify overweight/obesity in children. Methods:? A questionnaire was mailed to all GPs in one Primary Care Trust and all parents in one primary school in southern England, 2008. Information was gathered on socio-demographic background, views about causes, consequences and management of childhood overweight/obesity; judgements about the weight status of 14 images of children (seven boys, seven girls) in the Children's Body Image Scale (CBIS). Comparisons were made between GP and parents' responses using unpaired bivariate tests. Results:? The response rate was 33%. Differences exist between the views of GPs and parents about childhood weight management: 86.4% of parents felt GPs should be involved, compared to 73.3% of GPs (P
Current plans in the English National Health Service are to replace block contracts for mental health providers with a single tariff for each 'cluster' of conditions. A single tariff will not take into account the potential additional complexity and costs inherent in caring for older people. To examine the basis for a uniform tariff, differences in service utilisation and costs between working age adults and older adults in two populous clusters (non-psychotic, psychotic) were investigated across five mental health healthcare providers in and around London.Retrospective review of records over 3 months assessing service utilisation and costs using the Client Services Receipt Inventory.Records of 362 patients were reviewed, 179 older adults (90 non-psychotic, 89 psychotic) and 183 adults of working age (83 non-psychotic, 100 psychotic). Older adults in both clusters had more tests, assessments and home visits. Overall costs of care of older adults were significantly higher in the non-psychotic cluster (£5634, vs £4405 psychotic, p = 0.044).An appropriate age-related tariff is required for each cluster. Copyright © 2016 John Wiley & Sons, Ltd.
Gage H, Family H, Murphy F, Williams P, Sutton J, Taylor D (2015) Comparison of sole nurse and team-delivered community clozapine services for people with treatment-resistant schizophrenia., J Adv Nurs 71 (3) pp. 547-558
AIM: To compare sole nurse and doctor-led multidisciplinary team delivery of community clozapine services for people with treatment-resistant schizophrenia. BACKGROUND: Around 20% of people with schizophrenia are treatment resistant and fail to respond to front line medications. Clozapine, a second-line treatment, has potentially serious side effects requiring regular monitoring. Different models of community clozapine services are emerging in the British National Health Service, but there is little evidence about which is best. DESIGN: Questionnaire survey of service users. METHODS: All patients on the lists of seven clozapine clinics (four sole nurse, three multidisciplinary team) in one trust were invited to participate, 2009-2010. Forward stepwise regression was used to investigate associations between patient well-being, functioning, self-efficacy and satisfaction, and clinic model attended, controlling for socio-demographic and health characteristics and processes of care. Use (and costs) of other health and social services accessed was compared between models. RESULTS: Sixty-six service users (35% participation rate) responded. Well-being and functioning were associated with patient characteristics and processes of care, not clinic model. Patients managed by sole nurses reported, over 3 months: more community psychiatric nurse visits and hospital psychiatrist appointments. Clinic list size affects costs per patient. CONCLUSIONS: Multidisciplinary team delivery may reduce use of other services. Although multidisciplinary team delivery is regarded as best practice, sole nurses can effectively provide clozapine services and may be warranted in areas of low population density.
WILLIAMS P (1993) ASSESSING STATISTICS FOR THE MEASUREMENT OF WORKLOAD AT A GENITOURINARY MEDICINE CLINIC, INTERNATIONAL JOURNAL OF STD & AIDS 4 (5) pp. 266-270 ROYAL SOC MEDICINE SERVICES LTD
Egan B, Gage H, Williams P, Brands B, Gyoerei E, Lopez-Robles JC, Koletzko B, Campoy C, Desci T, Raats M (2013) FACTORS AFFECTING FOOD CHOICES OF PARENTS OF CHILDREN AGED 4-10 YEARS IN FOUR EUROPEAN COUNTRIES, ANNALS OF NUTRITION AND METABOLISM 63 pp. 1862-1862 KARGER
Fader MJ, Cottenden AM, Gage HM, Williams P, Getliffe K, Clarke-O'Neill S, Jamieson KM, Green NJ (2012) Individual budgets for people with incontinence: results from a 'shopping' experiment within the British National Health Service., Health Expectations Wiley
Background and context? Most people with urinary incontinence are given limited choice when provided with absorbent products through the British National Health Service (NHS), even though the available range is large. Objective? To investigate users' preferences for four disposable designs (inserts, all-in-ones, belted/T-shaped and pull-ups) and towelling washable/reusable products, day and night. Design? Shopping experiment. Setting and participants? Community-dwelling women and men in England with moderate-to-heavy urinary incontinence recruited to a larger trial. Intervention? Participants tested each design and selected products they would prefer with a range of different budgets. Main outcome measures? Design preferences (rankings); 'purchasing' decisions from designated budgets. Results? Eighty-five participants (49 men) tested products, 75 completed the shopping experiment. Inserts, most frequently supplied by the NHS, were ranked second to pull-ups by women and lowest by men. When faced with budget constraints, up to 40% of participants opted to 'mix-and-match' designs. Over 15 different combinations of products were selected by participants in the shopping experiment. Most (91%) stated a willingness to 'top-up' assigned budgets from income to secure preferred designs. Discussion? Participants displayed diverse preferences. Enabling user choice of absorbent product design through individual budgets could improve satisfaction of consumers and efficiency of allocation of limited NHS resources. Conclusion? Recent policy for the NHS seeks to provide consumers with more control in their care. Extension of the concept of individual budgets to continence supplies could be feasible and beneficial for patients and provide better value-for-money within the NHS. Further research is warranted.
Gage H, Knibb W, Evans J, Williams P, Rickman N, Bryan K (2009) Nursing homes More on quality of care, BRITISH MEDICAL JOURNAL 339 ARTN b3526 B M J PUBLISHING GROUP
Macaulay M, Broadbridge J, Broadbridge J, Gage H, Williams P, Birch B, Moore KN, Cottenden A, Fader MJ (2015) A trial of devices for urinary incontinence after treatment for prostate cancer, BJU International
© 2014 BJU International Published by John Wiley & Sons Ltd. Objective: To compare the performance of three continence management devices and absorbent pads used by men with persistent urinary incontinence (>1 year) after treatment for prostate cancer. Patients and Methods: Randomised, controlled trial of 56 men with 1-year follow-up. Three devices were tested for 3 weeks each: sheath drainage system, body-worn urinal (BWU) and penile clamp. Device and pad performance were assessed. Quality of life (QoL) was measured at baseline and follow-up with the King's Health Questionnaire. Stated (intended use) and revealed (actual use) preference for products were assessed. Value-for-money was gathered. Results: Substantial and significant differences in performance were found. The sheath was rated as 'good' for extended use (e.g. golf and travel) when pad changing is difficult; for keeping skin dry, not leaking, not smelling and convenient for storage and travel. The BWU was generally rated worse than the sheath and was mainly used for similar activities but by men who could not use a sheath (e.g. retracted penis) and was not good for seated activities. The clamp was good for short vigorous activities like swimming/exercise; it was the most secure, least likely to leak, most discreet but almost all men described it as uncomfortable or painful. The pads were good for everyday activities and best for night-time use; most easy to use, comfortable when dry but most likely to leak and most uncomfortable when wet. There was a preference for having a mixture of products to meet daytime needs; around two-thirds of men were using a combination of pads and devices after testing compared with baseline. Conclusions: This is the first trial to systematically compare different continence management devices for men. Pads and devices have different strengths, which make them particularly suited to certain circumstances and activities. Most men prefer to use pads at night but would choose a mixture of pads and devices during the day. Device limitations were important but may be overcome by better design.
Gage H, Cheynel J, Williams P, Mitchell K, Stinton C, Katz J, Holland C, Sheehan B (2014) Service utilisation and family support of people with dementia: a cohort study in England., Int J Geriatr Psychiatry 30 (2) pp. 166-177
OBJECTIVES: This study aimed to compare costs of caring for people with dementia in domiciliary and residential settings, central England. METHODS: A cohort of people with dementia was recruited during a hospital stay 2008-2010. Data were collected by interview at baseline, and 6- and 12-month follow-up, covering living situation (own home with or without co-resident carer, care home); cognition, health status and functioning of person with dementia; carer stress; utilisation of health and social services; and informal (unpaid) caring input. Costs of formal services and informal caring (replacement cost method) were calculated. Costs of residential and domiciliary care packages were compared. RESULTS: Data for 109 people with dementia were collected at baseline; 95 (87.2%) entered hospital from their own homes. By 12 months, 40 (36.7%) had died and 85% of the survivors were living in care homes. Over one-half of people with dementia reported social care packages at baseline; those living alone had larger packages than those living with others. Median caring time for co-resident carers was 400 min/day and 10 h/week for non co-resident carers. Residential care was more costly than domiciliary social care for most people. When the value of informal caring was included, the total cost of domiciliary care was higher than residential care, but not significantly so. Carer stress reduced significantly after the person with dementia entered a care home. CONCLUSIONS: Caring for people with dementia at home may be more expensive, and more stressful for carers, than care in residential settings.
BACKGROUND: A gene-based estimate of lung cancer risk in smokers has been shown to act as a smoking cessation motivator in hospital recruited subjects. The objective of this trial is to determine if this motivator is as effective in subjects recruited from an NHS primary care unit. METHOD/DESIGN: Subjects will be recruited by mailings using smoking entries on the GP electronic data-base (total practice population = 32,048) to identify smokers who may want to quit. Smoking cessation clinics based on medical centre premises will run for eight weeks. Clinics will be randomised to have the gene-based test for estimation of lung cancer risk or to act as controls groups. The primary endpoint will be smoking cessation at eight weeks and six months. Secondary outcomes will include ranking of the gene-based test with other smoking cessation motivators. DISCUSSION: The results will inform as to whether the gene-based test is both effective as motivator and acceptable to subjects recruited from primary care. TRIAL REGISTRATION: Registered with Clinical Trials.gov, REGISTRATION NUMBER: NCT01176383.
Gage H, Schmid M, Egan B, Morgan J, Raats M, Williams P, Von Rosen-Von Hoewel J, Koletzko B, Laitinen K, Jakobik V, Martin-Bautista E, Decsi T, Campoy C (2012) Influences on infant feeding decisions of first-time mothers in five European countries, European Journal of Clinical Nutrition
BACKGROUND/OBJECTIVES:Infant feeding decisions made by new parents have significant health implications. The study aimed to investigate: influences on infant feeding decisions; characteristics of mothers reporting reliance on alternative information sources; associations between reliance on different sources and intentions to exclusively breastfeed and introduce complementary foods later; and subsequent breastfeeding and weaning behaviours.SUBJECTS/METHODS:First-time mothers in five European countries (England, Finland, Germany, Hungary, Spain) completed questionnaires about the importance of 17 influences on infant feeding choices at birth and 8 months later, during 2007-2008. Use of individual sources and reliance on four categories (family and friends, health professionals, written materials, audio-visual media) were compared between countries. Associations between information sources used and mother characteristics, feeding intentions and behaviours were investigated using appropriate statistical tests.RESULTS:In all, 2071 first-time mothers provided baseline data; 78% at 8 months. Variation exists between countries in the influence of different sources on feeding decisions of first-time mothers. Across all countries, the most important influences at both time points were books, partner and antenatal midwife. Mothers in higher income quintiles and remaining at school beyond age 16 years reported greater reliance on written sources (P
Dowson HM, Gage H, Jackson D, Qiao Y, Williams P, Rockall TA (2012) Laparoscopic and Open Colorectal Surgery: A Prospective Cost Analysis., Colorectal Disease Wiley
Aim:? Cost has been perceived to be a factor limiting the development of laparoscopic colorectal surgery. This study aimed to compare the costs of laparoscopic and open colorectal surgery. Method:? Patients undergoing laparoscopic or open elective colorectal surgery were recruited into a prospective study to evaluate the healthcare costs of each operative procedure in a district general hospital in England. All healthcare resources used (operation, hospital, and community) were recorded, and converted to costs in British pounds, 2006/7. Costs of laparoscopic and open surgery were compared. Results:? 201 consecutive patients were consented and recruited (131 laparoscopic, 70 open). Operative costs were greater in the laparoscopic group (£2068 vs.£1263, p
Gage H, Ting S, Williams P, Bryan K, Kaye J, Castleton B, Trend P, Wade D (2011) A comparison of specialist rehabilitation and care assistant support with specialist rehabilitation alone and usual care for people with Parkinson's living in the community: study protocol for a randomised controlled trial., Trials 12 BioMed Central
Parkinson's Disease is a degenerative neurological condition that causes movement problems and other distressing symptoms. People with Parkinson's disease gradually lose their independence and strain is placed on family members. A multidisciplinary approach to rehabilitation for people with Parkinson's is recommended but has not been widely researched. Studies are needed that investigate cost-effective community-based service delivery models to reduce disability and dependency and admission to long term care, and improve quality of life.
Gage H, Holdsworth LM, Flannery C, Williams P, Butler C (2015) Impact of a hospice rapid response service on preferred place of death, and costs, BMC PALLIATIVE CARE 14 ARTN 75 BIOMED CENTRAL LTD
Francis G, Bishop L, Luke C, Middleton B, Williams P, Arendt J (2008) Sleep during the Antarctic winter: preliminary observations on changing the spectral composition of artificial light, JOURNAL OF SLEEP RESEARCH 17 (3) pp. 354-360 WILEY-BLACKWELL
Gage H, Knibb W, Evans J, Williams P, Rickman N, Bryan K (2009) Why are some care homes better than others? An empirical study of the factors associated with quality of care for older people in residential homes in Surrey, England, HEALTH & SOCIAL CARE IN THE COMMUNITY 17 (6) pp. 599-609 WILEY-BLACKWELL PUBLISHING, INC
Gibbs M, Harrington D, Starkey S, Williams P, Hampton S (2014) Diurnal postprandial responses to low and high glycaemic index mixed meals, Clinical Nutrition 33 (5) pp. 889-894
Background & aims: Glycaemic index testing is conducted in the morning, however postprandial glycaemia has a diurnal rhythm. The study aimed to evaluate the effect of glycaemic index on glucose tolerance at different times during the day. Methods: A randomised controlled crossover study was conducted in ten healthy participants after a standardised premeal and eight hour fast. Low (37) and high glycaemic index (73) meals, matched for energy, available carbohydrate, protein and fat, were consumed at 08:00 h and 20:00 h. Blood samples were taken for 2 h postprandially. Results: Postprandial glucose area under curve showed effect with time of day after both meals (Low p
Gage H, Von Rosen-Von Hoewel J, Laitinen K, Jakobik V, Martin-Bautista E, Schmid M, Egan B, Morgan J, Williams P, Decsi T, Campoy C, Koletzko B, Raats MM (2013) Health effects of infant feeding: Information for parents in leaflets and magazines in five European countries, Public Understanding of Science 22 (3) pp. 365-379 Sage
Parents? decisions about whether to breastfeed their infant, and when to introduce complementary foods, are important public health issues. Breastfeeding has beneficial health effects and is widely promoted. Leaflets and magazine articles on infant feeding were collected in 2005, in five European countries (England, Finland, Germany, Hungary, Spain), and screened for statements that link feeding behaviours to infant health outcomes. A total of 127 leaflets contained 512 statements (0.38 / published page). Magazines contained approximately 1 article / month. Health outcomes were more intensively covered in England and Germany. Most statements referred to short term health implications. Lack of scientific agreement may underlie lack of cover of longer term health effects. Scope may exist to promote improved infant feeding practices by increasing the quantity and specificity of messages about health effects. Further research is required to evaluate the impact of alternative means of providing information on infant feeding practices.
Rayman MP, Bath SC, Westaway J, Williams P, Mao J, Vanderlelie JJ, Perkins AV, Redman CW (2015) Selenium status in UK pregnant women and its relationship with hypertensive conditions of pregnancy., Br J Nutr 113 (2) pp. 249-258
Dietary intake/status of the trace mineral Se may affect the risk of developing hypertensive conditions of pregnancy, i.e. pre-eclampsia and pregnancy-induced hypertension (PE/PIH). In the present study, we evaluated Se status in UK pregnant women to establish whether pre-pregnant Se status or Se supplementation affected the risk of developing PE/PIH. The samples originated from the SPRINT (Selenium in PRegnancy INTervention) study that randomised 230 UK primiparous women to treatment with Se (60 ¼g/d) or placebo from 12 weeks of gestation. Whole-blood Se concentration was measured at 12 and 35 weeks, toenail Se concentration at 16 weeks, plasma selenoprotein P (SEPP1) concentration at 35 weeks and plasma glutathione peroxidase (GPx3) activity at 12, 20 and 35 weeks. Demographic data were collected at baseline. Participants completed a FFQ. UK pregnant women had whole-blood Se concentration lower than the mid-range of other populations, toenail Se concentration considerably lower than US women, GPx3 activity considerably lower than US and Australian pregnant women, and low baseline SEPP1 concentration (median 3·00, range 0·90-5·80 mg/l). Maternal age, education and social class were positively associated with Se status. After adjustment, whole-blood Se concentration was higher in women consuming Brazil nuts (P= 0·040) and in those consuming more than two seafood portions per week (P= 0·054). A stepwise logistic regression model revealed that among the Se-related risk factors, only toenail Se (OR 0·38, 95 % CI 0·17, 0·87, P= 0·021) significantly affected the OR for PE/PIH. On excluding non-compliers with Se treatment, Se supplementation also significantly reduced the OR for PE/PIH (OR 0·30, 95 % CI 0·09, 1·00, P= 0·049). In conclusion, UK women have low Se status that increases their risk of developing PE/PIH. Therefore, UK women of childbearing age need to improve their Se status.
Fader M, Cottenden A, Getliffe K, Gage H, Clarke-O'Neill S, Jamieson K, Green N, Williams P, Brooks R, Malone-Lee J (2008) Absorbent products for urinary/faecal incontinence: a comparative evaluation of key product designs - Introduction, Health Technology Assessment 12 (29) GRAY PUBLISHING
To compare the performance and cost-effectiveness of the key absorbent product designs to provide a more solid basis for guiding selection and purchase. Also to carry out the first stage in the development of a quality of life (QoL) instrument for measuring the impact of absorbent product use on users' lives.Design: Three clinical trials focused on the three biggest market sectors. Each trial had a similar crossover design in which each participant tested all products within their group in random order.Setting, participants and interventions: In Trial 1, 85 women with light urinary incontinence living in the community tested three products from each of the four design categories available (total of 12 test products): disposable inserts (pads); menstrual pads; washable pants with integral pad; and washable inserts. In Trial 2a, 85 moderate/ heavily incontinent adults (urinary or urinary/faecal) living in the community (49 men and 36 women) tested three (or two) products from each of the five design categories available (total of 14 test products): disposable inserts (with mesh pants); disposable diapers ( nappies); disposable pull-ups (similar to toddlers' trainer pants); disposable T-shaped diapers (nappies with waist-band); and washable diapers. All products were provided in a daytime and a (mostly more absorbent) night-time variant. In these first two trials, the test products were selected on the basis of data from pilot studies. In Trial 2b, 100 moderate/ heavily incontinent adults (urinary or urinary/faecal) living in 10 nursing homes (27 men and 73 women) evaluated one product from each of the four disposable design categories from Trial 2a. Products were selected on the basis of product performance in Trial 2a and, again, day time and night-time variants were provided. The first phase of developing a QoL tool for measuring the impact of using different pad designs was carried out by interviewing participants from Trials 1 and 2a.Main outcome measures: Product performance ( e. g. comfort, discreetness) was characterised using a weekly validated questionnaire. A daily pad change and leakage diary was used to record severity of leakage, numbers of laundry items and pads. Skin health changes were recorded weekly. At a final interview preferences were ranked, acceptability of each design recorded, and overall opinion marked on a visual analogue scale (VAS) of 0 - 100 points. This VAS score was used to estimate cost-effectiveness. In addition, a timed pad
Eagan B, Gage H, Williams P, Raats M, Brands B, Gyoerei E, Lopez-Robles J, Campoy C, Koletzko B, Decsi T (2011) Diet and mental performance of children: A questionnaire survey of parents in four European countries., ANNALS OF NUTRITION AND METABOLISM 58 pp. 29-29
Middleton B, Francis G, Bishop L, Luke C, Williams P, Arendt J (2005) Sleep in different artificial light environments in winter at Halley Bay Antarctica (75 degrees S), SLEEP 28 pp. A68-A68 AMER ACADEMY SLEEP MEDICINE
Gage H, Storey L, McDowell C, Maguire G, Williams P, Faithfull S, Thomas H, Poole K (2009) Integrated care: Utilisation of complementary and alternative medicine within a conventional cancer treatment centre, COMPLEMENTARY THERAPIES IN MEDICINE 17 (2) pp. 84-91 CHURCHILL LIVINGSTONE
Gage H, Ting S, Chorley C, Kaye J, Bryan K, Williams P, Axelrod L, Trend P, Wade D (2010) Disease-Specific Training for Care Assistants: A Randomized Controlled Trial Comparing Two Approaches for Improving Understanding of Parkinson's, MOVEMENT DISORD 25 pp. S700-S700 WILEY-LISS
Mottram V, Middleton B, Williams P, Arendt J (2011) The impact of bright artificial white and 'blue-enriched' light on sleep and circadian phase during the polar winter., J Sleep Res 20 (1 Pt 2) pp. 154-161
Delayed sleep phase (and sometimes free-run) is common in the Antarctic winter (no natural sunlight) and optimizing the artificial light conditions is desirable. This project evaluated sleep when using 17,000 K blue-enriched lamps compared with standard white lamps (5000 K) for personal and communal illumination. Base personnel, 10 males, five females, 32.5±8 years took part in the study. From 24 March to 21 September 2006 light exposure alternated between 4-5-week periods of standard white (5000 K) and blue-enriched lamps (17,000 K), with a 3-week control before and after extra light. Sleep and light exposure were assessed by actigraphy and sleep diaries. General health (RAND 36-item questionnaire) and circadian phase (urinary 6-sulphatoxymelatonin rhythm) were evaluated at the end of each light condition. Direct comparison (rmanova) of blue-enriched light with white light showed that sleep onset was earlier by 19 min (P=0.022), and sleep latency tended to be shorter by 4 min (P=0.065) with blue-enriched light. Analysing all light conditions, control, blue and white, again provided evidence for greater efficiency of blue-enriched light compared with white (P
Arber A, Odelius A, Williams P, Lemanska A, Faithfull S (2015) Do patients on oral chemotherapy have sufficient knowledge for optimal adherence? A mixed methods study., European journal of cancer care
A new treatment paradigm has emerged with many patients now receiving oral chemotherapy (OC) as first-line treatment for cancer. Treatment with OC has resulted in reduced hospital costs, more autonomy for patients but with added responsibilities for patient self-management. Little is known about patient's knowledge following patient education to enable optimal adherence with OC. A mixed methods study was carried out using a self-report questionnaire to patients on OC for multiple myeloma (MM) followed by semi-structured interviews with patients at home. Analysis identifies high rates of adherence (92.2%) with OC for MM. However, statistically significant knowledge deficits were identified, which were related to patient ethnicity and to gender. There is the potential for non-intentional non-adherence with OC due to deficits in knowledge of OC. Support at home needs to include primary care practitioners such as GPs, practice nurses and pharmacists so that timely support is easily accessible especially in the early phase of treatment.
Procopio M, Marriott PK, Williams P (1997) Season of birth: Aetiological implications for epilepsy, SEIZURE 6 (2) pp. 99-105 W B SAUNDERS CO LTD
Gage H, Egan B, Williams P, Gyoerei E, Brands B, Lopez-Robles J, Brown K, Campoy C, Koletzko B, Decsi T, Raats M (2013) VIEWS OF PARENTS IN FOUR EUROPEAN COUNTRIES ABOUT THE EFFECT OF FOOD ON THE MENTAL PERFORMANCE OF PRIMARY SCHOOL CHILDREN, ANNALS OF NUTRITION AND METABOLISM 63 pp. 1132-1132 KARGER
Aldayel TS, Hampton SM, Lanham-New SA, Williams P, Brown JE (2014) An evaluation of serum cytokine levels in overweight women consuming a cinnamon supplement for 8 weeks, IMMUNOLOGY 143 pp. 184-185 WILEY-BLACKWELL
Gage H, Von Rosen-Von Hoewel J, Laitinen K, Jakobik V, Martin-Bautista E, Schmid M, Egan B, Morgan J, Williams P, Decsi T, Campoy C, Koletzko B, Raats M (2013) Health effects of infant feeding: Information for parents in leaflets and magazines in five European countries, PUBLIC UNDERSTANDING OF SCIENCE 22 (3) pp. 365-379 SAGE PUBLICATIONS LTD
Gibbs M, Harrington D, Starkey S, Williams P, Hampton S (2013) Diurnal postprandial responses to low and high glycaemic index mixed meals., Clin Nutr
Glycaemic index testing is conducted in the morning, however postprandial glycaemia has a diurnal rhythm. The study aimed to evaluate the effect of glycaemic index on glucose tolerance at different times during the day.
Egan B, Gage H, Williams P, Gyoerei E, Brands B, Lopez-Robles JC, Campoy C, Koletzko B, Desci T, Raats M (2013) ASSOCIATION BETWEEN DIET AND MENTAL PERFORMANCE OF CHILDREN: VIEWS OF PARENTS AND TEACHERS IN FOUR EUROPEAN COUNTRIES, ANNALS OF NUTRITION AND METABOLISM 63 pp. 1862-1862 KARGER
Shams S, Shafi S, Bodman-Smith K, Williams P, Mehta S, Ferns GA (2008) Anti-heat shock protein-27 (Hsp-27) antibody levels in patients with chest pain: Association with established cardiovascular risk factors, CLINICA CHIMICA ACTA 395 (1-2) pp. 42-46 ELSEVIER SCIENCE BV
Macaulay M, Broadbridge J, Gage H, Williams P, Birch B, Moore KN, Cottenden A, Fader MJ (2015) A trial of devices for urinary incontinence after treatment for prostate cancer, BJU International 116 (3) pp. 432-442
© 2014 The Authors. BJU International © 2014 BJU International Published by John Wiley & Sons Ltd.Objective To compare the performance of three continence management devices and absorbent pads used by men with persistent urinary incontinence (>1 year) after treatment for prostate cancer. Patients and Methods Randomised, controlled trial of 56 men with 1-year follow-up. Three devices were tested for 3 weeks each: sheath drainage system, body-worn urinal (BWU) and penile clamp. Device and pad performance were assessed. Quality of life (QoL) was measured at baseline and follow-up with the King's Health Questionnaire. Stated (intended use) and revealed (actual use) preference for products were assessed. Value-for-money was gathered. Results Substantial and significant differences in performance were found. The sheath was rated as 'good' for extended use (e.g. golf and travel) when pad changing is difficult; for keeping skin dry, not leaking, not smelling and convenient for storage and travel. The BWU was generally rated worse than the sheath and was mainly used for similar activities but by men who could not use a sheath (e.g. retracted penis) and was not good for seated activities. The clamp was good for short vigorous activities like swimming/exercise; it was the most secure, least likely to leak, most discreet but almost all men described it as uncomfortable or painful. The pads were good for everyday activities and best for night-time use; most easy to use, comfortable when dry but most likely to leak and most uncomfortable when wet. There was a preference for having a mixture of products to meet daytime needs; around two-thirds of men were using a combination of pads and devices after testing compared with baseline. Conclusions This is the first trial to systematically compare different continence management devices for men. Pads and devices have different strengths, which make them particularly suited to certain circumstances and activities. Most men prefer to use pads at night but would choose a mixture of pads and devices during the day. Device limitations were important but may be overcome by better design.
Egan B, Gage H, Williams P, Brands B, Györei E, López-Robles JC, Campoy C, Decsi T, Koletzko B, Raats M (2016) The effect of diet on the physical and mental development of children: views of parents and teachers in four European countries., The British journal of nutrition pp. 1-9
Although the impact of diet on physical health is an important public health issue, less attention has been devoted to the relationship between nutrition and children's mental development. The views of parents and teachers about the extent to which diet affects physical and mental development of children were compared in four European countries. An online questionnaire (developed in English and translated) was circulated through a market research agency. Participants were parents or teachers of children aged 4-10 years without learning or behavioural issues. Questionnaires were returned by 1606 parents (401 in England, Germany and Hungary; 403 in Spain) and 403 teachers (100 in each country, except for 103 in Hungary). Teachers were older than parents (35·3 % v. 18·3 % over 45 years; P
Madhuri TK, Haagsma BEN, Williams P, Tailor A, Butler-Manuel SA (2014) PATHOLOGIC ANALYSIS OF TISSUE DESTRUCTION WITH NEUTRAL ARGON PLASMA, INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER 24 (9) pp. 1022-1023 LIPPINCOTT WILLIAMS & WILKINS
Krasovitsky A, Baerman M, Brown D, Corbett G, Williams P (2010) Morphosyntactic Change in Russian: A Corpus-based Approach, In: Hansen B, Grkovi?-Major J (eds.), Diachronic Slavic syntax: Gradual changes in focus. 74 pp. 109-119 Verlag Otto Sagner
Morgan J, Williams P, Norris F, Williams CM, Larkin M, Hampton S (2004) Eczema and early solid feeding in preterm infants, ARCHIVES OF DISEASE IN CHILDHOOD 89 (4) pp. 309-314 B M J PUBLISHING GROUP
Gage H, Avery M, Flannery C, Williams P, Fader M (2016) Community prevalence of long-term urinary catheters use in England., Neurourology and urodynamics
To calculate the prevalence of long term catheter use in the community in two areas in the south and west of England.People in England register with general practices to access health care through a National Health Service. Catheters are provided by prescription free of charge. In 2008, patients using urinary catheters for over 3 months were identified, and demographic information collected, from databases of general practices, using catheter prescribing records. The age and sex distributions of people in each practice were obtained from capitation claims. Overall, and age and sex-specific prevalence were calculated separately for each area, and compared.A total of 583 long term catheter users (329 south, 254 west) were identified from 404,328 people registered with practices. The overall population prevalence is similar in both locations (0.146% southern, 0.141% western). Extrapolating for the United Kingdom, this is over 90,000 long term catheter users. Prevalence increases with age (0.732% in over 70 years, 1.224% over 80), especially amongst men. Overall, higher proportions have neurological (vs. non-neurological) reasons (62.9% vs. 37.1%) and use urethral (vs. suprapubic) catheters (59.7% vs. 40.3%). Compared to men, more women tend to use suprapubic (56.4% vs. 29.3%) and have a catheter for neurological reasons (71.8% vs. 56.2%, P = 0.053).Previous evidence on prevalence of long term catheter use is sparse, and of variable quality. The strength of this study is utilisation of a reliable source of data (catheter prescriptions) from a large population of patients. Neurourol. Urodynam. © 2016 Wiley Periodicals, Inc.
Balmer TV, Williams P, Selman IE (1997) Comparison of carprofen and flunixin meglumine as adjunctive therapy in bovine respiratory disease, VETERINARY JOURNAL 154 (3) pp. 233-241 BAILLIERE TINDALL
Dowson HM, Ballard K, Gage H, Jackson D, Williams P, Rockall TA (2013) Quality of Life in the First 6 Weeks Following Laparoscopic and Open Colorectal Surgery, VALUE IN HEALTH 16 (2) pp. 367-372 ELSEVIER SCIENCE INC
Rayman MP, Bath SC, Westaway J, Williams P, Mao J, Vanderlelie JJ, Perkins AV, Redman CWG (2015) Selenium status in UK pregnant women and its relationship with hypertensive conditions of pregnancy, British Journal of Nutrition 113 (2) pp. 249-258
© 2015 The Authors.Dietary intake/status of the trace mineral Se may affect the risk of developing hypertensive conditions of pregnancy, i.e. pre-eclampsia and pregnancy-induced hypertension (PE/PIH). In the present study, we evaluated Se status in UK pregnant women to establish whether pre-pregnant Se status or Se supplementation affected the risk of developing PE/PIH. The samples originated from the SPRINT (Selenium in PRegnancy INTervention) study that randomised 230 UK primiparous women to treatment with Se (60 mg/d) or placebo from 12 weeks of gestation. Whole-blood Se concentration was measured at 12 and 35 weeks, toenail Se concentration at 16 weeks, plasma selenoprotein P (SEPP1) concentration at 35 weeks and plasma glutathione peroxidase (GPx3) activity at 12, 20 and 35 weeks. Demographic data were collected at baseline. Participants completed a FFQ. UK pregnant women had whole-blood Se concentration lower than the mid-range of other populations, toenail Se concentration considerably lower than US women, GPx3 activity considerably lower than US and Australian pregnant women, and low baseline SEPP1 concentration (median 3.00, range 0.90-5.80 mg/l). Maternal age, education and social class were positively associated with Se status. After adjustment, whole-blood Se concentration was higher in women consuming Brazil nuts (P=0.040) and in those consuming more than two seafood portions per week (P=0.054). A stepwise logistic regression model revealed that among the Se-related risk factors, only toenail Se (OR 0.38, 95% CI 0.17, 0.87, P=0.021) significantly affected the OR for PE/PIH. On excluding non-compliers with Se treatment, Se supplementation also significantly reduced the OR for PE/PIH (OR 0.30, 95% CI 0.09, 1.00, P=0.049). In conclusion, UK women have low Se status that increases their risk of developing PE/PIH. Therefore, UK women of childbearing age need to improve their Se status.
Fader MJ, Cottenden AM, Gage HM, Williams P, Getliffe K, Clarke-O'Neill S, Jamieson KM, Green NJ (2014) Individual budgets for people with incontinence: Results from a 'shopping' experiment within the British National Health Service, Health Expectations 17 (2) pp. 186-196
Background and context Most people with urinary incontinence are given limited choice when provided with absorbent products through the British National Health Service (NHS), even though the available range is large. Objective To investigate users' preferences for four disposable designs (inserts, all-in-ones, belted/T-shaped and pull-ups) and towelling washable/reusable products, day and night. Design Shopping experiment. Setting and participants Community-dwelling women and men in England with moderate-to-heavy urinary incontinence recruited to a larger trial. Intervention Participants tested each design and selected products they would prefer with a range of different budgets. Main outcome measures Design preferences (rankings); 'purchasing' decisions from designated budgets. Results Eighty-five participants (49 men) tested products, 75 completed the shopping experiment. Inserts, most frequently supplied by the NHS, were ranked second to pull-ups by women and lowest by men. When faced with budget constraints, up to 40% of participants opted to 'mix-and-match' designs. Over 15 different combinations of products were selected by participants in the shopping experiment. Most (91%) stated a willingness to 'top-up' assigned budgets from income to secure preferred designs. © 2012 John Wiley & Sons Ltd.
Courtenay M, Carey N, Gage H, Stenner K, Williams P (2015) A comparison of prescribing and non-prescribing nurses in the management of people with diabetes, JOURNAL OF ADVANCED NURSING 71 (12) pp. 2950-2964 WILEY-BLACKWELL
Jakobik V, Martin-Bautista E, Gage H, Von Rosen-Von Hoewel J, Laitinen K, Schmid M, Morgan J, Williams P, Campoy C, Koletzko B, Raats MM, Decsi T (2011) Programming effect of breast-feeding in infant nutrition policy documents in Hungary | Az anyatejes táplálás hosszú távú hatásainak megjelenése a csecsemotáplálási irányelvekben Magyarországon, Orvosi Hetilap 152 (41) pp. 1641-1647 Akadémiai Kiadó
Aims: To identify and describe infant feeding policy documents in Hungary and compare them to the documents of other four European countries (England, Finland, Germany and Spain). The question was also addressed how the phenomenon of nutritional programming was represented in the documents. Subjects: Policy documents on infant feeding were identified and analyzed in the five European countries by using uniform methods for searching and coding. Results: Twenty-six documents were identified: 4 in England, 2 in Finland, 9 in Germany, 6 in Hungary and 5 in Spain. Altogether 203 statements linked to references were identified: benefits of breast-feeding in general (24%), protection against infections (32%), long-term advantages like the prevention of diabetes (31%) or allergy (12%). Considerable variations were found within and between countries in the evaluation of the duration and character of the positive effects. The majority of the statements in the Hungarian documents referred either to the role of breast-feeding in infection protection (n = 8), or to long-term protective effects (n = 13). Conclusion: Policy documents in the study countries varied both in their extent and in the description of the long-term effects of infant nutrition. Majority of the documents failed to contain evidence based discussion of the phenomenon of early nutritional programming.
Gage H, Ting S, Williams P, Drennan V, Goodman C, Iliffe S, Manthorpe J, Davies SL, Masey H (2013) Nurse-led case management for community dwelling older people: An explorative study of models and costs, Journal of Nursing Management 21 (1) pp. 191-201
Aim To compare community matrons with other nurses carrying out case management for impact on service use and costs. Background In England, nurses working in general practice, as district nurses and disease-specific nurses, undertake use case management. Community matrons were introduced to case management to reduce unplanned hospitalizations of people with complex conditions. Methods Managers in three Primary Care Trusts (PCTs) identified four nurses/matrons engaged in case management. Nurses/matrons recruited five community-dwelling patients referred to them for case management. Patients reported use of health/social services for 9months, 2008 to 2009. Nurses/matrons completed activity diaries. Results Service use data were available for 33 patients. Compared with other nurse case managers, community matrons had: smaller caseloads; more patient contact time (mean 364 vs. 80minutes per patient per month); and older patients (mean age 81 vs. 75years, P=0.03) taking more medications (mean 8.9 vs. 5.6, P=0.014). Monthly costs were significantly higher for patients managed by community matrons (add £861), and who lived alone (add £696). Hospitalizations were not associated with patient or service delivery factors. Conclusion Further research on cost-effectiveness of case management models is required. Implications for Nursing Management The case for continued investment in community matrons remains to be proven. © 2012 Blackwell Publishing Ltd.
Gage H, Egan B, Williams P, Gyoerei E, Brands B, Lopez-Robles J, Campoy C, Koletzko B, Decsi T, Raats M (2014) Views of parents in four European countries about the effect of food on the mental performance of primary school children, European Journal of Clinical Nutrition 68 (1) pp. 32-37 Nature Publishing Group

Background/Objectives: Several factors affect the mental performance of children. The importance that parents attribute to food-related determinants, compared with genetic, socio-economic and school environment, was investigated.

Subjects/Methods: Parents of school children (aged 4?11) were recruited through state primary schools in four European countries. Interviews were conducted in which participants were asked to sort 18 cards representing possible determinants of four elements of mental performance (attention, learning, mood and behaviour) according to perceived strength of effect. Determinants were identified from the literature and grouped in six categories: food-related, school environment, physical, social, psychological and biological. Effects were scored: 0=none; 1=moderate; and 2=strong. Views were compared between and within countries.

Results: Two hundred parents took part (England: 53; Germany: 45; Hungary: 52; Spain: 50). Differences existed between countries in the proportions reporting university education and being in employment. Taking all countries together, parents consider the food category (mean 1.33) to have a lower impact on a child?s mental performance than physical (activity and sleep, 1.77), psychological (mood and behaviour, 1.69) and school environment (1.57). Social (1.12) and biological (0.91) determinants were ranked lower than food. Of determinants in the food category, parents thought regularity of meals had more influence on mental performance (1.58) than what a child eats now (1.36), food at school (1.35), nutrition as a baby/infant (1.02).

Conclusion: Scope exists to improve parental awareness of the repercussions of their dietary choices for the mental performance of their children.

Hindson D, Colliety P, Williams P, Shawe J (2012) An audit review of end-of-life care for inpatients with diabetes, Journal of Diabetes Nursing 16 (4) pp. 154-159
The decision to withdraw capillary blood glucose (CBG) monitoring and glycaemic treatment at the end of life in people with diabetes may have implications for comfort-care management in the dying individual in the acute care setting. The paradigm shift to the self-management of diabetes through CBG monitoring enables patients or their relatives to contribute to decisions for the withdrawal of CBG monitoring or antidiabetes treatment. Although it is unknown whether glycaemic symptoms are perceived in dying persons in the same way as those in full health, there is still an obligation to consider their effects on comfort at the end of life. In this article, the authors report the findings from a medical-notes audit in which they evaluated some key assumptions about advocacy (self or other) for end-of-life care decisions and the management of diabetes.
Gage H, Goodman C, Davies SL, Norton C, Fader M, Wells M, Morris J, Williams P (2010) Laxative use in care homes, JOURNAL OF ADVANCED NURSING 66 (6) pp. 1266-1272 WILEY-BLACKWELL
Arendt J, Middleton B, Williams P, Francis G, Luke C (2006) Sleep and circadian phase in a ships crew, JOURNAL OF BIOLOGICAL RHYTHMS 21 (3) pp. 214-221 SAGE PUBLICATIONS INC
Gage H, Raats MM, Williams P, Egan B, Jakobik V, Laitinen K, Martin-Bautista E, Schmid M, von Rosen-von Hoewel J, Campoy C, Decsi T, Morgan J, Koletzko B (2011) Developmental origins of health and disease: the views of first-time mothers in 5 European countries on the importance of nutritional influences in the first year of life., American Journal of Clinical Nutrition 94 (6S) pp. 2018S-2024S American Society for Nutrition
Background: The programming concept suggests that poor early nutrition causes an array of medical problems later in life. Public health messages about the implications of programming may not be reaching parents and influencing infant feeding behaviors.

Objective: The views of new mothers were sought about the extent to which lifelong health is influenced by diet as an infant, rather than by genetic predispositions or lifestyles and behaviors.

Design: A questionnaire survey of first-time mothers was undertaken in 5 European countries.

Results: A convenience sample of 2071 mothers from England (438), Finland (426), Germany (414), Hungary (389), and Spain (404) self-completed the questionnaire. High proportions of mothers agreed that how an infant is fed affects his or her health over the first year (95.8%) and in subsequent years (88.5%), but the effect of infant feeding decisions on the development of long-term conditions was the least-cited underlying reason. Diet as an infant was rated an extremely/very important influence on adult health by 64% of mothers, equivalent to environmental pollution (63%), but by fewer mothers than were diet and physical activity in childhood/adolescence (79%, 84%) and adulthood (81%, 83%), genetics/inheritance (70%), and exposure to cigarette smoke (81%). Inter- and intracountry differences were observed.

Conclusions: Mothers in this study consider diet as an infant to be a less important influence on lifelong health than many lifestyle, behavioral, and environmental factors and genetics. Further dissemination of the implications of programming to consumers may be warranted.

Gyoerei E, Egan B, Gage H, Williams P, Raats M, Brands B, Lopez-Robles J, Campoy C, Koletzko B, Decsi T (2011) Effect of food on learning: views of parents in four European countries, ANNALS OF NUTRITION AND METABOLISM 58 pp. 137-138
Gage H, Williams P, Von Rosen-Von Hoewel J, Laitinen K, Jakobik V, Martin-Bautista E, Schmid M, Egan B, Morgan J, Decsi T, Campoy C, Koletzko B, Raats M (2012) Influences on infant feeding decisions of first-time mothers in five European countries, European Journal of Clinical Nutrition 66 (8) pp. 914-919
BACKGROUND/OBJECTIVES:Infant feeding decisions made by new parents have significant health implications. The study aimed to investigate: influences on infant feeding decisions; characteristics of mothers reporting reliance on alternative information sources; associations between reliance on different sources and intentions to exclusively breastfeed and introduce complementary foods later; and subsequent breastfeeding and weaning behaviours.SUBJECTS/ METHODS:First-time mothers in five European countries (England, Finland, Germany, Hungary, Spain) completed questionnaires about the importance of 17 influences on infant feeding choices at birth and 8 months later, during 2007-2008. Use of individual sources and reliance on four categories (family and friends, health professionals, written materials, audio-visual media) were compared between countries. Associations between information sources used and mother characteristics, feeding intentions and behaviours were investigated using appropriate statistical tests.RESULTS:In all, 2071 first-time mothers provided baseline data; 78% at 8 months. Variation exists between countries in the influence of different sources on feeding decisions of first-time mothers. Across all countries, the most important influences at both time points were books, partner and antenatal midwife. Mothers in higher income quintiles and remaining at school beyond age 16 years reported greater reliance on written sources (P0.0005). Mothers relying most on written sources reported longer exclusive breastfeeding (P0.002), and a tendency to introduce foods other than milk later (P0.079) than mothers relying most on personal or professional contacts.CONCLUSION:Further research is required about which dissemination strategies are most effective at improving infant feeding behaviours in varied cultural settings, and for different socio-economic groups. © 2012 Macmillan Publishers Limited.
Flannery C, Burke LA, Grainger L, Williams P, Gage H (2015) Risky sun tanning behaviours amongst Irish University students: a quantitative analysis., Irish journal of medical science
Despite Ireland's temperate maritime climate, it has the third highest rate of malignant melanoma in the European Union, indicating the need to recognise tanning practices as a risky behaviour, especially amongst those most at risk (the younger population).To explore the factors associated with deliberate sun tanning amongst university students in Cork, Ireland.Self-reported sun exposure, attitudes to tanning and sun protection practices were investigated using an online questionnaire in April 2010.There were 833 responses (8.33 %), mean age 22 years, 75 % female. Reporting deliberate tanning in the previous summer (n = 389, 46.7 %) was positively correlated (r = 0.622, p 
Gage H, Cheynel J, Williams P, Mitchell K, Stinton C, Katz J, Holland C, Sheehan B (2015) Service utilisation and family support of people with dementia: A cohort study in England, International Journal of Geriatric Psychiatry 30 (2) pp. 166-177
Copyright © 2014 John Wiley & Sons, Ltd.Objectives: This study aimed to compare costs of caring for people with dementia in domiciliary and residential settings, central England. Methods: A cohort of people with dementia was recruited during a hospital stay 2008-2010. Data were collected by interview at baseline, and 6- and 12-month follow-up, covering living situation (own home with or without co-resident carer, care home); cognition, health status and functioning of person with dementia; carer stress; utilisation of health and social services; and informal (unpaid) caring input. Costs of formal services and informal caring (replacement cost method) were calculated. Costs of residential and domiciliary care packages were compared. Results: Data for 109 people with dementia were collected at baseline; 95 (87.2%) entered hospital from their own homes. By 12 months, 40 (36.7%) had died and 85% of the survivors were living in care homes. Over one-half of people with dementia reported social care packages at baseline; those living alone had larger packages than those living with others. Median caring time for co-resident carers was 400 min/day and 10 h/week for non co-resident carers. Residential care was more costly than domiciliary social care for most people. When the value of informal caring was included, the total cost of domiciliary care was higher than residential care, but not significantly so. Carer stress reduced significantly after the person with dementia entered a care home. Conclusions: Caring for people with dementia at home may be more expensive, and more stressful for carers, than care in residential settings.
Gage HM, Grainger L, Ting S, Williams P, Chorley, C, Carey G, Borg N, Bryan K, Castleton B, Trend P, Kaye J, Jordan J, Wade D (2014) Specialist rehabilitation for people with Parkinson?s disease in the community: a randomized controlled trial, Health Services and Delivery Research 2 (51) NIHR Journals Library
Background: Multidisciplinary rehabilitation is recommended for Parkinson?s disease, but evidence
suggests that benefit is not sustained.
Objectives: (1) Implement a specialist domiciliary rehabilitation service for people with Parkinson?s and
carers. (2) Provide continuing support from trained care assistants to half receiving the rehabilitation.
(3) Evaluate the clinical effectiveness of the service, and the value added by the care assistants, compared
with usual care. (4) Assess the costs of the interventions. (5) Investigate the acceptability of the service.
(6) Deliver guidance for commissioners.
Design: Pragmatic three-parallel group randomised controlled trial.
Setting: Community, county of Surrey, England, 2010?11.
Participants: People with Parkinson?s, at all stages of the disease, and live-in carers.
Interventions: Groups A and B received specialist rehabilitation from a multidisciplinary team
(MDT) ? comprising Parkinson?s nurse specialists, physiotherapists, occupational therapists, and speech
and language therapists ? delivered at home, tailored to individual needs, over 6 weeks (about 9 hours?
individual therapy per patient). In addition to the MDT, participants in group B received ongoing support
for a further 4 months from a care assistant trained in Parkinson?s (PCA), embedded in the MDT
(1 hour per week per patient). Participants in control group (C) received care as usual (no co-ordinated
MDT or ongoing support).
Main outcome measures: Follow-up assessments were conducted in participants? homes at 6, 24 and
36 weeks after baseline. Primary outcomes: Self-Assessment Parkinson?s Disease Disability Scale (patients);
the Modified Caregiver Strain Index (carers). Secondary outcomes included: for patients, disease-specific
and generic health-related quality of life, psychological well-being, self-efficacy, mobility, falls and speech;
for carers, strain, stress, health-related quality of life, psychological well-being and functioning. Results: A total of 306 people with Parkinson?s (and 182 live-in carers) were randomised [group A,
n = 102 (n = 61); group B, n = 101 (n = 60); group C, n = 103 (n = 61)], of whom 269 (155) were analysed
at baseline, pilot cohort excluded. Attrition occurred at all stages. A per-protocol analysis [people with
Parkinson?s, n = 227 (live-in carers, n = 125)] [group A, n = 75 (n = 45); group B, n = 69 (n = 37); group C,
n = 83 (n = 43)] showed that, at the end of the MDT intervention, people with Parkinson?s in group
Gage H, Ting S, Williams P, Drennan V, Goodman C, Iliffe S, Manthorpe J, Davies SL, Masey H (2012) Nurse-led case management for community dwelling older people: An explorative study of models and costs, Journal of Nursing Management
Aim To compare community matrons with other nurses carrying out case management for impact on service use and costs. Background In England, nurses working in general practice, as district nurses and disease-specific nurses, undertake use case management. Community matrons were introduced to case management to reduce unplanned hospitalizations of people with complex conditions. Methods Managers in three Primary Care Trusts (PCTs) identified four nurses/matrons engaged in case management. Nurses/matrons recruited five community-dwelling patients referred to them for case management. Patients reported use of health/social services for 9months, 2008 to 2009. Nurses/matrons completed activity diaries. Results Service use data were available for 33 patients. Compared with other nurse case managers, community matrons had: smaller caseloads; more patient contact time (mean 364 vs. 80minutes per patient per month); and older patients (mean age 81 vs. 75years, P=0.03) taking more medications (mean 8.9 vs. 5.6, P=0.014). Monthly costs were significantly higher for patients managed by community matrons (add £861), and who lived alone (add £696). Hospitalizations were not associated with patient or service delivery factors. Conclusion Further research on cost-effectiveness of case management models is required. Implications for Nursing Management The case for continued investment in community matrons remains to be proven. © 2012 Blackwell Publishing Ltd.
Gage H, Egan B, Williams P, Lopez-Robles JC, Brands B, Gyoerei E, Campoy C, Desci T, Koletzko B, Raats M (2013) ASSOCIATION BETWEEN DIET AND PHYSICAL AND MENTAL DEVELOPMENT OF CHILDREN: VIEWS OF PARENTS AND TEACHERS IN FOUR EUROPEAN COUNTRIES, ANNALS OF NUTRITION AND METABOLISM 63 pp. 1863-1863 KARGER
Gage H, Dickinson A, Victor C, Williams P, Cheynel J, Davies SL, Iliffe S, Froggatt K, Martin W, Goodman C (2012) Integrated working between residential care homes and primary care: a survey of care homes in England, BMC GERIATRICS 12 ARTN 71 BIOMED CENTRAL LTD
Gage H, Egan B, Williams P, Brands B, Györei E, López-Robles J, Campoy C, Decsi T, Koletzko B, Raats M (2016) Importance of mental performance in parental choice of food for children aged 4 ? 10 years: a study in four European countries, Public Health Nutrition 20 (6) pp. 992-1000 Cambridge University Press
Objective: Typically, attention focuses on how nutrition affects physical health. The present study investigated the importance that parents attach to the impact of diet on mental performance when choosing food for their child. Design: Questionnaire. Setting: Four European countries. Subjects: Parents of children aged 4?10 years (n 1574): England (n 397), Germany (n 389), Hungary (n 398) and Spain (n 390). Results: Most parents (80?85 %) considered the effect of food on four elements of mental performance (child?s ability to learn, attention, behaviour, mood) to be moderately, very, extremely (v. slightly, not at all) important in food choices; over 90% considered healthiness of food and making food appealing to their child important; 79·8% cost; 76·8% convenience. Belief that food affects mental performance was 57·4% (ability to learn), 60·5% (attention); less than 40% of parents agreed they were aware which foods had an effect. Parents with lower general interest in healthy eating were less likely to consider the effect of food on mental performance elements as important. Respondents from Germany were more likely to rate mental performance as important (except behaviour); those in Hungary less likely. The most important influence on parents? decisions about feeding their child was their own experience, except Spain, where family/friends/ health professionals were more important. Conclusions: Nutrition affects brain development and cognitive functioning. Low prioritisation of the effect of food on mental performance indicates potential for educating parents.
Axelrod L, Bryan K, Gage H, Kaye J, Ting S, Williams P, Trend P, Wade D (2012) Disease-specific training in Parkinson's disease for care assistants: A comparison of interactive and self-study methods, Clinical Rehabilitation 26 (6) pp. 545-557
Objective: To compare two approaches to providing training to care assistants in Parkinson's disease.Design: Pragmatic parallel arm controlled trial.Setting: Training either by an interactive training day at a local medical education establishment or self study.Subjects: Care assistants recruited from local health and social care providers.Interventions: The content of both interventions was similar, covering causes, symptoms, diagnosis of Parkinson's disease, multidisciplinary management, mobility, communication, swallowing, and involving 5 hours of study time.Main measures: Knowledge about Parkinson's (assessed by true/false quizzes and identifying 'four facts' about Parkinson's) immediately post training and six weeks later; views on training methods of care assistants and employers/managers.Results: Thirty-seven employers nominated 100 care staff who were allocated to interactive training (49) and self study (51). Training completion rates (retained to six-week follow-up) were lower for self study (42.1% vs. 83.7% training day). There were no significant differences between groups on quiz or 'four facts' scores at baseline or six-week follow-up. Immediately post training, the self-study group (with access to written materials) had significantly higher quiz scores than the training day group (no access to materials at test). Within-group comparisons showed improvements post training. Although interactive training may be preferred, obtaining release from duties can be problematic.Conclusions: Both approaches have similar effects on knowledge of care assistants without prior specific training. Providing a variety of approaches will cater for all preferences. The findings may be generalizable to training the care workforce for other specific roles. © The Author(s) 2011.
Morgan JB, Williams P, Foote KD, Marriott LD (2006) Do mothers understand healthy eating principles for low-birth-weight infants?, PUBLIC HEALTH NUTRITION 9 (6) pp. 700-706 CAMBRIDGE UNIV PRESS
Martin-Bautista E, Gage H, von Rosen-von Hoewel J, Jakobik V, Laitinen K, Schmid M, Morgan J, Williams P, Decsi T, Campoy C, Koletzko B, Raats M (2010) Lifetime health outcomes of breast-feeding: a comparison of the policy documents of five European countries, PUBLIC HEALTH NUTRITION 13 (10) pp. 1653-1662 CAMBRIDGE UNIV PRESS
Batehup L, Porter K, Gage H, Williams P, Simmonds P, Lowson E, Dodson L, Davies N, Wagland R, Winter J, Richardson A, Turner A, Corner J (2017) Follow-up after curative treatment for colorectal cancer: longitudinal evaluation of patient initiated follow-up in the first 12 months., Supportive Care in Cancer 25 (7) pp. 2063-2073 Springer Verlag
Purpose: To compare patient-triggered follow-up (PTFU) for curatively treated colorectal cancer against traditional outpatient follow-up (OPFU). Methods: Questionnaires were mailed at four time points over one-year post-treatment to two prospectively-recruited cohorts: A, patients entering follow-up and receiving OPFU pre-implementation of PTFU; B, patients entering follow-up (FU) and receiving either OPFU (B1) or PTFU (B2) post-implementation of PTFU. Bi-variate tests were used to compare patient characteristics and outcomes eight months after entering follow-up (generic and cancer-specific quality of life (QoL), satisfaction). Regression analysis explored associations between follow-up model and outcomes. Resource implications and costs of models were compared. Results: Patients in Cohort B1 were significantly more likely to have received chemotherapy (p
Ebru E, Saigal P, Gage HM, Raats MM, Ogden JE, Qiao Y, Williams P (2010) Overweight and obesity in children: a comparison of the views of general practitioners and parents, Proceedings of the Nutrition Society 69 Cambridge University Press
Parker Wendy, Gage Heather, Sterr Annette, Williams Peter (2017) Holiday play for disabled children in England: access, choice and parents? views about integration, International Journal of Disability, Development and Education 64 (6) pp. 573-595 Taylor & Francis
Families with children with disabilities can feel isolated during school holidays and concerns exist that they face greater difficulties than families of children without disabilities in finding enriching activities for their child. In the context of national policies that encourage integrated play, local service commissioners in England require evidence on what sort of short breaks parents and children prefer. The parents of 99 children with disabilities and 43 children without disabilities attending various holiday play schemes in summer 2010 completed mailed questionnaires. Parents of children with disabilities reported more difficulty getting information, less choice of schemes and further distances to travel than parents of children without disabilities. Although 72% of parents of children without disabilities and 55.5% of parents of children with disabilities stated integrated schemes would be suitable for their child, open text comments provided weaker support. Variety of provision is required to meet all needs and preferences.
Halimic Aida, Gage Heather, Raats Monique, Williams Peter (2017) Effect of price and information on the food choices of women university students in Saudi Arabia: an experimental study, Appetite 123 pp. 175-182 Elsevier
Objective:

To explore the impact of price manipulation and healthy eating information on intended food choices

Design:

Health information was provided to a random half of subjects (vs. information on Saudi agriculture). Each subject chose from the same lunch menu, containing two healthy and two unhealthy entrees, deserts and beverages, on five occasions. Reference case prices were 5, 3 and 2 Saudi Arabian Reals (SARs). Prices of healthy and unhealthy items were manipulated up (taxed) and down (subsidised) by 1 SAR in four menu variations (random order); subjects were given a budget enabling full choice within any menu. The number of healthy food choices were compared with different price combinations, and between information groups. Linear regression modelling explored the effect of relative prices of healthy / unhealthy options and information on number of healthy choices controlling for dietary behaviours and hunger levels.

Setting:

University campus, Saudi Arabia, 2013

Subjects:

99 women students

Results:

In the reference case, 49.5% of choices were for healthy items. When the price of healthy items was reduced, 58.5% of selections were healthy; 57.2% when the price of unhealthy items rose. In regression modelling, reducing the price of healthy items and increasing the price of unhealthy items increased the number of healthy choices by 5% and 6% respectively. Students reporting a less healthy usual diet selected significantly fewer healthy items. Providing healthy eating information was not a significant influence.

Conclusion:

Price manipulation offers potential for altering behaviours to combat rising youth obesity in Saudi Arabia.

Robertson T, Clifford M, Penson S, Williams P, Robertson M (2018) Postprandial glycaemic and lipaemic responses to chronic coffee consumption may be
modulated by CYP1A2 polymorphisms.,
British Journal of Nutrition 119 (7) pp. 792-800 Cambridge University Press
There is much epidemiological evidence suggesting a reduced risk of development of
type 2 diabetes (T2D) in habitual coffee drinkers, however to date there have been few longer
term interventions, directly examining the effects of coffee intake on glucose and lipid
metabolism. Previous studies may be confounded by inter-individual variation in caffeine
metabolism. Specifically, the rs762551 single nucleotide polymorphism (SNP) in the CYP1A2
gene has been demonstrated to influence caffeine metabolism, with carriers of the C allele
considered to be of a ?slow? metaboliser phenotype. This study investigated the effects of
regular coffee intake on markers of glucose and lipid metabolism in coffee-naïve individuals,
with novel analysis by rs762551 genotype. Participants were randomised to either a coffee
group (n=19) who consumed 4 cups/day instant coffee for 12 weeks or a control group (n=8)
who remained coffee/caffeine free. Venous blood samples were taken pre- and post13
intervention. Primary analysis revealed no significant differences between groups. Analysis of
the coffee group by genotype revealed several differences. Prior to coffee intake, the AC
genotype (?slow? caffeine metabolisers, n=9) displayed higher baseline glucose and non
esterified fatty acids (NEFA) than the AA genotype (?fast? caffeine metabolisers, n=10,
p were observed in the AC genotype, with the opposite result observed in the AA genotype
(p indicate there may be no one-size-fits-all recommendation with regard to coffee drinking and
T2D risk.