General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms cancer was higher in the intervention (4.3%) group than control (3.6%) group, but there was no significant difference in prostate cancer mortality (intervention, 0.29% vs. control, 0.29%) after a median follow-up of 10-years. Meaning:The CAP single PSA-screen intervention detected more prostate cancer cases, but after a median of 10-years' follow-up has, thus far, had no significant effect on prostate cancer mortality. Conclusion and relevance:Among practices randomized to a low-intensity PSA screening intervention compared with standard practice, there was no significant difference in prostate cancer mortality after a 4 median 10-years follow up, but the detection of low-risk prostate cancers increased. Although longer-term follow-up is in progress, the current findings do not support single PSA-testing for population-based screening.

Objective To investigate the effectiveness of a school based intervention to increase physical activity, reduce sedentary behaviour, and increase fruit and vegetable consumption in children.Design Cluster randomised controlled trial.Setting 60 primary schools in the south west of England.Participants Primary school children who were in school year 4 (age 8-9 years) at recruitment and baseline assessment, in year 5 during the intervention, and at the end of year 5 (age 9-10) at follow-up assessment.Intervention The Active for Life Year 5 (AFLY5) intervention consisted of teacher training, provision of lesson and child-parent interactive homework plans, all materials required for lessons and homework, and written materials for school newsletters and parents. The intervention was delivered when children were in school year 5 (age 9-10 years). Schools allocated to control received standard teaching.Main outcome measures The pre-specified primary outcomes were accelerometer assessed minutes of moderate to vigorous physical activity per day, accelerometer assessed minutes of sedentary behaviour per day, and reported daily consumption of servings of fruit and vegetables.Results 60 schools with more than 2221 children were recruited; valid data were available for fruit and vegetable consumption for 2121 children, for accelerometer assessed physical activity and sedentary behaviour for 1252 children, and for secondary outcomes for between 1825 and 2212 children for the main analyses. None of the three primary outcomes differed between children in schools allocated to the AFLY5 intervention and those allocated to the control group. The difference in means comparing the intervention group with the control group was -1.35 (95% confidence interval -5.29 to 2.59) minutes per day for moderate to vigorous physical activity, -0.11 (-9.71 to 9.49) minutes per day for sedentary behaviour, and 0.08 (-0.12 to 0.28) servings per day for fruit and vegetable consumption. The intervention was effective for three out of nine of the secondary outcomes after multiple testing was taken into account: self reported time spent in screen viewing at the weekend (-21 (-37 to -4) minutes per day), self reported servings of snacks per day (-0.22 (-0.38 to -0.05)), and servings of high energy drinks per day (-0.26 (-0.43 to -0.10)) were all reduced. Results from a series of sensitivity analyses testing different assumptions about missing data and from per protocol analyses produced similar results. ConclusionThe findings suggest that the AFLY5 school based intervention is not effective at increasing levels of physical activity,

OBJECTIVE. Rapid infant weight gain has been shown to predict later obesity risk; however, it is unclear which factors influence infant diet and weight gain. The objective of this study was to determine whether different feeding patterns and energy intakes that are provided to infants affect body weight and BMI later in childhood.METHODS. This representative birth cohort study was conducted in the United Kingdom. Energy intake at age 4 months was estimated from 1-day unweighed dietary records in 881 infants and related to their childhood weight gain and BMI.RESULTS. Among formula-or mixed-fed infants (N ϭ 582), energy intake was higher in first-born infants (mean Ϯ SE: 2730 Ϯ 29.4 kJ/day; n ϭ 263) than in subsequent-born infants (2620.8 Ϯ 25.2 kJ/day; n ϭ 296). Energy intake at 4 months was also higher in infants who were given solid foods earlier (1-2 months: 2805.6 Ϯ 50.4 kJ/day, n ϭ 89; 2-3 months: 2658.6 Ϯ 25.2 kJ/day, n ϭ 339; 4ϩ months: 2587.2 Ϯ 46.2 kJ/day, n ϭ 111). Higher energy intake at 4 months predicted greater weight gain between birth to age 1, 2, or 3 years and larger body weight and BMI at ages 1 to 5 years. No significant associations were seen in breastfed infants (N ϭ 299).CONCLUSIONS. Among formula-or mixed-fed infants, dietary energy intake at age 4 months predicted postnatal weight gain and childhood obesity risk. Both prenatal and postnatal factors may influence infant energy intake and postnatal weight gain. T HE WORK OF Hales and Barker 1 originally highlighted the possible link between early life influences and adult cardiovascular and metabolic disease. However, there is still much controversy as to whether prenatal rather than early postnatal nutrition influences later risks for obesity. Several recent population studies have reported that rapid weight gain during the first 2 to 3 years of life predicts increased obesity risk. We reported in the geographically based Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort that faster rates of weight gain between birth and 2 years predicted larger BMI, waist circumference, and body fat mass at 5 years of age. 2 Subsequent larger studies have confirmed that rapid weight gain during the first 4 to 12 months predicts larger BMI in later childhood 3,4 and also in young adults. 5,6 The first 2 to 3 years of postnatal life represents a hypervariable period of weight gain, as many infants show relatively rapid weight gain in apparent compensation for in utero growth restraint. 2,7,8 For example, first-born infants are thinner at birth and show subsequent rapid "catch-up" postnatal weight gain compared with a mother's subsequent offspring. 9 Infancy growth is largely regulated by nutrition, 10 and it is proposed that early postnatal catch-up and catch-down growth may be regulated by differences in appetite and satiety. 11 In the ALSPAC cohort, we therefore identified factors that influence early infancy dietary energy intake and hypothesized that greater energy intake at 4 months of age could predict subsequent faster chi...

Accurate resource-use measurement is challenging within an economic evaluation, but is a fundamental requirement for estimating efficiency. Considerable research effort has been concentrated on the appropriate measurement of outcomes and the policy implications of economic evaluation, while methods for resource-use measurement have been relatively neglected. Recently, the Database of Instruments for Resource Use Measurement (DIRUM) was set up at http://www.dirum.org to provide a repository where researchers can share resource-use measures and methods. A workshop to discuss the issues was held at the University of Birmingham in October 2011. Based on material presented at the workshop, this article highlights the state of the art of UK instruments for resource-use data collection based on patient recall. We consider methodological issues in the design and analysis of resource-use instruments, and the challenges associated with designing new questionnaires. We suggest a method of developing a good practice guideline, and identify some areas for future research. Consensus amongst health economists has yet to be reached on many aspects of resource-use measurement. We argue that researchers should now afford costing methodologies the same attention as outcome measurement, and we hope that this Current Opinion article will stimulate a debate on methods of resource-use data collection and establish a research agenda to improve the precision and accuracy of resourceuse estimates.

No abstract