Ruth Bell

Ruth Bell
Johns Hopkins Medicine | JHUSOM · Department of Radiation Oncology and Molecular Radiation Sciences

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80
Publications
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Introduction
Skills and Expertise

Publications

Publications (80)
Technical Report
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https://www.helsedirektoratet.no/rapporter/kunnskapsoppsummering-om-ulikheter-i-helse-og-livskvalitet-i-norge-siden-2014--sammendrag#referere Citation: Helsedirektoratet (2023). Kunnskapsoppsummering om ulikheter i helse og livskvalitet i Norge siden 2014 – sammendrag [nettdokument]. Oslo: Helsedirektoratet (sist faglig oppdatert 01. august 2023,...
Article
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Background/Objectives Obesity in pregnancy has been associated with increased childhood cardiometabolic risk and reduced life expectancy. The UK UPBEAT multicentre randomised control trial was a lifestyle intervention of diet and physical activity in pregnant women with obesity. We hypothesised that the 3-year-old children of women with obesity wou...
Article
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Background: Smoking during pregnancy has serious consequences for maternal and child health. An intervention package to embed National Institute for Health and Care Excellence guidance (babyClear©) was delivered across maternity and stop smoking services (SSS) within an English region, to support pregnant women to stop smoking. We aimed to ascerta...
Article
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Background: The National Health Service diabetes prevention programme in England, (NHS DPP) aims to identify people at high risk of type 2 diabetes (T2D) and offer them a face-to-face, group-based, behaviour change intervention for at least 9 months. The NHS DPP was rolled out in phases. We aimed to elicit stakeholders' perceptions and experiences...
Article
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Background: Smoking in pregnancy causes harm to mother and baby. Despite evidence from trials of what helps women quit, implementation in the real world has been hard to achieve. An evidence-based intervention, babyClear©, involving staff training, universal carbon monoxide monitoring, opt-out referral to smoking cessation services, enhanced follo...
Article
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Objective: The National Health Service (NHS) in England planned a national diabetes prevention programme (NHS DPP) with phased implementation. Evidence-based guidelines and service specifications support efficient and effective translation of research into practice. We aimed to evaluate the use of a structured mapping exercise to appraise how evid...
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: Obesity in pregnancy may negatively influence maternal and infant iron status. The aim of this study was to examine the association of obesity with inflammatory and iron status in both mother and infant in two prospective studies in pregnancy: UPBEAT and SCOPE. Maternal blood samples from obese (n = 245, BMI ≥ 30 kg/m2) and normal weight (n = 245...
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Objective: This paper highlights recruitment and retention problems identified during a pilot randomised controlled trial and process evaluation. The pilot trial aimed to evaluate the feasibility and acceptability of a web-delivered weight loss intervention for postnatal women and associated trial protocol. Results: General practice database sea...
Article
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Background and challenges to implementation An intervention to encourage and support pregnant women to stop smoking by implementing National Institute of Health and Clinical Excellence guidance (2010) was introduced across north east England, a region with almost 30 000 births per year. Intervention or response Comprised provision of equipment for...
Article
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Background and challenges to implementation In 2011/12, more pregnant women smoked at delivery in North East England (population 2.6 million) than the national average (21% vs 13%). Work with midwives across the region identified barriers to implementing national guidance for universal carbon monoxide (CO) screening and referral for smoking cessati...
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Objectives Evaluation of the demonstrator phase and first wave roll-out of the National Health Service (NHS) Diabetes Prevention Programme (DPP) in England. To examine: (1) intervention design, provision and fidelity assessment procedures; (2) risk assessment and recruitment pathways and (3) data collection for monitoring and evaluation. To provide...
Article
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Objectives Evaluation of the demonstrator phase and first wave roll-out of the National Health Service (NHS) Diabetes Prevention Programme (DPP) in England. To examine: (1) intervention design, provision and fidelity assessment procedures; (2) risk assessment and recruitment pathways and (3) data collection for monitoring and evaluation. To provide...
Article
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Background Obesity in pregnancy is associated with insulin resistance, which underpins many common complications including gestational diabetes mellitus (GDM) and fetal macrosomia. Objectives To assess the effect of a complex behavioural intervention based on diet and physical activity (PA) on the risk of GDM and delivery of a large-for-gestationa...
Article
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Objectives To evaluate the effectiveness of a complex intervention to improve referral and treatment of pregnant smokers in routine practice, and to assess the incremental costs to the National Health Service (NHS) per additional woman quitting smoking. Design Interrupted time series analysis of routine data before and after introducing the interv...
Article
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Background Understanding dietary patterns in obese pregnant women will inform future intervention strategies to improve pregnancy outcomes and the health of the child. The aim of this study was to investigate the effect of a behavioral intervention of diet and physical activity advice on dietary patterns in obese pregnant woman participating in the...
Article
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Maternal obesity is associated with an increased risk of pregnancy complications, including gestational diabetes. Physical activity (PA) might improve glucose metabolism and reduce the incidence of gestational diabetes. The purpose of this study was to explore patterns of PA and factors associated with change in PA in obese pregnant women. PA was a...
Article
Introduction: The incidence of pregnancies complicated by twinning and diabetes is increasing in the UK. This is a worrying trend as both diabetes and twinning are associated with a high risk of adverse pregnancy outcomes. The few studies that have specifically addressed how twinning and pre-gestational diabetes in the same pregnancy may affect ou...
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Behavioural interventions might improve clinical outcomes in pregnant women who are obese. We aimed to investigate whether a complex intervention addressing diet and physical activity could reduce the incidence of gestational diabetes and large-for-gestational-age infants. The UK Pregnancies Better Eating and Activity Trial (UPBEAT) is a randomised...
Article
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Women with preexisting (type 1 or type 2) diabetes experience an increased risk of serious adverse pregnancy outcomes. It is not known, however, how these risks change between the first and second pregnancy and whether there is an increased risk of recurrence. This study describes the absolute risks and recurrence of serious adverse pregnancy outco...
Article
Background: Obesity in pregnancy is associated with fetal macrosomia, a raised neonatal fat mass and an increased risk of obesity and poor metabolic health in childhood which persists into adulthood. The offspring of obese women are more likely to be obese than the offspring of lean women when they become pregnant themselves, perpetuating a cycle...
Article
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A person's mental health and many common mental disorders are shaped by various social, economic, and physical environments operating at different stages of life. Risk factors for many common mental disorders are heavily associated with social inequalities, whereby the greater the inequality the higher the inequality in risk. The poor and disadvant...
Article
Commentary on : Aune D, Saugstad OD, Henriksen T, et al. Maternal body mass index and the risk of fetal death, stillbirth and infant death: a systematic review and meta-analysis. JAMA 2014;311:1536–46.[OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Forty-two per cent of deliveries in England in 2007 involved obese or overweight women.1 Rai...
Article
Obesity in pregnancy is associated with macrosomia, neontatal fat mass and increased obesity and diabetes in the offspring. Physical activity during pregnancy may mediate the relationship between maternal insulin action and infant body composition. Interventions to increase physical activity might therefore improve metabolic outcomes for pregnant w...
Article
Diabetes, a common preexisting maternal condition complicating pregnancy, affects 0.5% to 2% of parturients. Optimizing glycemic control can improve birth outcomes in these women. Data from several population-based registers in the North of England were used to investigate the association between preexisting diabetes and risks of fetal and infant d...
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Education and wealth may have different associations with female obesity but this has not been investigated in detail outside high-income countries. This study examines the separate and inter-related associations of education and household wealth in relation to obesity in women in a representative sample of low- and middle-income countries (LMICs)....
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Despite the widespread recognition that obesity in pregnant women is associated with adverse outcomes for mother and child, there is no intervention proven to reduce the risk of these complications. The primary aim of this randomised controlled trial is to assess in obese pregnant women, whether a complex behavioural intervention, based on changing...
Article
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Pre-existing diabetes is associated with an increased risk of stillbirth, but few studies have excluded the effect of congenital anomalies. This study used data from a long-standing population-based survey of women with pre-existing diabetes to investigate the risks of fetal and infant death and quantify the contribution of glycaemic control. All n...
Article
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Background: Complex interventions in obese pregnant women should be theoretically based, feasible and shown to demonstrate anticipated behavioural change prior to inception of large randomised controlled trials (RCTs). The aim was to determine if a) a complex intervention in obese pregnant women leads to anticipated changes in diet and physical ac...
Article
In contrast to singletons, twins born to older mothers have lower rates of perinatal mortality than twins born to younger mothers. We examined whether differences in chorionicity could explain this unexpected maternal age effect. We used population-based data on twins born to mothers aged 20-29 (n = 3702) and ≥35 years (n = 1880) in the North of En...
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There is increasing evidence that pre-eclampsia, a principal cause of maternal morbidity, may also be a risk factor for future cardiovascular and cerebrovascular events. This review aimed to assess the current evidence and quantify the risks of cardiovascular disease (CVD), cerebrovascular events and hypertension associated with prior diagnosis of...
Article
The distribution of obesity in developed countries follows a social gradient. In developing countries, a similar pattern is emerging as national per capita income rises. The epidemiological evidence runs counter to the popular opinion that being overweight and obesity are matters solely of individual lifestyle choices or genetics. Both are importan...
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The population-based Northern Survey of Twin and Multiple Pregnancy (NorSTAMP, formerly the Multiple Pregnancy Register) has collected data since 1998 on all multiple pregnancies in North of England (UK) from the earliest point of ascertainment in pregnancy. This paper updates recent developments to the NorSTAMP and presents some early mortality da...
Article
The European region has seen remarkable heath gains in those populations that have experienced progressive improvements in the conditions in which people are born, grow, live, and work. However, inequities, both between and within countries, persist. The review reported here, of inequities in health between and within countries across the 53 Member...
Article
Objective: to explore midwives' perceptions of their training and education requirements in relation to maternal obesity. Design: an interpretive constructionist approach used focus groups and broad discussion topics to allow midwives to identify their own personal and professional needs. Data analysis incorporated researcher and data triangulat...
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Around 5,000 miscarriages and 300 perinatal deaths per year result from maternal smoking in the United Kingdom. In the northeast of England, 22% of women smoke at delivery compared to 14% nationally. Midwives have designated responsibilities to help pregnant women stop smoking. We aimed to assess perceived implementation difficulties regarding midw...
Data
Questionnaire “Smoking cessation and pregnant women: what are your views?”.
Article
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Health inequalities are present throughout the world, both within and between countries. The Commission on Social Determinants of Health drew attention to dramatic social gradients in health within most countries and made proposals for action. These inequalities are not inevitable. The purpose of this article is to report on activity that has taken...
Article
It is well established that twins have a higher risk of adverse birth outcomes compared with singletons; the stillbirth rate and neonatal mortality among twins are at least 4 times higher in twins. Chorionicity is an important predictor of perinatal mortality in twins. Most studies have reported higher risks of adverse perinatal outcomes in monocho...
Article
Chorionicity is one of the main predictors of higher perinatal mortality in twins. The aim of this large population-based study was to analyse stillbirth and neonatal mortality by cause of death and chorionicity and to quantify the risk of stillbirth by gestational age in dichorionic (DC) and monochorionic (MC) twins. We used data on twin materniti...
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Inexpensive, reliable objective methods are needed to measure physical activity (PA) in large scale trials. This study compared the number of pedometer step counts with accelerometer data in pregnant women in free-living conditions to assess agreement between these measures. Pregnant women (n = 58) with body mass index ≥25 kg/m(2) at median 13 week...
Article
Conditional cash transfer schemes, which use cash to incentivize uptake of basic health and educational services, are well established among social planners inlow- and middle-income countries and are now taking hold in high-income countries. We appraised these schemes within a social determinants framework and found some encouraging signs in their...
Article
The article examines the convergences and contrasts between social epidemiology, social medicine, and human rights approaches toward advancing global health and health equity. The first section describes the goals and work of the WHO Commission on Social Determinants of Health. The second section discusses the role of human rights in the Commission...
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Obese and overweight women may benefit from increased physical activity (PA) during pregnancy. There is limited published data describing objectively measured PA in such women. A longitudinal observational study of PA intensity, type and duration using objective and subjective measurement methods. Fifty five pregnant women with booking body mass in...
Article
In May 2009 the World Health Assembly passed a resolution on reducing health inequities through action on the social determinants of health, based on the work of the global Commission on Social Determinants of Health, 2005-2008. The Commission's genesis and findings raise some important questions for global health governance. We draw out some of th...
Article
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Whilst there has been increasing research interest in interventions which promote physical activity during pregnancy few studies have yielded detailed insights into the views and experiences of overweight and obese pregnant women themselves. The qualitative study described in this paper aimed to: (i) explore the views and experiences of overweight...
Article
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OBJECTIVE To investigate the association of preconception counseling with markers of care and maternal characteristics in women with pregestational diabetes. RESEARCH DESIGN AND METHODS The study includes data from a regional multi-center survey on 588 women with pregestational diabetes who delivered a singleton pregnancy between 2001 and 2004. Lo...
Article
A good start in life is the key to reducing health and social inequalities in society. Clyde Hertzman and colleagues argue that governments in rich and poor countries should be investing more in programmes to support early child development
Article
From the start, the WHO Commission on Social Determinants of Health built its case for taking action on the social determinants of health, unashamedly, on principles of social justice. Quite simply, the Commission stated that health inequities in the sense of avoidable and preventable differences in health between countries, and between groups with...
Article
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Here are 2 truisms. Rich countries have better health than poor countries, and medical care improves health. Consider, then, the case of the United States, which is among the richest countries in the world and spends more than any other country on medical care, US $6350 per person in 2005.1 Does the United States then have the best health? Not quit...
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Evidence suggests an association between maternal obesity and some congenital anomalies. To assess current evidence of the association between maternal overweight, maternal obesity, and congenital anomaly. MEDLINE, EMBASE, CINAHL, and Scopus (January 1966 through May 2008) were searched for English-language studies using a list of keywords. Referen...
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Global recession is likely to damage our health as well as our wealth, but it also offers an opportunity to build a more equitable economic model as Michael Marmot and Ruth Bell explain in light of the G20 summit
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The Commission on Social Determinants of Health, created to marshal the evidence on what can be done to promote health equity and to foster a global movement to achieve it, is a global collaboration of policy makers, researchers, and civil society, led by commissioners with a unique blend of political, academic, and advocacy experience. The focus o...
Article
This article describes trends in population birthweight distribution in the north of England between 1982 and 2000, and reviews the international literature on recent birthweight trends in industrialized populations. Two contrasting trends were observed: an increase in low birthweight from 7.0% to 7.7% of all births, and an increase in births weigh...
Article
To examine and quantify the changing contribution of some risk factors to the perinatal mortality rate. A population-based retrospective cohort study in Northern England compared stillbirth, neonatal, and perinatal mortality rates by birthweight, maternal age, plurality, and gender between 1982-1990 and 1991-2000. Atlhough the perinatal mortality r...
Chapter
This chapter asserts that inequality in the conditions under which people live and work translates into inequalities in health, and that this inequality is unjust. It discusses that socioeconomic disadvantage is more than low income and describes the impact of social injustice on the socioeconomically disadvantaged. Lifestyle does provide a partial...
Article
Perinatal mortality has long been used as a comparative measure of health and health care across regions, countries and over time. Recently, the validity of the measure has been questioned. Using data from a population-based survey of late fetal losses, stillbirths and infant deaths, the Northern Perinatal Mortality Survey, we demonstrate the poten...
Article
Progress in reducing late fetal deaths has slowed in recent years, despite changes in intrapartum and antepartum care. To describe recent trends in cause-specific fetal death rates. Retrospective cohort study. North of England. 3,386 late fetal deaths (> or = 28 weeks of gestation and at least 500 g), occuring between 1982 and 2000. Data on deaths...
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There is now substantial evidence that both short- and long-term increases in ambient air pollution are associated with increased mortality and morbidity in adults and children. Children's health is particularly vulnerable to environmental pollution, and infant mortality is still a major contributor to childhood mortality. In this systematic review...
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Research on the potential impact of air pollution on the health of adults and children has grown rapidly over the last decade. Recent studies have suggested that air pollution could also be associated with adverse effects on the developing fetus. This systematic review evaluates the current level of epidemiologic evidence on the association between...
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This study reports changes in the prevalence and outcome of Down's syndrome pregnancies within a 15-year period in a defined geographical population in the north of England. Cases of Down's syndrome in births and terminations of pregnancy occurring between 1985 and 1999, were identified from the Northern Congenital Abnormality Survey. The total pre...
Article
This paper draws lessons from a review of primary health care services in Windhoek, the capital of Namibia, undertaken by a regional health management team. The review was carried out because of perceived increases in workload and inadequate staffing levels, arising from the rapid expansion of the city associated with inward migration. A survey of...
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Full textFull text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (295K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References. 168 Selected References These references are in PubMed. This may not be the complete lis...

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