• Absence of association between behavior problems in childhood and hypertension in midlife

      Saad, Sadiq M.; Randhawa, Gurch; Pang, Dong; University of Bedfordshire (Public Library of Science, 2016-12-09)
      Background It is known that behavior in childhood is associated with certain physical and mental health problems in midlife. However, there is limited evidence on the role of childhood behavior problems in the development of hypertension in adulthood. The present study aimed to examine whether behavior problems in childhood influenced the risk of hypertension in midlife in the United Kingdom 1958 birth cohort. Methods The 1958 British birth cohort comprised 17,638 individuals born in the first week of March 1958 in the United Kingdom. Behavior problems were assessed at 7, 11, and 16 years of age by parents and teachers. At age 45, blood pressure was measured and hypertension was recorded if blood pressure was ≥140/90 mm Hg or if the participants were informed by their health professionals that they had high blood pressure. Behavioral information was reported according to the Rutter Children's Behaviour Questionnaire (RCBQ) and the Bristol Social Adjustment Guide (BSAG). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to examine behavior problems in childhood in relation to hypertension at 45 years of age according to logistic regression analysis, with adjustment for sex, social class in childhood and adulthood, childhood cognition, birth weight, gestational age at birth, body mass index (BMI), smoking, alcohol consumption, and physical activity. Results Behavior problems reported by parents at 7, 11, and 16 years were not associated with hypertension in midlife (OR, 0.93; 95% CI, 0.81, 1.07; OR, 0.95; 95% CI, 0.81, 1.11; OR, 0.98; 95% CI, 0.85, 1.12, respectively). Similarly, teacher-reported behavior problems at 7, 11, and 16 years were not associated with hypertension in midlife (OR, 0.92; 95% CI, 0.72, 1.18; OR, 0.92; 95% CI, 0.84, 1.02; OR, 1.03; 95% CI, 0.92, 1.15, respectively). Further separate analyses showed similar results for males and females. Conclusion There is no association between behavior problems in childhood and hypertension in midlife.
    • Access and utilisation of primary health care services comparing urban and rural areas of Riyadh Providence, Kingdom of Saudi Arabia

      Alfaqeeh, Ghadah Ahmad; Cook, Erica Jane; Randhawa, Gurch; Ali, Nasreen (BioMed Central, 2017-02-02)
      The Kingdom of Saudi Arabia (KSA) has seen an increase in chronic diseases. International evidence suggests that early intervention is the best approach to reduce the burden of chronic disease. However, the limited research available suggests that health care access remains unequal, with rural populations having the poorest access to and utilisation of primary health care centres and, consequently, the poorest health outcomes. This study aimed to examine the factors influencing the access to and utilisation of primary health care centres in urban and rural areas of Riyadh province of the KSA.
    • Accompany: Acceptable robotiCs COMPanions for AgeiNg Years : multidimensional aspects of human-system interactions

      Amirabdollahian, Farshid; Op den Akker, Rieks; Bedaf, Sandra; Bormann, Richard; Draper, Heather; Evers, Vanessa; Gelderblom, Gert Jan; Ruiz, Carolina Gutierrez; Hewson, David; Hu, Ninghang; et al. (IEEE, 2013-12-31)
      With changes in life expectancy across the world, technologies enhancing well-being of individuals, specifically for older people, are subject to a new stream of research and development. In this paper we present the ACCOMPANY project, a pan-European project which focuses on home companion technologies. The projects aims to progress beyond the state of the art in multiple areas such as empathic and social human-robot interaction, robot learning and memory visualisation, monitoring persons and chores at home, and technological integration of these multiple approaches on an existing robotic platform, Care-O-Bot®3 and in the context of a smart-home environment utilising a multitude of sensor arrays. The resulting prototype from integrating these developments undergoes multiple formative cycles and a summative evaluation cycle towards identifying acceptable behaviours and roles for the robot for example role as a butler or a trainer. Furthermore, the evaluation activities will use an evaluation grid in order to assess achievement of the identified user requirements, formulated in form of distinct scenarios. Finally, the project considers ethical concerns and by highlighting principles such as autonomy, independence, enablement, safety and privacy, it embarks on providing a discussion medium where user views on these principles and the existing tension between some of these principles for example tension between privacy and autonomy over safety, can be captured and considered in design cycles and throughout project developments.
    • Accuracy of online health information about controlling childhood fever during the H1N1 influenza pandemic

      Kulendran, Lavenia; Atherton, Helen; Pappas, Yannis; Car, Josip (BCS, 2009-09-16)
    • Acetaminophen (paracetamol) induces hypothermia during acute cold stress

      Foster, Josh; Mauger, Alexis R.; Govus, Andrew; Hewson, David; Taylor, Lee; University of Bedfordshire; Loughborough University; University of Kent; Mid Sweden University; Qatar Orthopaedic and Sports Medicine Hospital (Springer, 2017-08-01)
      Acetaminophen is an over-the-counter drug used to treat pain and fever, but it has also been shown to reduce core temperature (Tc) in the absence of fever. However, this side effect is not well examined in humans, and it is unknown if the hypothermic response to acetaminophen is exacerbated with cold exposure.
    • The added value of user involvement during the development of a feedback system regarding physical functioning for community-dwelling elderly people

      Vermeulen, Joan; Neyens, Jacques C.L.; Spreeuwenberg, Marieke D.; van Rossum, Erik; Hewson, David; de Witte, Luc P. (Ubiquity Press, 2012-06-08)
      The number of frail elderly people is increasing. Unfortunately, the number of caregivers is not increasing at the same pace, which affects older people, caregivers and healthcare systems. Because of these developments, self-management is becoming more important in healthcare. To support community-dwelling elderly people in their self-management, a system was developed that monitors their physical functioning. This system provides feedback to elderly people and their caregivers regarding physical indicators of frailty. The feedback is provided to elderly people via the screen of a mobile phone. It is important that elderly people understand the content of the feedback and are able to use the mobile phone properly. If not, it is unlikely that the system can support self-management. Many interactive health technologies that have been developed do not fulfil their promises. An important reason for this is that human and other non-technology issues are not sufficiently taken into consideration during the development process.
    • Ageing carers and intellectual disability: a scoping review

      Mahon, Aoife; Tilley, Elizabeth; Randhawa, Gurch; Pappas, Yannis; Vseteckova, Jitka; University of Bedfordshire; Open University (Emerald, 2019-11-28)
      Purpose: Individuals with intellectual disability(ies) are living longer contributing to an overall increase in the average age of caregivers. The purpose of this paper is to review the literature on the physical, social and psychological needs of ageing carers of individuals with intellectual disability(ies) in the UK. Design/methodology/approach: A scoping review framework was used to identify literature from eleven databases, the grey literature and the references lists of relevant studies. Only primary research studies that discussed the needs of non-professional carers, aged 65+ years old, of individuals with intellectual disability(ies) in the UK were included. No date restrictions were applied. Thematic analysis was used to narratively synthesise findings. Findings: Six studies were included. Five key themes were identified: Living with fear, lack of information, rebuilding trust, proactive professional involvement and being ignored. Housing and support information is not communicated well to carers. Professionals require more training on carer needs and trust must be rebuilt between carers and professionals. Proactive approaches would help identify carer needs, reduce marginalisation, help carers feel heard and reduce the risk of care crisis. Greater recognition of mutual caring relationships is needed. Originality/value: This review highlighted the needs of older caregivers for individuals with intellectual disability(ies) as well as the need for more high-quality research in this field. The information presented in this review may be considered by primary care providers and funding bodies when planning future support for this growing population of carers.
    • Aircraft control forces and EMG activity in a C-130 Hercules during strength-critical maneuvers

      Hewson, David; McNair, Peter J.; Marshall, R.N. (Aerospace Medical Association, 2001-03-31)
      BACKGROUND: The force levels required to operate aircraft controls should be readily generated by pilots, without undue fatigue or exertion. However, maximum pilot applied forces, as specified in aircraft design standards, were empirically derived from the subjective comments of test pilots, and may not be applicable for the majority of pilots. Further, experienced RNZAF Hercules flying instructors have indicated that endurance and fatigue are problems for Hercules pilots. The aim of this study was to quantify aircraft control forces during emergency maneuvers in a Hercules aircraft and compare these forces with design standards. In addition, EMG data were recorded as an indicator of muscle fatigue during flight. METHODS: Six subjects were tested in a C-130 Hercules aircraft. The maneuvers performed were low-level dynamic flight, one engine-off straight-and-level flight, and a two-engines-off simulated approach. The variables recorded were pilot-applied forces and EMG activity. RESULTS: Left rudder pedal force and vastus lateralis activity were both significantly greater during engine-off maneuvers than during low-level dynamic flight (p < 0.05). Maximum aircraft control forces for all controls were within 10% of the design standards. The mean EMG activity across all muscles and maneuvers was 26% MVC, with a peak of 61% MVC in vastus lateralis during the two-engine-off approach. The median frequency of the vastus lateralis EMG signal decreased 13.0% and 16.0% for the one engine-off and two-engine-off maneuvers, respectively. CONCLUSION: The forces required to fly a Hercules aircraft during emergency maneuvers are similar to the aircraft design standards. However, the levels of vastus lateralis muscle activation observed during the engine-off maneuvers can be sustained for approximately 1 min only. Thus, if two engines fail more than 1 min before landing, pilots may have to alternate control of the aircraft to share the workload and enable the aircraft to land safely.
    • Aircraft control forces and EMG activity in a UH-1H Iroquois helicopter during emergency maneuvers

      Hewson, David; McNair, Peter J.; Marshall, R.N. (Aerospace Medical Association, 2000-08-31)
      BACKGROUND: Some air forces are concerned with the adequacy of existing pilot selection standards in respect to pilot strength. Some studies have provided evidence that a large number of pilots may not be able to match the control force levels specified in both military and civilian aircraft design standards. However, both sets of design standards have been based on the subjective comments of test pilots and may not, therefore, be applicable for the majority of pilots. The aim of this study was to quantify aircraft control forces during emergency maneuvers in an Iroquois helicopter and compare these forces with design standards. The examination of muscle activation patterns of pilots during maneuvers, when normalized, can provide additional information on the relative activation levels that pilots are using to produce the aircraft control forces. METHODS: Six pilots were tested in a UH-1 H Iroquois helicopter. The maneuvers were three engine-out landings and a hydraulics-off landing. The variables recorded were pilot applied forces and EMG activity. Multivariate analysis of variance was used to test for differences between maneuvers. RESULTS: The greatest cyclic and upward collective control forces were observed during constant attitude and variable flare engine-out landings. The greatest downward collective forces were observed during hydraulics-off landing. Greater levels of muscle activation were consistently observed during hydraulics-off landing than during the engine-out landings. Control forces consistently exceeded military design standards for cyclic and collective controls, however muscle activity levels were sub-maximal for all maneuvers. CONCLUSION: Comparisons between existing aircraft control-force design standards and pilot strength may overestimate the number of pilots who are able to produce sufficient force to fly the aircraft. Despite the high control forces observed, all pilots tested were able to successfully maneuver the helicopter without requiring a maximal muscular effort.
    • Aircraft control forces and EMG activity in a UH-1H Iroquois helicopter during routine maneuvers

      Hewson, David; McNair, Peter J.; Marshall, R.N. (Aerospace Medical Association, 2000-05-31)
      Flying a helicopter requires greater coordination than flying a fixed-wing aircraft, because the pilot is required to apply force simultaneously to three controls: the cyclic, collective, and pedals. There has been one study of pilot applied forces during helicopter flight, but this investigation did not examine muscle activity patterns. The aim of this study was to examine the muscle activation patterns and control forces of helicopter pilots during routine maneuvers. METHODS: Six pilots were tested in a UH-1 h Iroquois helicopter. The maneuvers involved hovering, winching, under-slung loads, a constant rate turn, and a high-speed valley turn. Variables recorded were pilot applied forces and electromyographic activity (EMG). Multivariate analysis of variance was used to test for differences between maneuvers. RESULTS: Significant differences between the maximum forces recorded from each control across all maneuvers were recorded (p < 0.05). The greatest pilot applied forces were recorded from the pedals. No muscles were activated more than 25% of a maximum voluntary contraction for any maneuver. The greatest magnitude of EMG activity was recorded from vastus lateralis during high-speed valley turns. There were significant differences between the EMG activity of left triceps, right triceps, and right deltoid for some maneuvers (p < 0.05). CONCLUSION: The control forces required to fly a helicopter during routine maneuvers are small. The levels of muscle activation associated with pilot applied forces are also low, but are similar to those reported during routine maneuvers in a fast-jet flight simulator.
    • Aircraft control forces and EMG activity: comparison of novice and experienced pilots during simulated rolls, loops and turns

      Hewson, David; McNair, Peter J.; Marshall, R.N. (Aerospace Medical Association, 2000-08-31)
      BACKGROUND: Flying an aircraft requires a considerable degree of coordination, particularly during aerobatic activities such as rolls, loops and turns. Only one previous study has examined the magnitude of muscle activity required to fly an aircraft, and that was restricted to takeoff and landing maneuvers. The aim of this study was to examine the phasing of muscle activation and control forces of novice and experienced pilots during more complex simulated flight maneuvers. METHODS: There were 12 experienced and 9 novice pilots who were tested on an Aermacchi flight simulator while performing a randomized set of rolling, looping, and turning maneuvers. Four different runaway trim settings were used to increase the difficulty of the turns (elevator-up, elevator-down, aileron-left, and aileron-right). Variables recorded included aircraft attitude, pilot applied forces, and electromyographic (EMG) activity. Discriminant function analysis was used to distinguish between novice and experienced pilots. RESULTS: Over all maneuvers, 70% of pilots were correctly classified as novice or experienced. Better levels of classification were achieved when maneuvers were analyzed individually (67-91%), although the maneuvers that required the greatest force application, elevator-up turns, were unable to discriminate between novice and experienced pilots. There were no differences in the phasing of muscle activity between experienced and novice pilots. The only consistent difference in EMG activity between novice and experienced pilots was the reduced EMG activity in the wrist extensors of experienced pilots (p < 0.05). The increased wrist extensor activity of the novice pilots is indicative of a distal control strategy, whereby distal muscles with smaller motor units are used to perform a task that requires precise control. Muscle activity sensors could be used to detect the onset of high G maneuvers prior to any change in aircraft attitude and control G-suit inflation accordingly.
    • Aircraft control forces and EMG activity: comparison of novice and experienced pilots during simulated take-off and landing

      Hewson, David; McNair, Peter J.; Marshall, R.N. (Aerospace Medical Association, 1999-08-31)
      BACKGROUND: Flying an aircraft requires a considerable degree of coordination, particularly during activities such as takeoff and landing. No studies have examined the magnitude and phasing of muscle activity required to fly an aircraft. The aim of this study was to examine the muscle activation patterns and control forces of novice and experienced pilots during simulated flight. METHODS: Twelve experienced and nine novice pilots were tested on an Aermacchi flight simulator while performing a randomized set of take-off and landing maneuvers. Four different runaway trim settings were used to increase the difficulty of the landings (elevator-up, elevator-down, aileron-left, and aileron-right). Variables recorded included aircraft attitude, pilot applied forces, and electromyographic (EMG) activity. Discriminant function analysis was used to distinguish between novice and experienced pilots. RESULTS: Across all landings, wrist flexors and wrist extensors were the predominant muscles used, with EMG activity consistently around 20-30% maximum voluntary contraction (MVC). In respect to differences in EMG activity between novice and experienced pilots, novices had significantly more activity in wrist extensors during all landings. In contrast, experienced pilots had consistently more vastus lateralis activity for all landings than did novice pilots. Over all landings and take-off, 89.5% of pilots were correctly classified as novice or experienced. When the maneuvers were analyzed individually, normal, elevator-down, and aileron-left landings were the most accurate maneuvers for pilot prediction. EMG and force variables were more important than aircraft attitude in discriminating between novice and experienced pilots (83%, 79%, and 65%, respectively). CONCLUSION: The consistency of the finding that EMG activity and control forces are accurate discriminators of pilot experience is indicative of underlying differences in neuromuscular control strategies between novice and experienced pilots.
    • Aircraft control forces and EMG activity: Comparison of pilots before and after flying training

      Hewson, David; McNair, Peter J.; Marshall, R.N. (Aerospace Medical Association, 2001-05-31)
      BACKGROUND: Skilled performers in most motor tasks tend to require less force, muscle activity, and co-contraction of agonist and antagonist muscles to complete tasks. There have been two previous studies on muscle activation patterns and applied forces of skilled and novice pilots, but no longitudinal measurements have been made. The aim of this study was to compare the muscle activation patterns of pilots who had recently completed pilot training with those of experienced pilots. A secondary aim of the study was to examine co-contraction of novice and experienced pilots. METHODS: Novice (n = 12) and experienced (n = 9) pilots were tested on an Aermacchi flight simulator. The novice pilots were tested before and after completing pilot training. Pilots performed a set of landings, rolls, and turns, which were administered in a random order. Variables recorded included aircraft attitude, pilot applied forces, and electromyographic (EMG) activity. Discriminant function analysis was used to classify pilots as novice or experienced. RESULTS: Muscle activation patterns of the novice pilots after completion of pilot training were similar to those of experienced pilots. Of the recently graduated pilots, 77% were classified as experienced using discriminant function analysis. The maneuver in which the recently graduated pilots most closely resembled experienced pilots was the left aileron roll. During this maneuver, experienced and recently graduated pilots showed lower levels of co-contraction than novice pilots (p < 0.05). CONCLUSION: The similarities in some muscle activity patterns across qualified pilots, regardless of experience level, may be useful in initiating protective systems such as G-suit inflation.
    • Altruism, gift giving and reciprocity in organ donation: a review of cultural perspectives and challenges of the concepts

      Sharp, Chloe; Randhawa, Gurch; University of Bedfordshire (W.B. Saunders, 2014-10-01)
      Living and deceased organ donation are couched in altruism and gift discourse and this article reviews explores cultural views towards these concepts. Altruism and egoism theories and gift and reciprocity theories are outlined from a social exchange theory perspective to highlight the key differences between altruism and the gift and the wider implications of reciprocation. The notion of altruism as a selfless act without expectation or want for repayment juxtaposed with the Maussian gift where there are the obligations to give, receive and reciprocate. Lay perspectives of altruism and the gift in organ donation are outlined and illustrate that there are differences in motivations to donate in different programmes of living donation and for families who decide to donate their relative's organs. These motivations reflect cultural views of altruism and the gift and perceptions of the body and death.
    • Analysis of center of pressure signals using empirical mode decomposition and Fourier-Bessel expansion

      Pachori, Ram Bilas; Hewson, David; Snoussi, Hichem; Duchêne, Jacques (IEEE, 2008-12-31)
      Center of pressure (COP) measurements are often used to identify balance problems. A new method for analysis of COP signals using empirical mode decomposition (EMD) and Fourier-Bessel (FB) expansion is proposed in this paper. The EMD decomposes a COP signal into a finite set of band-limited signals termed intrinsic mode functions (IMFs), before FB expansion is applied on each IMF to compute mean frequency. The FB expansion based representation is suitable for use in non-stationary and very short duration signals. Seventeen subjects were tested under eyes open (EO) and eyes closed (EC) conditions, with different vibration frequencies applied for EC condition to further perturb sensory information. Mean frequency as calculated by FB expansion for the first three IMFs was able to distinguish between EO and EC conditions (p < 0.05), while only first IMF was able to detect a vibration effect.
    • An analysis of contemporary issues for leaders in healthcare education: achieving praxis and closing the theory practice divide

      Beckwith, Philip; University of Bedfordshire (Chinese American Scholars Association, 2015-01-01)
      In his executive summary of the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, Frances (2013) insists that "a list should be drawn up of all the qualities generally considered necessary for a good and effective leader. This in turn could inform a list of competencies a leader would be expected to have" (Frances, 2013, p108). While Frances does not specify educational leaders in his report, they are fundamental in the development of the future workforce through role modelling of the much hailed '6 C's' and therefore impact the patient experience (AACN, 2012; Frances, 2013). In this paper I will address the dilemmas faced by educational leaders engaged in healthcare education. One such dilemma is academic drift or the valuing and greater uptake of academic practices at the expense of vocational qualifications and practices (Edwards and Miller, 2008 p36). Another dilemma is the move from vocational to academic training, and then forward to a degree threshold profession due to various political drivers, in professions such as operating department practice (ODP). Other dilemmas that will be addressed include the paradigm shift created by change management strategies that employ the vocationally trained clinical assessors to support students enrolled in degree level study (Hauxwell, 2010).
    • Analysis of fatigue and tremor during sustained maximal grip contractions using Hilbert-Huang Transformation

      Li, Ke; Hogrel, Jean-Yves; Duchêne, Jacques; Hewson, David (Elsevier, 2012-09-30)
      The objective of this study was to evaluate muscle fatigue and tremor during a Sustained Maximal Grip Contraction (SMGC) using the Hilbert-Huang Transformation (HHT). Thirty-nine healthy subjects volunteered for the study and performed a 25-s SMGC. Fatigue parameters such as the relative force output (RFO) were calculated from the residual of SMGC after applying Empirical Mode Decomposition (EMD). Using the energy spectrum of the Intrinsic Mode Functions (IMF) obtained using HHT, isometric force tremor was identified from the 4 to 12 Hz region in IMF3 and IMF4. Data were analysed for five consecutive 5-s epochs to identify changes in fatigue and tremor over time. The HHT method was able to identify a greater resistance to fatigue in women compared to men (p≤0.05) and in non-dominant hands compared to dominant hands (p≤0.05). Consistent with the results for fatigue, women had less tremor than men (p≤0.05), while non-dominant hands trembled less than did dominant hands (p≤0.05). Higher levels of tremor were observed for non-fatigue-resistant subjects for both 10-15 s and 15-20 s epochs (p≤0.05). The HHT is an appropriate method to identify both fatigue and tremor during SMGC. It would be of interest to apply this method to the study the elderly or patients with neuromuscular disorders.
    • Analysis of sustained maximal grip contractions using Empirical Mode Decomposition

      Li, Ke; Hogrel, Jean-Yves; Duchêne, Jacques; Hewson, David (IEEE, 2010-12-31)
      Muscle fatigue and physiological tremor during a Sustained Maximal Grip Contraction (SMGC) were analyzed using Empirical Mode Decomposition (EMD) in this study. Thirty-nine healthy subjects volunteered for the experiment and performed a 25-s SMGC. Fatigue parameters such as the relative power output (RPO) were calculated from the residual of SMGC after applying EMD. Using the energy spectrum of the intrinsic mode functions (IMF) obtained using Hilbert-Huang Transform (HHT), physiological tremor was identified from the 4-12 Hz region in IMF3 and IMF4. Data were analyzed for five consecutive 5-s epochs to identify changes in fatigue and tremor over time. The EMD method was able to identify a greater resistance to fatigue in women compared to men (p<;;0.05) and in non-dominant hands compared to dominant hands (p<;;0.05). Consistent with the results for fatigue, women had less tremor than men (p<;;0.05), while non-dominant hands trembled less than did dominant hands (p<;;0.05). Higher levels of tremor were observed for non-fatigue-resistant subjects for both 10-15 s and 15-20 s epochs (p<;;0.05). The EMD is an appropriate method to indentify both fatigue and tremor during SMGC.
    • Antenatal care initiation in an ethnically dense socially disadvantaged maternal cohort

      Puthussery, Shuby; Tseng, Pei-Ching; Li, L.; Puthusserry, Thomas (Oxford University Press, 2019-11-20)
      Background: Differential utilisation of antenatal care among ethnic minority mothers is a contributor to their increased risk of poor birth outcomes in developed countries. Links between ethnicity, area deprivation and the timing of antenatal care initiation remain poorly understood. This study investigated patterns of antenatal care initiation among an ethnically dense, socially disadvantaged maternal cohort. Methods: We conducted a retrospective analysis of routinely collected anonymous data of live singleton births in a maternity unit serving an ethnically diverse population. We applied univariate regression models to examine the association between late antenatal care initiation and various predictor variables in particular ethnicity and area deprivation. Results: Gestational week at antenatal initiation was available for 46,089 births. One fifth (20.9%) of mothers initiated antenatal care after 12 weeks of gestation including 11.9% who had their first antenatal appointment at 13 -20 weeks (moderately late) and 8.9% who had it later than 20 weeks (extremely late). Among all the factors considered, late initiation was most strongly associated with non-White British ethnicity. Black African (34.2%) and Black Caribbean (29.0%) mothers were more than twice as likely to initiate antenatal care after 12 weeks of gestation compared to White British mothers [Odds ratio (OR) = 2.69 and 2.15 respectively). The odds did not increase with increasing area deprivation except for moderately late initiation in the most deprived and second most deprived areas [unadjusted OR = 1.54 and 1.24 respectively]. Conclusions: Non-White British ethnicity was the key predictor of late antenatal care initiation in our ethnically dense socially disadvantaged maternal cohort. Impact: Programs and policies should take in to account ethnic variations in antenatal careinitiation while designing programs and policies to improve birth outcomes in ethnically dense socially disadvantaged areas. Key messages: Non-White British ethnicity was the key predictor of late antenatal care initiation. Area deprivation per se appeared to have limited association with late antenatal care initiation.