Prevalence, incidence, primary care burden and medical treatment of angina in Scotland: age, sex and socioeconomic disparities: a population-based study

Objective: To examine the epidemiology, primary care burden and treatment of angina in Scotland. Design: Cross-sectional data from primary care practices participating in the Scottish continuous morbidity recording scheme between 1 April 2001 and 31 March 2002. Setting: 55 primary care practices (362 155 patients). Participants: 9508 patients with angina. Results: The prevalence of angina in Scotland was 28/1000 in men and 25/1000 in women (p < 0.05) and increased with age. The prevalence of angina also increased with increasing socioeconomic deprivation from 18/1000 in the least deprived category to 31/1000 in the most deprived group (p < 0.001 for trend). The incidence of angina was higher in men (1.8/1000) than in women (1.4/1000) (p = 0.004) and increased with increasing age and socioeconomic deprivation. Socioeconomically deprived patients (0.48 contacts/patient among the most deprived) were less likely than affluent patients (0.58 contacts/patient among the least deprived) to see their general practitioner on an ongoing basis p = 0.006 for trend). Among men, 52% were prescribed ß blockers, 44% calcium channel blockers, 72% aspirin, 54% statins and 36% angiotensin converting enzyme inhibitors or angiotensin receptor blockers. The corresponding prescription rates for women were 46% (p < 0.001), 41% (p = 0.02), 69% (p < 0.001), 45% (p < 0.001) and 30% (p < 0.001). Among patients < 75 years old 52% were prescribed a β blocker and 58% a statin. The corresponding figures for patients ≥ 75 years were 42% (p < 0.001) and 31% (p < 0.001). Conclusions: Angina is a common condition, more so in men than in women. Socioeconomically deprived patients are more likely to have angina but are less likely to consult their general practitioner. Guideline-recommended treatments for angina are underused in women and older patients. These suboptimal practice patterns, which are worst in older women, are of particular concern, as in Scotland more women (and particularly older women) than men have angina

Testing for sexually transmitted infections in general practice: cross-sectional study

Background: Primary care is an important provider of sexual health care in England. We sought to explore the extent of testing for chlamydia and HIV in general practice and its relation to associated measures of sexual health in two contrasting geographical settings.Methods: We analysed chlamydia and HIV testing data from 64 general practices and one genitourinary medicine (GUM) clinic in Brent (from mid-2003 to mid-2006) and 143 general practices and two GUM clinics in Avon (2004). We examined associations between practice testing status, practice characteristics and hypothesised markers of population need (area level teenage conception rates and Index of Multiple Deprivation, IMD scores).Results: No HIV or chlamydia testing was done in 19% (12/64) of general practices in Brent, compared to 2.1% (3/143) in Avon. In Brent, the mean age of general practitioners (GPs) in Brent practices that tested for chlamydia or HIV was lower than in those that had not conducted testing. Practices where no HIV testing was done had slightly higher local teenage conception rates (median 23.5 vs. 17.4/1000 women aged 15-44, p = 0.07) and served more deprived areas (median IMD score 27.1 vs. 21.8, p = 0.05). Mean yearly chlamydia and HIV testing rates, in practices that did test were 33.2 and 0.6 (per 1000 patients aged 15-44 years) in Brent, and 34.1 and 10.3 in Avon, respectively. In Brent practices only 20% of chlamydia tests were conducted in patients aged under 25 years, compared with 39% in Avon.Conclusions: There are substantial geographical differences in the intensity of chlamydia and HIV testing in general practice. Interventions to facilitate sexually transmitted infection and HIV testing in general practice are needed to improve access to effective sexual health care. The use of routinely-collected laboratory, practice-level and demographic data for monitoring sexual health service provision and informing service planning should be more widely evaluated

Changing patterns of teenage pregnancy: population based study of small areas

OBJECTIVES: To measure the impact of socioeconomic deprivation on rates of teenage pregnancy and the extent of local variation in pregnancy rates in Scotland, and to examine how both have changed over time. DESIGN: Population study using routine data from hospital records, aggregated for small areas. SUBJECTS: Female teenagers resident in Scotland who were treated for pregnancy in an NHS hospital in either 1981-5 (62 338 teenagers) or 1991-5 (48 514) and who were aged 13-19 at the time of conception. MAIN OUTCOME MEASURES: Pregnancy rates per 1000 in age group and the proportions of pregnancies resulting in a maternity (live birth or stillbirth) in teenagers aged 13-15, 16-17, and 18-19. RESULTS: From the 1980s to the 1990s pregnancy rates increased differentially according to levels of local deprivation, as measured by the Carstairs index. Among teenagers aged less than 18 the annual pregnancy rate increased in the most deprived areas (from 7.0 to 12.5 pregnancies per 1000 13-15 year olds and from 67.6 to 84.6 per 1000 16-17 year olds), but there was no change, on average, among teenagers in the most affluent areas (3.8 per 1000 13-15 year olds and 28.9 per 1000 16-17 year olds). Among 18-19 year olds the pregnancy rate decreased in the most affluent areas (from 60.0 to 46.3 per 1000) and increased in the most deprived areas (from 112.4 to 116.0 per 1000). The amount of local variation explained by deprivation more than doubled from the 1980s to the 1990s. The proportion of pregnancies resulting in a maternity was positively associated with level of deprivation, but the effect remained similar over time. CONCLUSION: From the 1980s to the 1990s the difference in rates of teenage pregnancy between more affluent and more deprived areas widened. This has implications for allocating resources to achieve government targets and points to important social processes behind the general increase in the number of teenage pregnancies in Scotland

Features controlling the early stages of creep deformation of Waspaloy

A model has been presented for describing primary and second stage creep. General equations were derived for the amount and time of primary creep. It was shown how the model can be used to extrapolate creep data. Applicability of the model was demonstrated for Waspaloy with gamma prime particle sizes from 75 - 1000 A creep tested in the temperature range 1000 - 1400 F (538 - 760 C). Equations were developed showing the dependence of creep parameters on dislocation mechanism, gamma prime volume fraction and size

The effect of manganese oxide on the sinterability of hydroxyapatite

The sinterability of manganese oxide (MnO2) doped hydroxyapatite (HA) ranging from 0.05 to 1 wt% was investigated. Green samples were prepared and sintered in air at temperatures ranging from 1000 to 1400 °C. Sintered bodies were characterized to determine the phase stability, grain size, bulk density, hardness, fracture toughness and Young's modulus. XRD analysis revealed that the HA phase stability was not disrupted throughout the sintering regime employed. In general, samples containing less than 0.5 wt% MnO2 and when sintered at lower temperatures exhibited higher mechanical properties than the undoped HA. The study revealed that all the MnO2-doped HA achieved >99% relative density when sintered at 1100–1250 °C as compared to the undoped HA which could only attained highest value of 98.9% at 1150 °C. The addition of 0.05 wt% MnO2 was found to be most beneficial as the samples exhibited the highest hardness of 7.58 GPa and fracture toughness of 1.65 MPam1/2 as compared to 5.72 GPa and 1.22 MPam1/2 for the undoped HA when sintered at 1000 °C. Additionally, it was found that the MnO2-doped samples attained E values above 110 GPa when sintered at temperature as low as 1000 °C if compared to 1050 °C for the undoped HA

Scalar Field Dark Energy Perturbations and their Scale Dependence

We estimate the amplitude of perturbation in dark energy at different length scales for a quintessence model with an exponential potential. It is shown that on length scales much smaller than hubble radius, perturbation in dark energy is negligible in comparison to that in in dark matter. However, on scales comparable to the hubble radius ($\lambda_{p}>1000\mathrm{Mpc}$) the perturbation in dark energy in general cannot be neglected. As compared to the $\Lambda$CDM model, large scale matter power spectrum is suppressed in a generic quintessence dark energy model. We show that on scales $\lambda_{p} < 1000\mathrm{Mpc}$, this suppression is primarily due to different background evolution compared to $\Lambda$CDM model. However, on much larger scales perturbation in dark energy can effect matter power spectrum significantly. Hence this analysis can act as a discriminator between $\Lambda$CDM model and other generic dark energy models with $w_{de} \neq -1$.Comment: 12 pages, 13 figures, added new section, accepted for publication in Phys. Rev.