Allostatic load as a predictor of all-cause and cause-specific mortality in the general population: Evidence from the Scottish Health Survey

Allostatic load is a multiple biomarker measure of physiological ‘wear and tear’ that has shown some promise as marker of overall physiological health, but its power as a risk predictor for mortality and morbidity is less well known. This study has used data from the 2003 Scottish Health Survey (SHeS) (nationally representative sample of Scottish population) linked to mortality records to assess how well allostatic load predicts all-cause and cause-specific mortality. From the sample, data from 4,488 men and women were available with mortality status at 5 and 9.5 (rounded to 10) years after sampling in 2003. Cox proportional hazard models estimated the risk of death (all-cause and the five major causes of death in the population) according to allostatic load score. Multiple imputation was used to address missing values in the dataset. Analyses were also adjusted for potential confounders (sex, age and deprivation). There were 258 and 618 deaths over the 5-year and 10-year follow-up period, respectively. In the fully-adjusted model, higher allostatic load (poorer physiological ‘health’) was not associated with an increased risk of all-cause mortality after 5 years (HR = 1.07, 95% CI 0.94 to 1.22; p = 0.269), but it was after 10 years (HR = 1.08, 95% CI 1.01 to 1.16; p = 0.026). Allostatic load was not associated with specific causes of death over the same follow-up period. In conclusions, greater physiological wear and tear across multiple physiological systems, as measured by allostatic load, is associated with an increased risk of death, but may not be as useful as a predictor for specific causes of death

Allostatic load as a predictor of all-cause and cause-specific mortality in the general population: Evidence from the Scottish Health Survey

Allostatic load is a multiple biomarker measure of physiological ‘wear and tear’ that has shown some promise as marker of overall physiological health, but its power as a risk predictor for mortality and morbidity is less well known. This study has used data from the 2003 Scottish Health Survey (SHeS) (nationally representative sample of Scottish population) linked to mortality records to assess how well allostatic load predicts all-cause and cause-specific mortality. From the sample, data from 4,488 men and women were available with mortality status at 5 and 9.5 (rounded to 10) years after sampling in 2003. Cox proportional hazard models estimated the risk of death (all-cause and the five major causes of death in the population) according to allostatic load score. Multiple imputation was used to address missing values in the dataset. Analyses were also adjusted for potential confounders (sex, age and deprivation). There were 258 and 618 deaths over the 5-year and 10-year follow-up period, respectively. In the fully-adjusted model, higher allostatic load (poorer physiological ‘health’) was not associated with an increased risk of all-cause mortality after 5 years (HR = 1.07, 95% CI 0.94 to 1.22; p = 0.269), but it was after 10 years (HR = 1.08, 95% CI 1.01 to 1.16; p = 0.026). Allostatic load was not associated with specific causes of death over the same follow-up period. In conclusions, greater physiological wear and tear across multiple physiological systems, as measured by allostatic load, is associated with an increased risk of death, but may not be as useful as a predictor for specific causes of death.REF Compliant by Deposit in Stirling's Repositor

A commentary on Quintus Curtius' Historiae Alexandri Magni Macedonis Book IV 1-8

This textual and linguistic commentary, which is the first of any kind in English on the Historiae of Quintus Curtius, discusses the uncertainties presented by the text as transmitted, evaluates the solutions offered by previous scholars and suggests some new emendations. Curtius' grammar, syntax and linguistic usage are examined in comparison with the standards accepted before the time of Livy and the developments thereafter. His expression and style are compared with those of other authors, with special reference to Livy and Curtius' near-contemporary, Seneca the Younger. Literary analogies with other authors in all periods are given and similarities in thought and style are also noticed. Curtius' treatment of his subject-matter is considered in the light of the parallel accounts of Arrian, Diodorus Siculus, and in some places Plutarch and Justin, and questions of historical fact are discussed where they arise from the text of Curtius himself. Two appendices are included, of which the first deal with the dispute over the date of composition of the work, and Curtius' identity. It presents the case for identifying the Princeps referred to at X 9.1-6 with Claudius and suggests that Curtius composed the Historiae during the early years of that emperor's reign. The second appendix deals with our author's vocabulary and his use of participles and infinitives, and demonstrates some aspects of his contribution to, and place within, the evolution of the Latin language since the time of Livy. The apparatus criticus is derivative; the commentary, except insofar as every such work must take account of previous scholarship, is entirely original.<p

Beyond a boundary – conceptualising and measuring multiple health conditions in the Scottish population

The concurrent experience of multiple health conditions (often termed multimorbidity) has become an important issue in recent years. Most research on this topic uses clinical data (e.g. GP or hospital records) that lack important socio-contextual information about the lives of people with multiple conditions. Population health surveys can help to overcome these limitations, but identifying people who have multiple conditions is problematic. Decisions need to be taken regarding what is meant by a condition, which ones should be included, and how multiple should be defined. These decisions tend to be based on what data are available, rather than on any universal inclusion criteria or theoretical underpinnings. This thesis used an approach informed by sociological theory and principles drawn from critical realist philosophy to estimate the prevalence of multiple conditions among adults (16+) in the general population, using data from the 1998 and 2008- 2011 Scottish Health Surveys. It explicitly acknowledged the multiple, contested and constructed nature of health, illness and diagnosis; the limits of empirical enquiry; and the need to approach concepts such as multiple conditions critically. To support the decision-making process, longitudinal analyses of mortality were used to examine the impact of including various contested conditions on people’s long-term chance of survival (if there was no evidence of impact then the definition was rejected). The final measure of multiple conditions arrived at suggested that 24.9% of adults had multiple conditions (compared with 17.2% using the survey’s original, unadjusted, measure). This measure was then used to explore how this status related to people’s wellbeing, which helped to highlight importance differences in experiences. Among adults with multiple conditions, 33.5% of those in the most deprived areas had low wellbeing compared with 13.5% of those in the least deprived areas. Low wellbeing was also higher among people with multiple conditions aged under 65 than those aged 65 and over, especially for those living in areas of high deprivation. There was some evidence that having multiple conditions and additional vulnerabilities (e.g. psychological distress, living in a deprived area, having activity limitations) before the age of 55 increased people’s risk of mortality, which might result in older populations appearing to have better wellbeing due to less healthy people not reaching old age. Working-age people with multiple conditions were also more likely than people of the same age with no conditions to be economically inactive, to not live in an owner-occupied property, and not have a co-resident partner. All of which suggest that poor health at younger ages limits access to the social and economic norms enjoyed by most people. The approach adopted arguably helped to avoid over-classifying largely healthy people as having multiple conditions, while still ensuring that people’s own perspectives on their health were not under-privileged with respect to more traditional biomedically-focused approaches. However, it was also clear that the experiences of adults with multiple conditions are highly varied, and in particular, socially stratified. This heterogeneity has implications for research in this field, as well as clinical practice and public health policy. Recommendations for better reflecting this diversity in future studies included collecting more measures of functional capacity, aspirations, illness experiences, and social stressors (such as financial insecurity)

Trends in adult cardiovascular disease risk factors and their socio-economic patterning in the Scottish population 1995–2008: cross-sectional surveys

&lt;p&gt;Objectives To examine secular and socio-economic changes in cardiovascular disease risk factor prevalences in the Scottish population. This could contribute to a better understanding of why the decline in coronary heart disease mortality in Scotland has recently stalled along with a widening of socio-economic inequalities.&lt;/p&gt; &lt;p&gt;Design Four Scottish Health Surveys 1995, 1998, 2003 and 2008 (6190, 6656, 5497 and 4202 respondents, respectively, aged 25–64 years) were used to examine gender-stratified, age-standardised prevalences of smoking, alcohol consumption, physical activity, fruit and vegetable consumption, discretionary salt use and self-reported diabetes or hypertension. Prevalences were determined according to education and social class. Inequalities were assessed using the slope index of inequality, and time trends were determined using linear regression.&lt;/p&gt; &lt;p&gt;Results There were moderate secular declines in the prevalence of smoking, excess alcohol consumption and physical inactivity. Smoking prevalence declined between 1995 and 2008 from 33.4% (95% CI 31.8% to 35.0%) to 29.9% (27.9% to 31.8%) for men and from 36.1% (34.5% to 37.8%) to 27.4% (25.5% to 29.3%) for women. Adverse trends in prevalence were noted for self-reported diabetes and hypertension. Over the four surveys, the diabetes prevalence increased from 1.9% (1.4% to 2.4%) to 3.6% (2.8% to 4.4%) for men and from 1.7% (1.2% to 2.1%) to 3.0% (2.3% to 3.7%) for women. Socio-economic inequalities were evident for almost all risk factors, irrespective of the measure used. These social gradients appeared to be maintained over the four surveys. An exception was self-reported diabetes where, although inequalities were small, the gradient increased over time. Alcohol consumption was unique in consistently showing an inverse gradient, especially for women.&lt;/p&gt; &lt;p&gt;Conclusions There has been only a moderate decline in behavioural cardiovascular risk factor prevalences since 1995, with increases in self-reported diabetes and hypertension. Adverse socio-economic gradients have remained unchanged. These findings could help explain the recent stagnation in coronary heart disease mortalities and persistence of related inequalities.&lt;/p&gt

Trends in cardiovascular disease biomarkers and their socioeconomic patterning among adults in the Scottish population 1995 to 2009: cross-sectional surveys

Objectives To examine secular and socioeconomic changes in biological cardiovascular disease risk factor and biomarker prevalences in the Scottish population. This could contribute to an understanding of why the decline in coronary heart disease mortality in Scotland has recently stalled along with persistence of associated socioeconomic inequalities. Design Cross-sectional surveys. Setting Scotland. Participants Scottish Health Surveys: 1995, 1998, 2003, 2008 and 2009 (6190, 6656, 5497, 4202 and 4964 respondents, respectively, aged 25–64 years). Primary outcome measures Gender-stratified, age-standardised prevalences of obesity, hypertension, hypercholesterolaemia and low high-density lipoprotein cholesterol blood concentration as well as elevated fibrinogen and C reactive protein concentrations according to education and social class groupings. Inequalities were assessed using the slope index of inequality, and time trends were assessed using linear regression. Results The prevalence of obesity, including central obesity, increased between 1995 and 2009 among men and women, irrespective of socioeconomic position. In 2009, the prevalence of obesity (defined by body mass index) was 29.8% (95% CI 27.9% to 31.7%) for men and 28.2% (26.3% to 30.2%) for women. The proportion of individuals with hypertension remained relatively unchanged between 1995 and 2008/2009, while the prevalence of hypercholesterolaemia declined in men from 79.6% (78.1% to 81.1%) to 63.8% (59.9% to 67.8%) and in women from 74.1% (72.6% to 75.7%) to 66.3% (62.6% to 70.0%). Socioeconomic inequalities persisted over time among men and women for most of the biomarkers and were particularly striking for the anthropometric measures when stratified by education. Conclusions If there are to be further declines in coronary heart disease mortality and reduction in associated inequalities, then there needs to be a favourable step change in the prevalence of cardiovascular disease risk factors. This may require radical population-wide interventions

A single and rapid calcium wave at egg activation in Drosophila.

Activation is an essential process that accompanies fertilisation in all animals and heralds major cellular changes, most notably, resumption of the cell cycle. While activation involves wave-like oscillations in intracellular Ca(2+) concentration in mammals, ascidians and polychaete worms and a single Ca(2+) peak in fish and frogs, in insects, such as Drosophila, to date, it has not been shown what changes in intracellular Ca(2+) levels occur. Here, we utilise ratiometric imaging of Ca(2+) indicator dyes and genetically encoded Ca(2+) indicator proteins to identify and characterise a single, rapid, transient wave of Ca(2+) in the Drosophila egg at activation. Using genetic tools, physical manipulation and pharmacological treatments we demonstrate that the propagation of the Ca(2+) wave requires an intact actin cytoskeleton and an increase in intracellular Ca(2+) can be uncoupled from egg swelling, but not from progression of the cell cycle. We further show that mechanical pressure alone is not sufficient to initiate a Ca(2+) wave. We also find that processing bodies, sites of mRNA decay and translational regulation, become dispersed following the Ca(2+) transient. Based on this data we propose the following model for egg activation in Drosophila: exposure to lateral oviduct fluid initiates an increase in intracellular Ca(2+) at the egg posterior via osmotic swelling, possibly through mechano-sensitive Ca(2+) channels; a single Ca(2+) wave then propagates in an actin dependent manner; this Ca(2+) wave co-ordinates key developmental events including resumption of the cell cycle and initiation of translation of mRNAs such as bicoid.This work was supported by the University of Cambridge, ISSF to T.T.W. [grant number 097814]; and Wellcome Trust Senior Research Fellowship to I.D. [grant number 096144].This is the final version of the article. It first appeared from the Company of Biologists via http://dx.doi.org/10.1242/bio.20141129