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

Marxism Lost and Found: Alasdair MacIntyre and the Contemporary Debate

This paper examines the changing nature of debates that focus on the philosophy of Alasdair MacIntyre. Whilst outlining the history of MacIntyre’s engagement with Marxism and some of his key ideas, it argues that it is only recently that such debates have begun to rightfully recognise the continued relevance of Marxism to such discussions. I note that crucial aspects of MacIntyre’s politics and philosophy, particularly his opposition to capitalism, are now integral to the contemporary debate which helps in generating a shared vision of radical politics. Nevertheless, I point out that key disagreements still remain as to the role of Marxism within such debates, the validity of MacIntyre’s critique of Marxism, as well as the potentially problematic post-Marxist practice that MacIntyre advocates in After Virtue and beyond

Do residents’ perceptions of being well-placed and objective presence of local amenities match? A case study in West Central Scotland, UK

Background:<p></p> Recently there has been growing interest in how neighbourhood features, such as the provision of local facilities and amenities, influence residents’ health and well-being. Prior research has measured amenity provision through subjective measures (surveying residents’ perceptions) or objective (GIS mapping of distance) methods. The latter may provide a more accurate measure of physical access, but residents may not use local amenities if they do not perceive them as ‘local’. We believe both subjective and objective measures should be explored, and use West Central Scotland data to investigate correspondence between residents’ subjective assessments of how well-placed they are for everyday amenities (food stores, primary and secondary schools, libraries, pharmacies, public recreation), and objective GIS-modelled measures, and examine correspondence by various sub-groups.<p></p> Methods:<p></p> ArcMap was used to map the postal locations of ‘Transport, Health and Well-being 2010 Study’ respondents (n = 1760), and the six amenities, and the presence/absence of each of them within various straight-line and network buffers around respondents’ homes was recorded. SPSS was used to investigate whether objective presence of an amenity within a specified buffer was perceived by a respondent as being well-placed for that amenity. Kappa statistics were used to test agreement between measures for all respondents, and by sex, age, social class, area deprivation, car ownership, dog ownership, walking in the local area, and years lived in current home.<p></p> Results:<p></p> In general, there was poor agreement (Kappa <0.20) between perceptions of being well-placed for each facility and objective presence, within 800 m and 1000 m straight-line and network buffers, with the exception of pharmacies (at 1000 m straight-line) (Kappa: 0.21). Results varied between respondent sub-groups, with some showing better agreement than others. Amongst sub-groups, at 800 m straight-line buffers, the highest correspondence between subjective and objective measures was for pharmacies and primary schools, and at 1000 m, for pharmacies, primary schools and libraries. For road network buffers under 1000 m, agreement was generally poor.<p></p> Conclusion:<p></p> Respondents did not necessarily regard themselves as well-placed for specific amenities when these amenities were present within specified boundaries around their homes, with some exceptions; the picture is not clear-cut with varying findings between different amenities, buffers, and sub-groups

Critical Care in the Emergency Department: An assessment of the length of stay and invasive procedures performed on critically ill ED patients

<p>Abstract</p> <p>Introduction</p> <p>Critically ill patients commonly present to the ED and require aggressive resuscitation. Patient transfer to an ICU environment in an expedient manner is considered optimal care. However, this patient population may remain in the ED for prolonged periods of time. The goal of this study is to describe the ED length of stay, and the invasive procedures performed in critically ill ED patients.</p> <p>Methods</p> <p>This is a retrospective medical record review of all patients who presented to the study center over a 1 year period. Patient demographic data, in addition to the times of ED presentation and ICU admission were recorded. Invasive procedures performed in the pre-hospital, ED and the initial 24 hours of ICU care were also recorded.</p> <p>Results</p> <p>Overall, 178 patients' required direct admission to an ICU from the ED, with a mortality rate of 21.9%. The median LOS in the ED for critically ill patients requiring ICU admission was 4.9 h (mean 6.5 h, range 1.4-28.2 h). Seventy percent of patients (125,178, 70.2%) required endotracheal intubation with the majority (118/125, 94.4%) being performed in the ED (80/125, 64.0%) or the prehospital setting (38/125, 30.4%). Central venous access was obtained in 56/178 patients (31.5%), with 17.9% (10/56) completed in the ED. Similarly, arterial catheters were inserted in 99/178 patients (55.6%) with 14.1% (14/99) inserted in the ED.</p> <p>Conclusion</p> <p>Critically ill patients are managed in the emergency department for a significant length of time. Although the majority of airway intervention occurs in the prehospital setting and ED, relatively few patients undergo invasive procedures while in the emergency department.</p

Hydrographic data collection for Operation James River--1964

Data presented in this report were collected to provide information for verification of an hydraulic model of the James River below the fall line at Richmond, and for calculation of circulation dynamics in the James River

Listeners are sensitive to the speech breathing time series: Evidence from a gap detection task

The effect of non-speech sounds, such as breathing noise, on the perception of speech timing is currently unclear. In this paper we report the results of three studies investigating participants' ability to detect a silent gap located adjacent to breath sounds during naturalistic speech. Experiment 1 (n = 24, in-person) asked whether participants could either detect or locate a silent gap that was added adjacent to breath sounds during speech. In Experiment 2 (n = 182; online), we investigated whether different placements within an utterance were more likely to elicit successful detection of gaps. In Experiment 3 (n = 102; online), we manipulated the breath sounds themselves to examine the effect of breath-specific characteristics on gap identification. Across the study, we document consistent effects of gap duration, as well as gap placement. Moreover, in Experiment 2, whether a gap was positioned before or after an interjected breath significantly predicted accuracy as well as the duration threshold at which gaps were detected, suggesting that nonverbal aspects of audible speech production specifically shape listeners' temporal expectations. We also describe the influences of the breath sounds themselves, as well as the surrounding speech context, that can disrupt objective gap detection performance. We conclude by contextualising our findings within the literature, arguing that the verbal acoustic signal is not "speech itself" per se, but rather one part of an integrated percept that includes speech-related respiration, which could be more fully explored in speech perception studies

Relation between socioeconomic deprivation and death from a first myocardial infarction in Scotland: population based analysis

No abstract available

Exposure to liquid sweetness in early childhood:artificially-sweetened and sugar-sweetened beverage consumption at 4–5 years and risk of overweight and obesity at 7–8 years

Background: A significant gap exists in longitudinal evidence on early exposure to artificially sweetened beverages (ASBs) and weight outcomes for paediatric populations. Objective: The objective of this study is to examine the relationship between ASB/sugar‐sweetened beverage (SSB) consumption at 4–5 years and risk of overweight and obesity at 7–8 years. Methods: Data from a nationally representative cohort (n = 2986) in Scotland were analysed using logistic regression to evaluate the association between exposure to ASBs/SSBs at 4–5 years and risk of overweight and obesity at 7–8 years. Results: There were positive unadjusted associations between ASB consumption and risk of obesity, and following adjustment for confounders, ASB associations attenuated, and only the middle consumption category (1 to 6 times per week) remained significant (odds ratio 1.57, 95% confidence interval {CI} 1.05–2.36). For SSB consumption, there were no significant unadjusted associations, and following adjustment for confounders, only the middle consumption category was significant (odds ratio 1.65, 95% CI 1.12–2.44). There were no significant associations for risk of overweight. Conclusions: Longitudinal analysis from 4–5 to 7–8 years demonstrated some evidence of associations between ASBs/SSB consumption and risk of obesity. However, non‐linear patterns and wide CIs suggest cautious interpretation and need for future studies with long‐term follow‐up