Road-traffic pollution and asthma – using modelled exposure assessment for routine public health surveillance

Asthma is a common disease and appears to be increasing in prevalence. There is evidence linking air pollution, including that from road-traffic, with asthma. Road traffic is also on the increase. Routine surveillance of the impact of road-traffic pollution on asthma, and other diseases, would be useful in informing local and national government policy in terms of managing the environmental health risk. Several methods for exposure assessment have been used in studies examining the association between asthma and road traffic pollution. These include comparing asthma prevalence in areas designated as high and low pollution areas, using distance from main roads as a proxy for exposure to road traffic pollution, using traffic counts to estimate exposure, using vehicular miles travelled and using modelling techniques. Although there are limitations to all these methods, the modelling approach has the advantage of incorporating several variables and may be used for prospective health impact assessment. The modelling approach is already in routine use in the United Kingdom in support of the government's strategy for air quality management. Combining information from such models with routinely collected health data would form the basis of a routine public health surveillance system. Such a system would facilitate prospective health impact assessment, enabling policy decisions concerned with road-traffic to be made with knowledge of the potential implications. It would also allow systematic monitoring of the health impacts when the policy decisions and plans have been implemented

A comparison of methods for calculating general practice level socioeconomic deprivation

Background: A measure of the socioeconomic deprivation experienced by the registered patient population of a general practice is of interest because it can be used to explore the association between deprivation and a wide range of other variables measured at practice level. If patient level geographical data are available a population weighted mean area-based deprivation score can be calculated for each practice. In the absence of these data, an area-based deprivation score linked to the practice postcode can be used as an estimate of the socioeconomic deprivation of the practice population. This study explores the correlation between Index of Multiple Deprivation 2004 (IMD) scores linked to general practice postcodes (main surgery address alone and main surgery plus any branch surgeries), practice population weighted mean IMD scores, and practice level mortality (aged 1 to 75 years, all causes) for 38 practices in Rotherham UK. Results: Population weighted deprivation scores correlated with practice postcode based scores (main surgery only, Pearson r = 0.74, 95% CI 0.54 to 0.85; main plus branch surgeries, r = 0.79, 95% CI 0.63 to 0.89). All cause mortality aged 1 to 75 correlated with deprivation (main surgery postcode based measure, r = 0.50, 95% CI 0.22 to 0.71; main plus branch surgery based score, r = 0.55, 95% CI 0.28 to 0.74); population weighted measure, r = 0.66, 95% CI 0.43 to 0.81). Conclusion: Practice postcode linked IMD scores provide a valid proxy for a population weighted measure in the absence of patient level data. However, by using them, the strength of association between mortality and deprivation may be underestimated

Protodiscs around Hot Magnetic Rotator Stars

We develop equations and obtain solutions for the structure and evolution of a protodisc region that is initially formed with no radial motion and super-Keplerian rotation speed when wind material from a hot rotating star is channelled towards its equatorial plane by a dipole-type magnetic field. Its temperature is around $10^7$K because of shock heating and the inflow of wind material causes its equatorial density to increase with time. The centrifugal force and thermal pressure increase relative to the magnetic force and material escapes at its outer edge. The protodisc region of a uniformly rotating star has almost uniform rotation and will shrink radially unless some instability intervenes. In a star with angular velocity increasing along its surface towards the equator, the angular velocity of the protodisc region decreases radially outwards and magnetorotational instability (MRI) can occur within a few hours or days. Viscosity resulting from MRI will readjust the angular velocity distribution of the protodisc material and may assist in the formation of a quasi-steady disc. Thus, the centrifugal breakout found in numerical simulations for uniformly rotating stars does not imply that quasi-steady discs with slow outflow cannot form around magnetic rotator stars with solar-type differential rotation.Comment: Accepted for publication in MNRAS. 16 pages, 1 figure, 7 table

Socioeconomic deprivation, mortality and health of within-city migrants: a population cohort study.

BACKGROUND: Evidence linking selective migration (the situation where people in good health move from deprived to affluent areas, whilst people in poor health move in the opposite direction) within local areas to mortality is inconclusive. METHODS: Mortality in within-city migrants was examined using a Sheffield population cohort, adjusted for moves to care homes. The cohort comprised 310 894 people aged 25+ years in 2001 followed up for 9.18 years, with 42 252 (13.6%) deaths. Information on pre-existing medical conditions, socioeconomic indicators and smoking was available from a sample survey. RESULTS: Relative risks (95% CI) of mortality in migrants from deprived to affluent areas were lower compared with people remaining in deprived areas; 0.53 (0.42 to 0.65), 0.70 (0.61 to 0.80), 0.76 (0.68 to 0.86), 0.93 (0.88 to 1.00) and 0.98 (0.93 to 1.03) in the 25-44, 45-64, 65-74, 75-84 and 85+ year age bands, respectively. They also had lower prevalence ORs (95% CI) for bronchitis (0.59 (0.39 to 0.89)), asthma (0.70 (0.53 to 0.93)), depression (0.59 (0.38 to 0.94)), and were less likely to receive benefits (0.60 (0.47 to 0.76)) and less likely to smoke (0.66 (0.51 to 0.85)).Conversely, mortality relative risks in migrants from affluent to deprived areas were higher compared with people remaining in affluent areas; 1.71 (1.37 to 2.12), 1.59 (1.40 to 1.82), 1.44 (1.26 to 1.63), 1.18 (1.10 to 1.27) and 1.04 (1.00 to 1.09) in the corresponding age groups. They also had higher prevalence odds ratios for long-term illness (2.37 (1.71 to 3.29)), asthma (1.71 (1.25 to 2.35)), diabetes (3.03 (1.70 to 5.41)), depression (2.71 (1.74 to 4.21)), were more likely to receive benefits (2.25 (1.65 to 3.07)) and more likely to smoke (1.51 (1.12 to 2.05)). CONCLUSIONS: People moving from deprived to affluent areas had lower mortality and better health, and vice versa, especially in the younger age groups. This study provides strong evidence linking selective migration within local areas to mortality

Magnetic Rotator Winds and Keplerian Disks of Hot Stars

We consider rotating magnetic stars with winds and disks. We establish a theorem that relates the angular velocity of a disk region with no meridional motion to the angular velocity of the star. Also, we show that for a given value of the magnetic field strength, if the rotation rate is too high or the flow velocity into the shock boundary is too low, a Keplerian disk region will not be formed. We develop a model for the formation of disks in magnetic rotators through the processes of fill-up and diffusion into Keplerian orbits. At the end of the fill-up stage the density of the disk increases significantly and the magnetic force in the disk becomes negligible. We derive analytical expressions for the inner and outer radii of Keplerian disks in terms of the stellar rotation rate. A disk can form if the meridional component Bm of the field at the stellar surface is larger than a minimum value. The radial extent of the Keplerian region becomes larger for larger values of Bm and is largest when Bm equals an optimal value. The strengths of the minimum fields required for Keplerian disk formation in B-type stars varies from order 1G to 10G. In O-type stars they must be of order 500G. Also, we suggest that the stellar magnetic fields may be affected by rotationally driven meridional circulation leading to some of the the observed variations of disks with time.Comment: 44 pages, 1 figure, accepted by Ap

Population-level linkages between urban greenspace and health inequality : the case for using multiple indicators of neighbourhood greenspace

Exposure to greenspace in urban environments is associated with a range of improved health and well-being outcomes. There is a need to understand which aspects of greenspace influence which components of health. We investigate the relationship of indicators of greenspace quantity (total and specific types of greenspace), accessibility and quality with poor general health, depression, and severe mental illness, in the city of Sheffield, UK. We find complex relationships with multiple greenspace indicators that are different for each health measure, highlighting a need for future studies to include multiple, nuanced indicators of neighbourhood greenspace in order to produce results that can inform planning and policy guidance

Statin induced myopathy: a case report

Statin-induced necrotizing autoimmune myopathy is an immune-mediated necrotizing myopathy related to the use of statins. It is a very rare disease, which usually presents with proximal muscle weakness and frank elevation in creatine kinase levels. Stopping statin and the use of immunosuppressive therapy are considered the mainstay therapy. Herein, we present a case of a 75-year-old patient with statin-induced myopathy based on the presence of proximal muscle weakness, magnetic resonance findings. The patient was treated with IVIg and corticosteroid therapy with a particularly good response to intravenous immunoglobulin. However, medications are accompanied by the not so friendly adverse events. Through this report we highlight the importance of understanding. This report highlights the importance of timely diagnosis and early use of combined immunosuppressive therapy to improve patients' outcome affected by this rare disease

Investigation of the Association Between Alcohol Outlet Density and Alcohol-Related Hospital Admission Rates in England: Study Protocol.

BACKGROUND: Availability of alcohol is a major policy issue for governments, and one of the availability factors is the density of alcohol outlets within geographic areas. OBJECTIVE: The aim of this study is to investigate the association between alcohol outlet density and hospital admissions for alcohol-related conditions in a national (English) small area level ecological study. METHODS: This project will employ ecological correlation and cross-sectional time series study designs to examine spatial and temporal relationships between alcohol outlet density and hospital admissions. Census units to be used in the analysis will include all Lower and Middle Super-Output Areas (LSOAs and MSOAs) in England (53 million total population; 32,482 LSOAs and 6781 MSOAs). LSOAs (approximately 1500 people per LSOA) will support investigation at a fine spatial resolution. Spatio-temporal associations will be investigated using MSOAs (approximately 7500 people per MSOA). The project will use comprehensive coverage data on alcohol outlets in England (from 2003, 2007, 2010, and 2013) from a commercial source, which has estimated that the database includes 98% of all alcohol outlets in England. Alcohol outlets may be classified into two broad groups: on-trade outlets, comprising outlets from which alcohol can be purchased and consumed on the premises (eg, pubs); and off-trade outlets, in which alcohol can be purchased but not consumed on the premises (eg, off-licenses). In the 2010 dataset, there are 132,989 on-trade and 51,975 off-trade outlets. The longitudinal data series will allow us to examine associations between changes in outlet density and changes in hospital admission rates. The project will use anonymized data on alcohol-related hospital admissions in England from 2003 to 2013 and investigate associations with acute (eg, admissions for injuries) and chronic (eg, admissions for alcoholic liver disease) harms. The investigation will include the examination of conditions that are wholly and partially attributable to alcohol, using internationally standardized alcohol-attributable fractions. RESULTS: The project is currently in progress. Results are expected in 2017. CONCLUSIONS: The results of this study will provide a national evidence base to inform policy decisions regarding the licensing of alcohol sales outlets