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

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

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

Socioeconomic deprivation, urban-rural location and alcohol-related mortality in England and Wales

Background: Many causes of death are directly attributable to the toxic effects of alcohol and deaths from these causes are increasing in the United Kingdom. The aim of this study was to investigate variation in alcohol-related mortality in relation to socioeconomic deprivation, urban-rural location and age within a national context. Methods: An ecological study design was used with data from 8797 standard table wards in England and Wales. The methodology included using the Carstairs Index as a measure of socioeconomic deprivation at the small-area level and the national harmonised classification system for urban and rural areas in England and Wales. Alcohol-related mortality was defined using the National Statistics definition, devised for tracking national trends in alcohol-related deaths. Deaths from liver cirrhosis accounted for 85% of all deaths included in this definition. Deaths from 1999-2003 were examined and 2001 census ward population estimates were used as the denominators. Results: The analysis was based on 28,839 deaths. Alcohol-related mortality rates were higher in men and increased with increasing age, generally reaching peak levels in middle-aged adults. The 45-64 year age group contained a quarter of the total population but accounted for half of all alcohol-related deaths. There was a clear association between alcohol-related mortality and socioeconomic deprivation, with progressively higher rates in more deprived areas. The strength of the association varied with age. Greatest relative inequalities were seen amongst people aged 25-44 years, with relative risks of 4.73 (95% CI 4.00 to 5.59) and 4.24 (95% CI 3.50 to 5.13) for men and women respectively in the most relative to the least deprived quintiles. People living in urban areas experienced higher alcohol-related mortality relative to those living in rural areas, with differences remaining after adjustment for socioeconomic deprivation. Adjusted relative risks for urban relative to rural areas were 1.35 (95% CI 1.20 to 1.52) and 1.13 (95% CI 1.01 to 1.25) for men and women respectively. Conclusions: Large inequalities in alcohol-related mortality exist between sub-groups of the population in England and Wales. These should be considered when designing public health policies to reduce alcohol-related harm

XMM-Newton X-ray study of early type stars in the Carina OB1 association

<p><b>Aims:</b> X-ray properties of the stellar population in the Carina OB1 association are examined with special emphasis on early-type stars. Their spectral characteristics provide some clues to understanding the nature of X-ray formation mechanisms in the winds of single and binary early-type stars.</p> <p><b>Methods:</b> A timing and spectral analysis of five observations with XMM-Newton is performed using various statistical tests and thermal spectral models.</p> <p><b>Results:</b> 235 point sources have been detected within the field of view. Several of these sources are probably pre-main sequence stars with characteristic short-term variability. Seven sources are possible background AGNs. Spectral analysis of twenty four sources of type OB and WR 25 was performed. We derived spectral parameters of the sources and their fluxes in three energy bands. Estimating the interstellar absorption for every source and the distance to the nebula, we derived X-ray luminosities of these stars and compared them to their bolometric luminosities. We discuss possible reasons for the fact that, on average, the observed X-ray properties of binary and single early type stars are not very different, and give several possible explanations.</p&gt

Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis

Improving access to HIV testing is a key priority in scaling up HIV treatment and prevention services. Home-based voluntary counselling and testing (HBT) as an approach to delivering wide-scale HIV testing is explored here

Social deprivation and exposure to health promotion. A study of the distribution of health promotion resources to schools in England

This article has been made available through the Brunel Open Access Publishing Fund and is available from the specified link - Copyright @ 2010 Chivu and ReidpathBACKGROUND: Area deprivation is a known determinant of health. It is also known that area deprivation is associated with lower impact health promotion. It is less well known, however, whether deprived areas are less responsive to health promotion, or whether they are less exposed. Using data from a national, school-based campaign to promote vaccination against the human papilloma virus (HPV), the relationship between area deprivation and exposure was examined. METHODS: Taking advantage of a health promotion campaign to provide information to schools about HPV vaccination, a cross sectional study was conducted to examine the relationship between area level, social deprivation, and take-up of (i.e., exposure to) available health promotion material. The sample was 4,750 schools across England, including government maintained and independent schools. The relationship between area deprivation and exposure was examined using bi- and multivariate logistic regression. RESULTS: It was found that schools in the least deprived quintile had 1.32 times the odds of requesting health promotion materials than schools in the most deprived areas (p = .01). This effect was independent of the school size, the type of school, and the geographic region. Conclusion The relationship between area deprivation and the impact of health promotion may be due, at least in part, to differential levels of exposure. The study was limited in scope, pointing to the need for more research, but also points to potentially important policy implications

RNA Sequencing of Pancreatic Circulating Tumour Cells Implicates WNT Signaling in Metastasis

Circulating tumour cells (CTCs) shed into blood from primary cancers include putative precursors that initiate distal metastases. While these cells are extraordinarily rare, they may identify cellular pathways contributing to the blood-borne dissemination of cancer. Here, we adapted a microfluidic device for efficient capture of CTCs from an endogenous mouse pancreatic cancer model and subjected CTCs to single molecule RNA sequencing, identifying Wnt2 as a candidate gene enriched in CTCs. Expression of Wnt2 in pancreatic cancer cells suppresses anoikis, enhances anchorage-independent sphere formation, and increases metastatic propensity in vivo. This effect is correlated with fibronectin upregulation and suppressed by inhibition of Map3k7 (Tak1) kinase. In humans, formation of non-adherent tumour spheres by pancreatic cancer cells is associated with upregulation of multiple Wnt genes, and pancreatic CTCs revealed enrichment for Wnt signaling in 5 of 11 cases. Thus, molecular analysis of CTCs may identify candidate therapeutic targets to prevent the distal spread of cancer