High blood pressure and the incidence of non-insulin dependent diabetes mellitus: Findings in A 11.5 year follow-up study in the Netherlands

To examine the contribution of cardiovascular risk factors to the development of non-insulin dependent diabetes mellitus, a prospective follow-up study was performed of a cohort, initially examined in a population survey on cardiovascular risk factors. The survey was conducted from 1975 to 1978 in the Netherlands among 5700 men and women aged 20 to 65. In 1988 a questionnaire on the prevalence of chronic diseases, including diabetes mellitus, was sent to all living participants of the initial survey. The general practitioners of the persons who indicated to have diabetes mellitus were asked to confirm the diagnosis. Diabetes mellitus was defined as current use of oral hypoglycemic drugs or insulin. After exclusion of the prevalent cases at the initial survey, 65 incident confirmed cases remained. All others responding to the questionnaire served as controls. The incidence of diabetes mellitus was associated with body mass index, use of diuretics, systolic and diastolic blood pressure. After adjustment for age and body mass index systolic and diastolic blood pressure were still associated with the incidence of non-insulin dependent diabetes mellitus in men; relative risks 1.28 (95% confidence interval 1.06-1.54) and 1.40 (95% CI 1.06-1.85) per 10 mmHg respectively. For women, only the relative risk associated with the use of diuretics remained statistically significant (2.26, 95% CI 1.04-4.90). This probably reflects the risk of (treated) hypertension: adjusted for blood pressure, the relative risk lost statistical significance. These findings suggest that elevated blood pressure is a risk for the development of non-insulin dependent diabetes mellitus (NIDDM). This supports the view that NIDDM and hypertension may have a similar origin

Health characteristics and consultation patterns of people with intellectual disability: a cross-sectional database study in English general practice.

BACKGROUND: People with intellectual disability (ID) are a group with high levels of healthcare needs; however, comprehensive information on these needs and service use is very limited. AIM: To describe chronic disease, comorbidity, disability, and general practice use among people with ID compared with the general population. DESIGN AND SETTING: This study is a cross-sectional analysis of a primary care database including 408 English general practices in 2012. METHOD: A total of 14 751 adults with ID, aged 18-84 years, were compared with 86 221 age-, sex- and practice-matched controls. Depending on the outcome, prevalence (PR), risk (RR), or odds (OR) ratios comparing patients with ID with matched controls are shown. RESULTS: Patients with ID had a markedly higher prevalence of recorded epilepsy (18.5%, PR 25.33, 95% confidence interval [CI] = 23.29 to 27.57), severe mental illness (8.6%, PR 9.10, 95% CI = 8.34 to 9.92), and dementia (1.1%, PR 7.52, 95% CI = 5.95 to 9.49), as well as moderately increased rates of hypothyroidism and heart failure (PR>2.0). However, recorded prevalence of ischaemic heart disease and cancer was approximately 30% lower than the general population. The average annual number of primary care consultations was 6.29 for patients with ID, compared with 3.89 for matched controls. Patients with ID were less likely to have longer doctor consultations (OR 0.73, 95% CI = 0.69 to 0.77), and had lower continuity of care with the same doctor (OR 0.77, 95% CI = 0.73 to 0.82). CONCLUSION: Compared with the general population, people with ID have generally higher overall levels of chronic disease and greater primary care use. Ensuring access to high-quality chronic disease management, especially for epilepsy and mental illness, will help address these greater healthcare needs. Continuity of care and longer appointment times are important potential improvements in primary care

Attitudes towards English in Cuban Higher Education. Recent Developments and Challenges

[EN] English is used as a lingua franca in an increasing number of domains. In higher education, English has become prominent as the language of course materials, scientific publications, research, as well as teaching, a trend which is particularly noticeable in Europe. In Latin America, however, the surge of English is relatively recent, and within Latin America, Cuba is an interesting case. Whereas learning English was not encouraged in the 1980s, in today’s Cuba English has gained importance, and learning and teaching English has become a priority. The current research explores how Cuban students and lecturers of two different fields (English and Engineering) perceive the growing importance of English in today’s higher education in Cuba. Data were collected by means of a questionnaire conducted at Universidad de Oriente, Santiago de Cuba. The results reveal a positive attitude towards English, which most participants perceive as very important for their career prospects. On the other hand, it was found that most respondents overrate their ability to communicate in English. Moreover, they are not acquainted with the Common European Framework of Reference for Languages (CEFR), even though the Cuban Ministry of Higher Education has accepted the CEFR as its official standard.http://ocs.editorial.upv.es/index.php/HEAD/HEAD18Van Splunder, F.; Dávila Pérez, G. (2018). Attitudes towards English in Cuban Higher Education. Recent Developments and Challenges. Editorial Universitat Politècnica de València. 125-132. https://doi.org/10.4995/HEAD18.2018.7911OCS12513

English as a medium of instruction in a non-English speaking context

English is increasingly being used as a language of instruction in a non-English speaking environment. That is, lecturers as well as students are native speakers of languages other than English. this also implies that different varieties of English are brought into the classroom, some of which have more prestige than others. The context of the current research is higher education in Europe after the 1999 Bologna Declaration and the ensuing construction of a European Higher Education Area (EHEA, 2010). The irony is that, while Bologna stresses the diversity of languages and cultures1, English has clearly become dominant, which may be regarded as an unintended side-effect of Bologna. Yet it may be obvious that the internationalization of higher education goes hand in hand with its commercialization (that is, education is increasingly seen as a commodity) and the concomitant marketization of English (‘English sells’).Een colloquium over universitair taalvaardigheidonderwijs gehouden op 8 & 9 juni 2012 Universiteit Leiden, the complete issue can be found at: http://hdl.handle.net/1887/21789Vakpublicati

The biogeomorphological life cycle of poplars during the fluvial biogeomorphological succession: a special focus on Populus nigra L.

Riverine ecosystems are recurrently rejuvenated during destructive flood events and vegetation succession starts again. Poplars (i.e. species from Populus genera) respond to hydrogeomorphological constraints, but, in turn, also influence these processes. Thus, poplar development on bare mineral substrates is not exclusively a one-way vegetative process. Reciprocal interactions and adjustments between poplar species and sediment dynamics during their life cycle lead to the emergence of biogeomorphological entities within the fluvial corridor, such as vegetated islands, benches and floodplains. Based on a review of geomorphological, biological and ecological literature, we have identified and described the co-constructing processes between riparian poplars and their fluvial environment. We have explored the possibility that the modification of the hydrogeomorphological environment exerted, in particular, by the European black poplar (Populus nigra L.), increases its fitness and thus results in positive niche construction. We focus on the fundamental phases of dispersal, recruitment and establishment until sexual maturity of P. nigra by describing the hierarchy of interactions and the pattern of feedbacks between biotic and abiotic components. We explicitly relate the biological life cycle of P. nigra to the fluvial biogeomorphic succession model by referring to the ‘biogeomorphological life cycle’ of P. nigra. Finally, we propose new research perspectives based on this theoretical framework

An evaluation of the effectiveness of annual health checks and quality of health care for adults with intellectual disability: an observational study using a primary care database

Background People with intellectual disability (ID) have poorer health than the general population; however, there is a lack of comprehensive national data describing their health-care needs and utilisation. Annual health checks for adults with ID have been incentivised through primary care since 2009, but only half of those eligible for such a health check receive one. It is unclear what impact health checks have had on important health outcomes, such as emergency hospitalisation. Objectives To evaluate whether or not annual health checks for adults with ID have reduced emergency hospitalisation, and to describe health, health care and mortality for adults with ID. Design A retrospective matched cohort study using primary care data linked to national hospital admissions and mortality data sets. Setting A total of 451 English general practices contributing data to Clinical Practice Research Datalink (CPRD). Participants A total of 21,859 adults with ID compared with 152,846 age-, gender- and practice-matched controls without ID registered during 2009–13. Interventions None. Main outcome measures Emergency hospital admissions. Other outcomes – preventable admissions for ambulatory care sensitive conditions, and mortality. Data sources CPRD, Hospital Episodes Statistics and Office for National Statistics. Results Compared with the general population, adults with ID had higher levels of recorded comorbidity and were more likely to consult in primary care. However, they were less likely to have long doctor consultations, and had lower continuity of care. They had higher mortality rates [hazard ratio (HR) 3.6, 95% confidence interval (CI) 3.3 to 3.9], with 37.0% of deaths classified as being amenable to health-care intervention (HR 5.9, 95% CI 5.1 to 6.8). They were more likely to have emergency hospital admissions [incidence rate ratio (IRR) 2.82, 95% CI 2.66 to 2.98], with 33.7% deemed preventable compared with 17.3% in controls (IRR 5.62, 95% CI 5.14 to 6.13). Health checks for adults with ID had no effect on overall emergency admissions compared with controls (IRR 0.96, 95% CI 0.87 to 1.07), although there was a relative reduction in emergency admissions for ambulatory care-sensitive conditions (IRR 0.82, 95% CI 0.69 to 0.99). Practices with high health check participation also showed a relative fall in preventable emergency admissions for their patients with ID, compared with practices with minimal participation (IRR 0.73, 95% CI 0.57 to 0.95). There were large variations in the health check-related content that was recorded on electronic records. Limitations Patients with milder ID not known to health services were not identified. We could not comment on the quality of health checks. Conclusions Compared with the general population, adults with ID have more chronic diseases and greater primary and secondary care utilisation. With more than one-third of deaths potentially amenable to health-care interventions, improvements in access to, and quality of, health care are required. In primary care, better continuity of care and longer appointment times are important examples that we identified. Although annual health checks can also improve access, not every eligible adult with ID receives one, and health check content varies by practice. Health checks had no impact on overall emergency admissions, but they appeared influential in reducing preventable emergency admissions. Future work No formal cost-effectiveness analysis of annual health checks was performed, but this could be attempted in relation to our estimates of a reduction in preventable emergency admissions. Funding The National Institute for Health Research Health Services and Delivery Research programme

Modeling the interactions between river morphodynamics and riparian vegetation

The study of river-riparian vegetation interactions is an important and intriguing research field in geophysics. Vegetation is an active element of the ecological dynamics of a floodplain which interacts with the fluvial processes and affects the flow field, sediment transport, and the morphology of the river. In turn, the river provides water, sediments, nutrients, and seeds to the nearby riparian vegetation, depending on the hydrological, hydraulic, and geomorphological characteristic of the stream. In the past, the study of this complex theme was approached in two different ways. On the one hand, the subject was faced from a mainly qualitative point of view by ecologists and biogeographers. Riparian vegetation dynamics and its spatial patterns have been described and demonstrated in detail, and the key role of several fluvial processes has been shown, but no mathematical models have been proposed. On the other hand, the quantitative approach to fluvial processes, which is typical of engineers, has led to the development of several morphodynamic models. However, the biological aspect has usually been neglected, and vegetation has only been considered as a static element. In recent years, different scientific communities (ranging from ecologists to biogeographers and from geomorphologists to hydrologists and fluvial engineers) have begun to collaborate and have proposed both semiquantitative and quantitative models of river-vegetation interconnections. These models demonstrate the importance of linking fluvial morphodynamics and riparian vegetation dynamics to understand the key processes that regulate a riparian environment in order to foresee the impact of anthropogenic actions and to carefully manage and rehabilitate riparian areas. In the first part of this work, we review the main interactions between rivers and riparian vegetation, and their possible modeling. In the second part, we discuss the semiquantitative and quantitative models which have been proposed to date, considering both multi- and single-thread river