Regional differences in multidimensional aspects of health: findings from the MRC cognitive function and ageing study

BACKGROUND: Differences in mortality and health experience across regions are well recognised and UK government policy aims to address this inequality. Methods combining life expectancy and health have concentrated on specific areas, such as self-perceived health and dementia. Few have looked within country or across different areas of health. Self-perceived health, self-perceived functional impairment and cognitive impairment are linked closely to survival, as well as quality of life. This paper aims to describe regional differences in healthy life expectancy using a variety of states of health and wellbeing within the MRC Cognitive Function and Ageing Study (MRC CFAS). METHODS: MRC CFAS is a population based study of health in 13,009 individuals aged 65 years and above in five centres using identical study methodology. The interviews included self-perceived health and measures of functional and cognitive impairment. Sullivan's method was used to combine prevalence rates for cognitive and functional impairment and life expectancy to produce expectation of life in various health states. RESULTS: The prevalence of both cognitive and functional impairment increases with age and was higher in women than men, with marked centre variation in functional impairment (Newcastle and Gwynedd highest impairment). Newcastle had the shortest life expectancy of all the sites, Cambridgeshire and Oxford the longest. Centre differences in self-perceived health tended to mimic differences in life expectancy but this did not hold for cognitive or functional impairment. CONCLUSION: Self-perceived health does not show marked variation with age or sex, but does across centre even after adjustment for impairment burden. There is considerable centre variation in self-reported functional impairment but not cognitive impairment. Only variation in self-perceived health relates to the ranking of life expectancy. These data confirm that quite considerable differences in life experience exist across regions of the UK beyond basic life expectancy

Evaluation of Amendments to Control Phosphorus Losses in Runoff from Dairy-Soiled Water

peer-reviewedAmendments with the potential to reduce phosphorus (P) losses from agricultural grassland arising from the land application of dairy-soiled water (DSW) were investigated. Optimal application rates were studied, and associated costs and feasibility were estimated. First, batch tests were carried out to identify appropriate chemicals or phosphorus sorbing materials to control P in runoff from DSW. Then, the best four treatments were examined in an agitator test. In this test, soil—placed in a beaker—was loaded with DSW or amended DSW at a rate equivalent to 5 mm ha−1 (the maximum permissible application rate of DSW allowable in a 42-day period in Ireland). The soil was overlain with continuously stirred water to simulate runoff on land-applied DSW. Optimum application rates were selected based on percentage removal of dissolved reactive phosphorus in overlying water and the estimated cost of amendment. The costs of the amendments, per cubic metre of DSW, increased in the order: bottom ash (1.55 €), alum (1.67 to 1.92 €), FeCl2·4H2O (3.55 to 8.15 €), and lime (20.31 to 88.65 €). The feasibility of the amendments, taking into account their cost, potential adverse effects, public perception, and their performance, decreased in the order: alum > FeCl2·4H2O > bottom ash > lime. Amendments to DSW could be introduced in critical source areas—areas where high soil test P and direct migration pathways to a receptor overlap.Department of Agriculture, Fisheries and Food (Ireland) Research Stimulus Programme 2007 (RSF 07 525