Practice characteristics and prescribing of cardiovascular drugs in areas with higher risk of CHD in Scotland: cross-sectional study

Background We examine whether practices in areas with higher risks of CHD prescribe different levels of cardiovascular drugs and describe how they differ in GP and practice characteristics. Methods Propensity score matching was used to identify two groups of practices in Scotland. The cases were in areas with 5% or more of the population in South Asian ethnic groups. The controls were in areas with less than 1% of the population in South Asian ethnic groups and were matched for other population characteristics. Results The 39 case practices have lower prescribing rates than the matched controls for all heart disease drugs Significant different are found for six drugs (statins, ace Inhibitors, clopidogrel, thiazides, warfarin and digoxin. The differences range from 12.8% less for amlodipine to 43.9% for clopidogrel. The case practices also have lower prescribing costs than the unmatched group with the exception of ace inhibitors and aspirin. The highest prescribing costs for all drugs are found in the matched control group. The case practices are smaller than the controls, and have fewer GPs per 1,000 patients. Case practices have fewer quality markers and receive less in total resources, but have higher sums reimbursed to cover their employed staff costs. Conclusion Patients with higher risk of CHD tend to live in areas served by practices with lower prescribing rates and poorer structural characteristics. The scale of the differences in prescribing suggests that health care system factors rather than individual treatment decisions cause inequity in care. Identifying whether South Asian individuals are less likely to receive heart disease drugs than non South Asians requires individual-level prescribing data, which is currently not available in the UK

Proton binding by groundwater fulvic acids of different age, origins, and structure modeled with the Model V and NICA−Donnan Model

The proton binding properties of four fulvic acids from pristine groundwater and leachate-polluted groundwater were measured at four different ionic strengths (0.005−0.12 M) and modeled by the Model V and the NICA−Donnan model in order to evaluate the necessity of detailed proton binding parameters for groundwater fulvic acids. The proton binding parameters derived from the various fulvic acids were very similar, and on the basis of these parameters, it was not possible to distinguish between pristine and polluted groundwater. Normalization of the proton charge density by the proton charge density at pH 7 for each fulvic acid made all four fulvic acids regress to the same curve. The effects of varying the proton binding parameters were evaluated by simulating cadmium complexation using sets of proton binding parameters for the four fulvic acids and default sets of proton binding parameters available in the models WHAM (based on Model V) and Ecosat (based on NICA−Donnan). The Model V was rather indifferent with respect to specific characteristics of fulvic acids proton binding, and for most practical uses, the default values available in the model can be used. The NICA−Donnan model resulted in larger deviations between simulations based on default values and specific parameters. However, the NICA−Donnan database is still rather limited, and specific proton binding parameters should be used until the database providing default values has been extended