Double trouble: the impact of multimorbidity and deprivation on preference-weighted health related quality of life - a cross sectional analysis of the Scottish Health Survey

<b>Objective</b> To investigate the association between multimorbidity and Preference_Weighted Health Related Quality of Life (PW_HRQoL), a score that combines physical and mental functioning, and how this varies by socioeconomic deprivation and age.<p></p> <b>Design</b> The Scottish Health Survey (SHeS) is a cross-sectional representative survey of the general population which included the SF-12, a survey of HRQoL, for individuals 20 years and over.<p></p> <b>Methods</b> For 7,054 participants we generated PW_HRQoL scores by running SF-12 responses through the SF-6D algorithm. The resulting scores ranged from 0.29 (worst health) to 1 (perfect health). Using ordinary least squares, we first investigated associations between scores and increasing counts of longstanding conditions, and then repeated for multimorbidity (2+ conditions). Estimates were made for the general population and quintiles of socioeconomic deprivation. For multimorbidity, the analyses were repeated stratifying the population by age group (20--44, 45--64, 65+).<p></p> <b>Results</b> 45% of participants reported a longstanding condition and 18% reported multimorbidity. The presence of 1, 2, or 3+ longstanding conditions were associated with average reductions in PW_HRQoL scores of 0.081, 0.151 and 0.212 respectively. Reduction in scores associated with multimorbidity was 33% greater in the most deprived quintile compared to the least deprived quintile, with the biggest difference (80%) in the 20--44 age groups. There were no significant gender differences.<p></p> <b>Conclusions</b> PW_HRQoL decreases markedly with multimorbidity, and is exacerbated by higher deprivation and younger age. There is a need to prioritise interventions to improve the HRQoL for (especially younger) adults with multimorbidity in deprived areas

Evaluation of the implementation of the alert issued by the UK National Patient Safety Agency on the storage and handling of potassium chloride concentrate solution

Objectives: To assess the effectiveness of the response of NHS hospital trusts to an alert issued by the National Patient Safety Agency designed to limit the availability of concentrated potassium chloride in hospitals in England and Wales, and to determine the nature of any unintended consequences. Design: Multi-method study involving interviews and a physical inspection of clinical areas. Setting: 207 clinical areas in 20 randomly selected acute NHS trusts in England and Wales between 31 October 2002 and 31 January 2003. Participants: Senior managers and ward based medical and nursing staff. Main outcome measures: Degree of staff awareness of and compliance with the requirements of the national alert, withdrawal of concentrated potassium chloride solutions from non-critical areas, provision of pre-diluted alternatives, storage and recording in accordance with controlled drug legislation. Results: All trusts required that potassium chloride concentrate be stored in a separate locked cupboard from common injectable diluents (100% compliance). Unauthorised stocks of potassium chloride were found in five clinical areas not authorised by the trust (98% compliance). All trusts required documentation control of potassium chloride concentrate in clinical areas, but errors were recorded in 20 of the 207 clinical areas visited (90% compliance). Of those interviewed, 78% of nurses and 30% of junior doctors were aware of the alert. Conclusions: The NPSA alert was effective and resulted in rapid development and implementation of local policies to reduce the availability of concentrated potassium chloride solutions. The success is likely to be partly due to the nature of the proposed changes and it cannot be assumed that future alerts will be equally effective. Continued vigilance will be necessary to help sustain the changes

Physical activity : strategies for school communities : based on strategies developed during the Be Active School & Community Project 1995-1998

The Be Active School and Community Project (BASC) operated in approximately 30 WA primary and secondary schools each year from August 1995 until December 1998 (three years). BASC was a Healthway funded project, promoting the National Heart Foundation\u27s Be Active Everyday message. Under the direction of a Management Committee, two project officers worked with the broad aim of increasing the physical activity rates of children at school and in the local community

Mapping and explaining the productivity of Pinus radiata in New Zealand

Mapping Pinus radiata productivity for New Zealand not only provides useful information for forest owners, industry stakeholders and policy managers, but also enables current and future plantations to be visualised, quantified, and planned. Using an extensive set of permanent sample plots, split into fitting (n = 1,146) and validation (n = 618) datasets, models of P. radiata 300 Index (an index of volume mean annual increment) and Site Index (an index of height growth) were developed using a regression kriging technique. Spatial predictions were accurate and accounted for 61% and 70% of the variance for 300 Index and Site Index, respectively. Productivity predicted from these surfaces for the entire plantation estate averaged 27.4 m³ ha⁻¹ yr⁻¹ for the 300 Index and 30.4 m for Site Index. Surfaces showed wide regional variation in this productivity, which was attributable mainly to variation in air temperature and root-zone water storage from site to site

Crystal design approaches for the synthesis of paracetamol co-crystals

Crystal engineering principles were used to design three new co-crystals of paracetamol. A variety of potential cocrystal formers were initially identified from a search of the Cambridge Structural Database for molecules with complementary hydrogen-bond forming functionalities. Subsequent screening by powder X-ray diffraction of the products of the reaction of this library of molecules with paracetamol led to the discovery of new binary crystalline phases of paracetamol with trans-1,4- diaminocyclohexane (1); trans-1,4-di(4-pyridyl)ethylene (2); and 1,2-bis(4-pyridyl)ethane (3). The co-crystals were characterized by IR spectroscopy, differential scanning calorimetry, and 1H NMR spectroscopy. Single crystal X-ray structure analysis reveals that in all three co-crystals the co-crystal formers (CCF) are hydrogen bonded to the paracetamol molecules through O−H···N interactions. In co-crystals (1) and (2) the CCFs are interleaved between the chains of paracetamol molecules, while in co-crystal (3) there is an additional N−H···N hydrogen bond between the two components. A hierarchy of hydrogen bond formation is observed in which the best donor in the system, the phenolic O−H group of paracetamol, is preferentially hydrogen bonded to the best acceptor, the basic nitrogen atom of the co-crystal former. The geometric aspects of the hydrogen bonds in co-crystals 1−3 are discussed in terms of their electrostatic and charge-transfer components

An alternative search for the electron capture of Te-123

A search for the electron capture of Te-123 has been performed using CdZnTe detectors. After a measuring time of 195 h no signal could be found resulting in a lower half-life limt of $T_{1/2} > 3.2 \cdot 10^{16}$ yrs (95 % CL) for this process. This clearly discriminates between existing experimental results which differ by six orders of magnitude and our data are in strong favour of the result with longer half-lifes.Comment: 2 pages, 2 eps-figures, reanalysis of data set

Gender Differences in the Relationships between Alcohol, Tobacco and Mental Health in Patients attending an Emergency Department

Aims: There is evidence of a non-linear relationship between alcohol consumption and mental health status, and of an association between tobacco use and poor mental health. This paper examines the nature of the association between usual alcohol consumption, tobacco use and symptoms of anxiety and depression in Emergency Department patients in Queensland, Australia. Methods: A cross sectional survey of patients aged 16-84 presenting for treatment over a 14 day period to Gold Coast Hospital Emergency Department using socio-demographic items, the Alcohol Use Disorders Identification Test (AUDIT) to measure moderate, hazardous and harmful alcohol consumption, and the Hospital Anxiety and Depression Scale (HADS) to measure state anxiety and depression. Results: 812 patients were interviewed. Gender differences in results were evident. For men, there was a U-shaped relationship between alcohol consumption and anxiety/depression, and a linear association between smoking and anxiety. For women, alcohol consumption and anxiety/depression showed a more linear relationship, but there was no significant relationship between tobacco use and anxiety/depression. Conclusions: There may be important gender differences in the relationships between alcohol consumption, tobacco use and mental health status. This study supports previous evidence that mental health status of non-drinkers is worse than that of moderate drinkers, but only among males (First published on August 2, 2004, doi:10.1093/alcalc/agh080

The latest FAD – Faecal antibody detection in cattle:Protocol and results from three UK beef farms naturally infected with gastrointestinal nematodes

Antibodies at gastrointestinal mucosal membranes play a vital role in immunological protection against a range of pathogens, including helminths. Gastrointestinal health is central to efficient livestock production, and such infections cause significant losses. Fecal samples were taken from 114 cattle, across three beef farms, with matched blood samples taken from 22 of those animals. To achieve fecal antibody detection, a novel fecal supernatant was extracted. Fecal supernatant and serum samples were then analysed, using adapted enzyme-linked immunosorbent assay protocols, for levels of total immunoglobulin (Ig)A, IgG, IgM, and Teladorsagia circumcincta-specific IgA, IgG, IgM and IgE (in the absence of reagents for cattle-specific nematode species). Fecal nematode egg counts were conducted on all fecal samples. Assays performed successfully and showed that IgA was the predominant antibody in fecal samples, whereas IgG was predominant in serum. Total IgA in feces and serum correlated within individuals (0.581, P = 0.005), but other Ig types did not. Results support the hypothesis that the tested protocols are an effective method for the non-invasive assessment of cattle immunology. The method could be used as part of animal health assessments, although further work is required to interpret the relationship between results and levels of infection and immunity

Timing of N application and water constraints on N accumulation and juice amino N concentration in Chardonnay grapevines

The amount and timing of nitrogen (N) application to a vineyard is critical for must yeast assimilable nitrogen (YAN) concentrations. YAN concentrations and amino acid profiles are important for the fermentation process and wine composition. Commonly, N is applied at flowering to optimize leaf functioning or after harvest to enhance vine productivity the following season. In this study N was applied at various stages of berry development to determine allocation patterns between vine perennial and annual components and to assess when berry YAN concentrations can best be optimized. Five year old potted 'Chardonnay' vines received ammonium sulfate fertilizer at six different times from full bloom to two weeks before harvest and were also exposed to either full or half irrigation during that period. Reduced water supply resulted in a higher allocation of N to the perennial structures and less to the annual components of the vine. N allocation to the annual components of the vine was greatest when it was applied at full bloom, however allocation to the perennial components was greatest when it was applied after fruit-set to veraison. The timing of N supply had a substantial influence on YAN concentrations, and was highest when N was applied about two weeks after veraison. Low water supply also resulted in higher juice YAN concentrations. The perennial N reserves in the roots were highest under low water supply and when N was applied at veraison, while the allocation to the annual parts was lower under this irrigation regime. The study indicates that timing of N application and the application of water constraints during berry development can impact on N partitioning, while the total amount accumulated by the vine is not altered