Internet access among the most income deprived: the case of Glasgow

Glasgow is Scotland’s largest city and since 2009 it has seen stagnating levels of fixed broadband uptake (Ofcom, 2013). As recently as August 2013, Ofcom reported that fixed broadband uptake in Glasgow remained at 50%; this is significantly below the Scottish average of 68% (Ofcom, 2013). As the ‘Digital by Default’ agenda of the United Kingdom government, which places government services online, becomes ever more pervasive this becomes a more pressing issue for the city. That needs to find ways to increase broadband adoption. There is also a need to uncover the deep seated reasons why there has been no improvement in fixed broadband uptake in the last five years in Glasgow. Internet access is lowest amongst the most deprived in society and those with the lowest incomes (SHS, 2012). Analysis based on the Scottish Index of Multiple Deprivation highlights that ‘income deprivation in Glasgow City is greater than in Scotland as a whole’- 21.5% of Glasgow’s population were income deprived in 2012 (Scottish Government, 2012a, p3). This paper focuses on the deprived areas of Glasgow and whether and how the most disadvantaged in the city use the Internet. The analysis draws on data from the Scottish Index of Multiple Deprivation (SIMD) and from individuals in deprived areas. This paper will investigate those who do and do not have access to the Internet to answer the following questions: In areas of deprivation what differentiates those who do and do not have access to the Internet? Do demographic or geographic factors have greater influence in determining whether a person has access to the Internet at home? What factors, other than demographics, influence the adoption of the Internet in areas of deprivation? The attitude of individuals towards the Internet rather than demographic factors has been highlighted as an important factor in Glasgow (White, 2013). This paper takes this analysis a step further by targeting the most disadvantaged to ascertain whether neighbourhood effects or attitudes to technology are the most important. This will enable a greater understanding of how to engage those who do not use the Internet. It will also provide insight into the development of policy initiatives in Glasgow to address this particular issue. Since geography plays an influential role in shaping public policy through, for instance, local politics, this paper will initially map the available demographic and economic data. Previous work in Glasgow on public Internet access in areas of deprivation highlighted specific areas of the city with low broadband uptake and high levels of deprivation (Anderson and Whalley, 2013). Although this paper continues in the same vain, it instead focuses on home Internet uptake in similarly deprived areas. This was accomplished by questioning people seeking benefits assistance at Citizens Advice Bureau (CAB) across the city. CAB provides impartial advice to those who visit their offices. Each CAB is separately run, with its own funding from Glasgow City Council or other sources. They operate independently, almost like a franchise model. Due to 2 how they are funded, CABs are only meant to serve their immediate local community. Thus, where the CAB is positioned will have a huge effect on who visits. Targeting CAB provides valuable and insightful data from the most vulnerable and marginalised members of society. Those affected by the ‘Digital by Default’ program are the most likely to need to apply for benefits online and provide evidence of job searching to be entitled to benefits. There are several components to the methodology adopted. Firstly, the responses of 950 individuals from eight CABs across the city were analysed to identify differences between those who do and do not have the Internet. This was combined with SIMD data using postcode information. Geographic analysis was also conducted on this data to identify differences between some of the most deprived communities in Glasgow. Secondly, a more detailed data collection on specific identified areas of the city concentrated on collecting information other than that related to the demographic barriers to Internet participation. This provided a further insight into the other barriers to adoption in areas of deprivation. This paper provides valuable insight into the use and non-use of the Internet by the most disadvantaged in Glasgow. It is expected that the first question around the differences of who does and does not have the Internet will be answered by separating the data into groups of five per cent based on their SIMD income rank. This highlights a switching point which was then used as a reference for comparing multiple factors in the dataset. Moreover, this approach highlights that some income groups did not conform to the general pattern. Indeed it could be expected, based on the literature, that higher income would mean that they are more likely to use the Internet and have devices that they can connect to the Internet (Ofcom, 2013, p279). This pattern is not consistent with the analysis of Internet use, where the relationship is non-linear and some groups have higher or lower usage than expected. This highlights that income alone is not a determinant of whether an individual uses the Internet. It also shows that there are variations in use of the Internet and ownership of devices in areas of deprivation that require further investigation. The second and third research questions focus on specific communities within the city. Communities provide different opportunities and barriers to Internet use, even within deprived areas. The geographic analysis of these areas of the city highlights the importance of place, the effects of geography on Internet use and the drivers and barriers specific to each community. This paper provides further insight into Internet use in areas of deprivation that could be of use to similar cities. There are multiple organisations which could assist in addressing the diverse needs of communities in increasing Internet access. However, they will need to work together and be responsive to the diverse needs of these communities. The evidence also provides direction for Glasgow City Council on ways to engage the disconnected, move forward with their Digital Strategy and close the Digital chasm that exists in the city

Screening for left ventricular hypertrophy in patients with type 2 diabetes mellitus in the community

<p>Abstract</p> <p>Background</p> <p>Left ventricular hypertrophy (LVH) is a strong predictor of cardiovascular disease and is common among patients with type 2 diabetes. However, no systematic screening for LVH is currently recommended for patients with type 2 diabetes. The purpose of this study was to determine whether NT-proBNP was superior to 12-lead electrocardiography (ECG) for detection of LVH in patients with type 2 diabetes.</p> <p>Methods</p> <p>Prospective cross-sectional study comparing diagnostic accuracy of ECG and NT-proBNP for the detection of LVH among patients with type 2 diabetes. Inclusion criteria included having been diagnosed for > 5 years and/or on treatment for type 2 diabetes; patients with Stage 3/4 chronic kidney disease and known cardiovascular disease were excluded. ECG LVH was defined as either the Sokolow-Lyon or Cornell voltage criteria. NT-proBNP level was measured using the Roche Diagnostics Elecsys assay. Left ventricular mass was assessed from echocardiography. Receiver operating characteristic curve analysis was carried out and area under the curve (AUC) was calculated.</p> <p>Results</p> <p>294 patients with type 2 diabetes were recruited, mean age 58 (SD 11) years, BP 134/81 ± 18/11 mmHg, HbA_1c7.3 ± 1.5%. LVH was present in 164 patients (56%). In a logistic regression model age, gender, BMI and a history of hypertension were important determinants of LVH (p < 0.05). Only 5 patients with LVH were detected by either ECG voltage criteria. The AUC for NT-proBNP in detecting LVH was 0.68.</p> <p>Conclusions</p> <p>LVH was highly prevalent in asymptomatic patients with type 2 diabetes. ECG was an inadequate test to identify LVH and while NT-proBNP was superior to ECG it remained unsuitable for detecting LVH. Thus, there remains a need for a screening tool to detect LVH in primary care patients with type 2 diabetes to enhance risk stratification and management.</p

Multiple AMPK activators inhibit L-Carnitine uptake in C2C12 skeletal muscle myotubes

Mutations in the gene that encodes the principal L-Carnitine transporter, OCTN2, can lead to a reduced intracellular L-Carnitine pool and the disease Primary Carnitine Deficiency. L-Carnitine supplementation is used therapeutically to increase intracellular L-Carnitine. As AMPK and insulin regulate fat metabolism and substrate uptake we hypothesised that AMPK activating compounds and insulin would increase L-Carnitine uptake in C2C12myotubes. The cells express all three OCTN transporters at the mRNA level and immunohistochemistry confirmed expression at the protein level. Contrary to our hypothesis, despite significant activation of PKB and 2DG uptake, insulin did not increase L-Carnitine uptake at 100nM. However, L-Carnitine uptake was modestly increased at a dose of 150nM insulin. A range of AMPK activators that increase intracellular calcium content [caffeine (10mM, 5mM, 1mM, 0.5mM), A23187 (10&mu;M)], inhibit mitochondrial function [Sodium Azide (75&mu;M), Rotenone (1&mu;M), Berberine (100&mu;M), DNP (500&mu;M)] or directly activate AMPK [AICAR (250&mu;M)] were assessed for their ability to regulate L-Carnitine uptake. All compounds tested significantly inhibited L-Carnitine uptake. Inhibition by caffeine was not dantrolene (10&mu;M) sensitive. Saturation curve analysis suggested that caffeine did not competitively inhibit L-Carnitine transport. However, the AMPK inhibitor Compound C (10&mu;M) partially rescued the effect of caffeine suggesting that AMPK may play a role in the inhibitory effects of caffeine. However, caffeine likely inhibits L-Carnitine uptake by alternative mechanisms independently of calcium release. PKA activation or direct interference with transporter function may play a role

Convalescent troponin and cardiovascular death following acute coronary syndrome

Objectives: High-sensitivity cardiac troponin testing is used in the diagnosis of acute coronary syndromes but its role during convalescence is unknown. We investigated the long-term prognostic significance of serial convalescent high-sensitivity cardiac troponin concentrations following acute coronary syndrome. Methods: In a prospective multicentre observational cohort study of 2140 patients with acute coronary syndrome, cardiac troponin I concentrations were measured in 1776 patients at 4 and 12 months following the index event. Patients were stratified into three groups according to the troponin concentration at 4 months using the 99th centile (women&gt;16 ng/L, men&gt;34 ng/L) and median concentration of those within the reference range. The primary outcome was cardiovascular death. Results: Troponin concentrations at 4 months were measurable in 99.0% (1759/1776) of patients (67±12 years, 72% male), and were ≤5 ng/L (median) and &gt;99th centile in 44.8% (795) and 9.3% (166), respectively. There were 202 (11.4%) cardiovascular deaths after a median of 4.8 years. After adjusting for the Global Registry of Acute Coronary Events score, troponin remained an independent predictor of cardiovascular death (HR 1.4, 95% CI 1.3 to 1.5 per doubling) with the highest risk observed in those with increasing concentrations at 12 months. Patients with 4-month troponin concentrations &gt;99th centile were at increased risk of cardiovascular death compared with those ≤5 ng/L (29.5% (49/166) vs 4.3% (34/795); adjusted HR 4.9, 95% CI 3.8 to 23.7). Conclusions: Convalescent cardiac troponin concentrations predict long-term cardiovascular death following acute coronary syndrome. Recognising this risk by monitoring troponin may improve targeting of therapeutic interventions

Solutions to the chronic wounds problem in Australia: A call to action

Background: Chronic wounds are a silent epidemic in Australia. They are an under-recognised public health issue, and their significant health and economic impact is underestimated. Evidence-based practice in wound care has significant health and economic benefits, yet there are still considerable evidence–practice gaps. Methods: Stakeholders attended a national forum to refine and prioritise solutions to the chronic wounds problem in Australia. A survey was administered to identify key priorities and recommendations. Results: Stakeholders agreed on 17 recommendations and strategies to improve the outcomes of Australians with chronic wounds. The identified priorities for immediate action were to raise awareness of the significance of chronic wounds, and to make chronic wounds a strategic priority for governments. The Chronic Wounds Solutions Collaborating Group was established to encourage, support and monitor action on the implementation of these recommendations. Conclusions: Large health and economic gains can be achieved with modest investments in evidence-based strategies for the prevention and control of chronic wounds in Australia. We call for a critical and sustained national effort to prevent and treat chronic wounds in Australia. Urgent action is needed at all levels if Australia is to reduce the significant preventable burden of chronic wounds and improve patient outcomes

Correction: Exome Sequencing in an Admixed Isolated Population IndicatesNFXL1 Variants Confer a Risk for Specific Language Impairment

Children affected by Specific Language Impairment (SLI) fail to acquire age appropriate language skills despite adequate intelligence and opportunity. SLI is highly heritable, but the understanding of underlying genetic mechanisms has proved challenging. In this study, we use molecular genetic techniques to investigate an admixed isolated founder population from the Robinson Crusoe Island (Chile), who are affected by a high incidence of SLI, increasing the power to discover contributory genetic factors. We utilize exome sequencing in selected individuals from this population to identify eight coding variants that are of putative significance. We then apply association analyses across the wider population to highlight a single rare coding variant (rs144169475, Minor Allele Frequency of 4.1% in admixed South American populations) in the NFXL1 gene that confers a nonsynonymous change (N150K) and is significantly associated with language impairment in the Robinson Crusoe population (p = 2.04 × 10–4, 8 variants tested). Subsequent sequencing of NFXL1 in 117 UK SLI cases identified four individuals with heterozygous variants predicted to be of functional consequence. We conclude that coding variants within NFXL1 confer an increased risk of SLI within a complex genetic model

Public library internet access in areas of deprivation: The case of Glasgow

The Internet plays an increasingly central role in the lives of individuals. It enables individuals to engage in social, economic, leisure and entertainment activities including wider access to information. Due to extensive societal use of the Internet, those without access are clearly disadvantaged. They will lack the necessary information to make decisions, forgo the savings from shopping online and limit their opportunities for social interaction. This paper investigates the role that libraries can play in providing free public Internet access. This role is examined within the context of Glasgow, a large post-industrial city in the United Kingdom where Internet adoption is lower than in comparable cities and where a large proportion of its population face a range of socio-economic hardships. Primary data was collected from library users in three areas of deprivation. Our analysis demonstrates the role that libraries play as the provider of public Internet access. It shows that this role is not without its difficulties – inadequate levels of resources have been provided to fulfill the multiple roles that libraries perform in these communities. Libraries enable users to engage in a wide array of online activities, the range of which reflects both the push of government policies and the pull of innovative services

Association between endothelin type A receptor haplotypes and mortality in coronary heart disease

Coronary heart disease (CHD) encompasses a range of conditions including unstable angina, acute myocardial infarction (MI) and sudden ischemic death, characterized by the common pathophysiologic process of atherosclerotic plaque rupture and thrombosis [1,2] . CHD patients with a high risk of poor clinical outcome are identified with the use of biochemical and clinical measurements, including circulating cardiac markers and echocardiographic indices. Prognosis of patients varies widely and genetic factors are likely to play an important role in the pathogenesis and progression of disease. The identification of genes that influence progression of disease may inform future patient management and care

Heart failure with preserved ejection fraction

Progressive aging of the population and prolongation of life expectancy have led to the rising prevalence of heart failure (HF). Despite the improvements in medical therapy, the mortality rate of this condition has remained unacceptably high, becoming the primary cause of death in the elderly population. Almost half of patients with signs and symptoms of HF are found to have a nearly normal ejection fraction, which delineates a distinct clinical syndrome, known as HF with preserved ejection fraction (HF-PEF). While early research focused on the importance of diastolic dysfunction, more recent studies reported the pathophysiological complexity of the disease with multiple cardiovascular abnormalities contributing to its development and progression. HF-PEF is a challenging major health problem with yet no solution as there is no evidence-based treatment which improves clinical outcomes. This review summarizes the state of current knowledge on diagnosis, prognosis and treatment of HF-PEF, with particular insights on the pathological characteristics in the elderly population