The Applicability of the Framingham coronary heart disease prediction function to black and minority ethnic groups in the UK

In the UK, coronary heart disease (CHD) morbidity and mortality is higher among the black and minority ethnic groups (BMEG). A number of clinical tools are available to calculate an individual’s absolute risk of developing CHD. These are based upon data derived from the Framingham heart study (FHS), the participants of which were white, middle class Americans. The prediction functions derived from the FHS data are multivariable mathematical weightings applied to major CHD risk factors to produce a probability estimate of developing CHD within a timeframe, and limitations are acknowledged when applying the Framingham data to other populations.\ud \ud Currently, data from UK cohort studies do not exist to test these functions among the BMEGs.\ud \ud The aim of this study is to assess the applicability of the Framingham prediction function to BMEGs, by comparing the summary CHD risk scores between BMEG and whites, generated after application of the Framingham prediction function to individual cardiovascular risk factor data, and then to compare the relative summary risk scores with previously published measures of CHD mortality

Family support for stroke: one year follow up of a randomised controlled trial

Background: There is evidence that family support can benefit carers of stroke patients, but not the patients themselves. Objective: To extend the follow up of a single blind randomised controlled trial of family support for stroke patients and carers to one year to ascertain whether there were any late effects of the intervention. Methods: The study was a randomised controlled trial. Patients admitted to hospital with acute stroke who had a close carer were assigned to receive family support or normal care. Families were visited at home by a researcher 12 months after the stroke, and a series of questionnaires was administered to patient and carer. Results: The benefits to carers mostly persisted, though they were no longer statistically significant because some patients were lost to follow up. There was no evidence of any effects on patients. Conclusion: Family support is effective for carers, but different approaches need to be considered to alleviate the psychosocial problems of stroke patients. Abbreviations: FSO, family support organiser; SF-36, short form 36 item health assessment questionnaire Keywords: caregiver; family support; stroke In recognition of the impact that stroke has on carers as well as patients,1 services such as Stroke Association family support have been developed in the United Kingdom which provide information, emotional support, and liaison with other services. The service maintains contact through a combination of home and hospital visits and telephone calls. In the Oxford family support trial, we found that this service was associated with significantly improved quality of life of carers at follow up six months after the stroke, but had no effects on patients.2 Other randomised controlled trials of the service in other areas have also found no evidence of benefit to patients with follow up varying from four to nine months after recruitment.3,4 The lack of benefit to patients may be attributable to the short duration of follow up in these trials. The service usually maintains contact with a family for a year, and some patients spend a significant proportion of the first six months in hospital, during which time family support might be anticipated to have less impact. We carried out a second follow up of participants in the Oxford trial to investigate the effects of family support on patients and carers one year after the stroke

Working politically: combining socio-legal tools to study experiences of law

This Article provides a novel insight into how earlycareer scholars in the UK may combine different theoretical tools in their research, and the implications that this may have for the socio-legal discipline. This Article draws upon the author’s experience of combining theoretical tools from different schools of thought: Feminist legal theory, Bourdieusian theory, and Actor Network Theory, within the context of recent research into experiences of those representing themselves in family court hearings in England and Wales. Combining these theories for the first time, this Article explores the difficulties, tensions, and benefits of combining tools within socio-legal research and reflects upon the influence of the pedagogical and institutional resources that characterize the socio-legal research environment in the UK. This Article argues that the task of combining different tools provides scholars with the opportunity to work politically, because the process of reconciling tensions between different approaches requires researchers to reflect upon the worldviews that underpin their selected theories. In this sense, it argues that combining different theories within socio-legal research is a political activity, because researchers are required to reflect not only on how theoretical choices may contest, expand, or develop dominant assumptions that characterize socio-legal scholarly traditions

ExoMol molecular line lists - XXVII: spectra of C2H4

A new line list for ethylene, $^{12}$C$_2$$^1$H$_4$ is presented. The line list is based on high level ab initio potential energy and dipole moment surfaces. The potential energy surface is refined by fitting to experimental energies. The line list covers the range up to 7000 cm$^{-1}$ (1.43 $\mu$m) with all ro-vibrational transitions (50 billion) with the lower state below 5000 cm$^{-1}$ included and thus should be applicable for temperatures up to 700 K. A technique for computing molecular opacities from vibrational band intensities is proposed and used to provide temperature dependent cross sections of ethylene for shorter wavelength and higher temperatures. When combined with realistic band profiles (such as the proposed three-band model), the vibrational intensity technique offers a cheap but reasonably accurate alternative to the full ro-vibrational calculations at high temperatures and should be reliable for representing molecular opacities. The C$_2$H$_4$ line list, which is called MaYTY, is made available in electronic form from the CDS

Biochemical diagnosis of ventricular dysfunction in elderly patients in general practice: observational study

Objective: To investigate the usefulness of measuring plasma concentrations of B type natriuretic peptide in the diagnosis of left ventricular systolic dysfunction in an unselected group of elderly people. Design: Observational study. Setting: General practice with four centres in Poole, Dorset. Participants: 155 elderly patients aged 70 to 84 years. Main outcome measures: Diagnostic characteristics of plasma B type natriuretic peptide measured by radioimmunoassay as a test for left ventricular systolic dysfunction assessed by echocardiography. Results: The median plasma concentration of B type natriuretic peptide was 39.3 pmol/l in patients with left ventricular systolic dysfunction and 15.8 pmol/l in those with normal function. The proportional area under the receiver operator curve was 0.85. At a cut-off point of 18.7 pmol/l the test sensitivity was 92% and the predictive value 18%. Conclusions: Plasma concentration of B type natriuretic peptide could be used effectively as an initial test in a community screening programme and, possibly, using a low cut-off point, as a means of ruling out left ventricular systolic dysfunction. It is, however, not a good test to “rule in” the diagnosis, and access to echocardiography remains essential for general practitioners to diagnose heart failure early

Oral contraception and eye disease: findings in two large cohort studies

AIM : To investigate the relation between oral contraceptive use and certain eye diseases. \ud \ud METHODS : Abstraction of the relevant data from the two large British cohort studies of the effects of oral contraception, the Royal College of General Practitioners' (RCGP) Oral Contraception Study and the Oxford-Family Planning Association (Oxford-FPA) Contraceptive Study. Both cohort studies commenced in 1968 and were organised on a national basis. Between them they have accumulated over 850 000 person years of observation involving 63 000 women. \ud \ud RESULTS : The conditions considered in the analysis were conjunctivitis, keratitis, iritis, lacrimal disease, strabismus, cataract, glaucoma, retinal detachment, and retinal vascular lesions. With the exception of retinal vascular lesions, there was no consistent evidence of important increases in risk of eye diseases in users of oral contraception. There was about a twofold increase in the risk of retinal vascular lesions in recent pill users in both studies (statistically significant only in the RCGP study). The increase was not limited to any specific type of lesion and may well reflect diagnostic bias. \ud \ud CONCLUSION : Oral contraceptive use does not appear to increase the risk of eye disease, with the possible exception of retinal vascular lesions. \ud \ud Keywords: oral contraception; eye disease; cohort studie

Accidental Hypothermia in Medico-Legal Practice

The autopsy findings in 28 cases of fatal hypothermia have been described. Hypothermia, in temperate climates, is one of the complications of longevity. The hypothermic state may be precipitated by a wide range of natural diseases, especially chronic cardiac disease. The classical case of hypothermia may be recognized at post-mortem by the myxoedematous appearance of the patient and the presence of gastric and pancreatic lesions

Carbon Monoxide Poisoning: Some Aspects of the Problem in Great Britain

In Great Britain, until recently, domestic gas was made from coal and was always referred to as coal gas. Today we are beginning to use natural gas, and the term coal gas is being replaced by town gas. Most of the domestic supply, however, is still coal gas, which has a high though variable percentage of carbon monoxide (Mant, 1964). In any event it is always present in a highly lethal concentration. As coal gas is so readily available, it has been the most popular suicidal poison for many years, although the recent figures show that barbiturates are overtaking it in popularity. Nevertheless, out of the 5,000 odd suicides that occur annually in England and Wales, some two-fifths are due to coal gas poisoning. Perhaps even more alarming are the 1,000 odd persons each year who die from some form of accidental carbon monoxide poisoning, usually due to the accidental release of coal gas