Variations in statin prescribing for primary cardiovascular disease prevention: cross-sectional analysis

Background Statins are an important intervention for primary and secondary cardiovascular disease (CVD) prevention. We aimed to establish the variation in primary preventive treatment for CVD with statins in the English population. Methods Cross sectional analyses of 6155 English primary care practices with 40,017,963 patients in 2006/7. Linear regression was used to model prescribing rates of statins for primary CVD prevention as a function of IMD (index of multiple deprivation) quintile, proportion of population from an ethnic minority, and age over 65 years. Defined Daily Doses (DDD) were used to calculate the numbers of patients receiving a statin. Statin prescriptions were allocated to primary and secondary prevention based on the prevalence of CVD and stroke. Results We estimated that 10.5% (s.d.3.7%) of the registered population were dispensed a statin for any indication and that 6.3% (s.d. 3.0%) received a statin for primary CVD prevention. The regression model explained 21.2% of the variation in estimates of prescribing for primary prevention. Practices with higher prevalence of hypertension (β co-efficient 0.299 p <0.001) and diabetes (β co-efficient 0.566 p < 0.001) prescribed more statins for primary prevention. Practices with higher levels of ethnicity (β co-efficient-0.026 p <0.001), greater deprivation (β co-efficient −0.152 p < 0.001) older patients (β co-efficient −0.032 p 0.002), larger lists (β co-efficient −0.085, p < 0.001) and were more rural (β co-efficient −0.121, p0.026) prescribed fewer statins. In a small proportion of practices (0.5%) estimated prescribing rates for statins were so low that insufficient prescriptions were issued to meet the predicted secondary prevention requirements of their registered population. Conclusions Absolute estimated prescribing rates for primary prevention of CVD were 6.3% of the population. There was evidence of social inequalities in statin prescribing for primary prevention. These findings support the recent introduction of a financial incentive for primary prevention of CVD in England

Interiority, exteriority and the realm of intentionality

The realm of intentionality is definitive of phenomenology as a reflective methodology. Yet it is precisely the focus on the intentional given that has been condemned recently. Speculative realism (e.g. Meillassoux, 2008/2006) argues that phenomenology is unsatisfactory since the reduction to the intentional realm excludes the 'external', i.e. reality independent of consciousness. This criticism allows me to clarify the nature of intentionality. Material phenomenology finds, in contrast, that the intentional realm excludes the 'inner' ('auto-affective life' - Henry, 1973/1963). This criticism allows me to discuss the way in which ipseity enters as an element of experience. Intentionality, viewed psychologically, is rightly the distinct arena of phenomenological psychology. However, there is no doubting the difficulty of maintaining a research focus precisely on the realm of intentionality; there are aporias of the reduction. I discuss some of the difficulties

Utilisation of microvertebrates in biostratigraphy and chemostratigraphy

The utility of marine microvertebrate fossils for bio- and chemostratigraphy and subsequent correlation were tested on the exceptionally preserved Devonian reef complexes of the Canning Basin, Western Australia. Microvertebrates provided refined age ranges for restricted depositional environments unable to be dated using conodonts or ammonoids. In addition, the O-isotope signatures recovered from hypermineralised tissues within microvertebrate fossils enabled the reconstruction of palaeoenvironmental conditions, in addition to providing the basis for chemical stratigraphy

Embodied Community Engagement: Is a University-Based Program in Dialogue and Civic Engagement a Site of Transformational Learning?

Recently, a mid-sized Canadian university launched a unique certificate program in dialogue and civic engagement. Taught by academics and practitioners, the program aims to synthesize diverse concepts and practices from a variety of disciplines related to civic engagement. The goal is to offer learners a mix of conceptual and practical knowledge that empowers them to become civic engagement leaders in their own communities or practice settings

PSYCHLOPS in Polish primary care: how do clients conceptualise their problems on a patient-generated outcome measure?

PSYCHLOPS in Polish primary care: how do clients conceptualise their problems on a patient-generated outcome measure? Author links open overlay panel MariaKordowiczaSƚawomirCzachowskibPeterSchofieldaMarkAshwortha Show more https://doi.org/10.1016/j.heliyon.2019.e02209 Get rights and content Under a Creative Commons license open access Abstract Background PSYCHLOPS, a patient-generated mental health outcome questionnaire, invites clients to describe the problem that troubles them most. PSYCHLOPS was utilised in Polish primary care in the context of a brief CBT-based intervention for mild to moderate mental health problems. Aim To explore how patients conceptualise their problems and the consequences of these problems with the aid of PSYCHLOPS. Method 243 patients were recruited from a primary care setting; 241 completed PSYCHLOPS. Free-text data were obtained from the Problem and Function domains of PSYCHLOPS, blind translated into English and independently analysed using a pre-existing thematic framework. A total of 780 free-text responses were analysed. Results The most commonly reported responses to the pre-therapy Problem domain category were “somatic” (denoting responses relating to physical health); the most common responses to the Function domain category were “competence/performance” (denoting responses relating to the respondents’ perceived ability to achieve, cope, function). Compared with pre-therapy Problem 1 domain categories, during-therapy responses revealed a higher proportion of the “interpersonal” category (denoting responses relating to social relationships) and a lower proportion of the “somatic” category. Conclusions Despite the brevity of clients' responses, PSYCHLOPS allowed an insight into patients' most troubling problems and their consequences. Possible reasons underlying the transition from a somatic to an interpersonal problem reporting during the course of talking therapy are discussed

Measuring Psychological Change during Cognitive Behaviour Therapy in Primary Care: A Polish Study Using ‘PSYCHLOPS’ (Psychological Outcome Profiles)

Psychological outcome measures are evolving into measures that depict progress over time. Interval measurement during therapy has not previously been reported for a patient-generated measure in primary care. We aimed to determine the sensitivity to change throughout therapy, using ‘PSYCHLOPS’ (Psychological Outcome Profiles), and to determine if new problems appearing during therapy diminish overall improvement.Responses to PSYCHLOPS, pre-, during- and post-therapy were compared. Setting: patients offered brief cognitive behaviour therapy in primary care in Poland.238 patients completed the pre-therapy questionnaire, 194 (81.5%) the during-therapy questionnaire and 142 the post-therapy questionnaire (59.7%). For those completing all three questionnaires (n = 135), improvement in total scores produced an overall Effect Size of 3.1 (2.7 to 3.4). We estimated change using three methods for dealing with missing values. Single and multiple imputation did not significantly change the Effect Size; ‘Last Value Carried Forward’, the most conservative method, produced an overall Effect Size of 2.3 (1.9 to 2.6). New problems during therapy were reported by 81 patients (60.0%): new problem and original problem scores were of similar magnitude and change scores were not significantly different when compared to patients who did not report new problems.A large proportion of outcome data is lost when outcome measures depend upon completed end of therapy questionnaires. The use of a during-therapy measure increases data capture. Missing data still produce difficulties in interpreting overall effect sizes for change. We found no evidence that new problems appearing during therapy hampered overall recovery

The perception and management of risk in UK office property development

Risk is an ever-present aspect of business, and risk taking is necessary for profit and economic progress. Speculative property development is popularly perceived as a 'risky business' yet, like other entrepreneurs, developers have opportunities to manage the risks they face; techniques include phasing and joint ventures. The associated areas of investment portfolio risk, development risk analysis and construction risk management have all been addressed by research. This article presents new knowledge about how developers perceive risks and the means they subsequently adopt to manage them. The developers of office projects across the UK were sent questionnaires by post. Respondents were asked about their perceptions of risks at the first appraisal stage and currently and about the risk management techniques that they had adopted. In-depth interviews with a selection of respondents were then used to discuss and augment the findings. Developers were most concerned about market-based risks at both stages. Concern about production-orientated risks was lower and fell significantly between the two stages. A fixed price contract was the most common risk management technique. Risk management techniques were used more often outside London and the South East. Developer type affects both the perception and management of risk. While developers do manage risk, decisions are made on the basis of professional and business experience. These findings should help development companies manage risk in a more objective and analytical way

Incidence of type 2 diabetes after bariatric surgery: population-based matched cohort study

Background:- The effect of currently used bariatric surgical procedures on the development of diabetes in obese people is not well defined. We aimed to assess the effect of bariatric surgery on development of type 2 diabetes in a large population of obese individuals. Methods:- We did a matched cohort study of adults (age 20–100 years) identified from a UK-wide database of family practices, who were obese (BMI ≥30 kg/m2) and did not have diabetes. We enrolled 2167 patients who had undergone bariatric surgery between Jan 1, 2002, and April 30, 2014, and matched them—according to BMI, age, sex, index year, and HbA1c—with 2167 controls who had not had surgery. Procedures included laparoscopic gastric banding (n=1053), gastric bypass (795), and sleeve gastrectomy (317), with two procedures undefined. The primary outcome was development of clinical diabetes, which we extracted from electronic health records. Analyses were adjusted for matching variables, comorbidity, cardiovascular risk factors, and use of antihypertensive and lipid-lowering drugs. Findings:- During a maximum of 7 years of follow-up (median 2·8 years [IQR 1·3–4·5]), 38 new diagnoses of diabetes were made in bariatric surgery patients and 177 were made in controls. By the end of 7 years of follow-up, 4·3% (95% CI 2·9–6·5) of bariatric surgery patients and 16·2% (13·3–19·6) of matched controls had developed diabetes. The incidence of diabetes diagnosis was 28·2 (95% CI 24·4–32·7) per 1000 person-years in controls and 5·7 (4·2–7·8) per 1000 person-years in bariatric surgery patients; the adjusted hazard ratio was 0·20 (95% CI 0·13–0·30, p<0·0001). This estimate was robust after varying the comparison group in sensitivity analyses, excluding gestational diabetes, or allowing for competing mortality risk. Interpretation:- Bariatric surgery is associated with reduced incidence of clinical diabetes in obese participants without diabetes at baseline for up to 7 years after the procedure

Creativity and the computer nerd: an exploration of attitudes

This study arises from our concern that many of our best art and design students are failing to make the most of the opportunities provided by IT because of their fear or dislike of computers. This not only deprives them of useful skills, but, even more importantly, deprives many IT based developments of their input. In this paper we investigate the relationship between attitudes to creativity and to computers among students. We quickly discard an approach based on theories of personality types as philosophically and educationally problematic. An approach based on the self-concept of artists and designers, in relation to their own creativity and to their feelings about computers, offers more hope of progress. This means that we do not try to define the attributes of "creative people". Rather, we ask what creativity means to students of art and design and relate these responses to their attitudes to computers. Self-concept depends on how the subjects see themselves within society and culture, and is liable to change as culture changes. One major instrument of cultural change at the present time is the growth of IT itself. We then describe a first attempt at using a psychological method - Kelly's Repertory Grids - to investigate the self-concept of artists and designers. It is hoped to continue with this approach in further studies over the next few years