Predicting admissions and time spent in hospital over a decade in a population-based record linkage study: the EPIC-Norfolk cohort.

OBJECTIVE: To quantify hospital use in a general population over 10 years follow-up and to examine related factors in a general population-based cohort. DESIGN: A prospective population-based study of men and women. SETTING: Norfolk, UK. PARTICIPANTS: 11,228 men and 13,786 women aged 40-79 years in 1993-1997 followed between 1999 and 2009. MAIN OUTCOMES MEASURES: Number of hospital admissions and total bed days for individuals over a 10-year follow-up period identified using record linkage; five categories for admissions (from zero to highest ≥ 7) and hospital bed days (from zero to highest ≥ 20 nights). RESULTS: Over a period of 10 years, 18,179 (72.7%) study participants had at least one admission to hospital, 13.8% with 7 or more admissions and 19.9% with 20 or more nights in hospital. In logistic regression models with outcome ≥ 7 admissions, low education level OR 1.14 (1.05 to 1.24), age OR per 10-year increase 1.75 (1.67 to 1.82), male sex OR 1.32 (1.22 to 1.42), manual social class 1.22 (1.13 to 1.32), current cigarette smoker OR 1.53 (1.37 to 1.71) and body mass index >30 kg/m² OR 1.41 (1.28 to 1.56) all independently predicted the outcome with p30 kg/m², estimated percentages of the cohort in the categories of admission numbers and hospital bed days in stratified age bands with twofold to threefold differences in future hospital use between those with high-risk and low-risk scores. CONCLUSIONS: The future probability of cumulative hospital admissions and bed days appears independently related to a range of simple demographic and behavioural indicators. The strongest of these is increasing age with high body mass index and smoking having similar magnitudes for predicting risk of future hospital usage.The design and conduct of the EPIC-Norfolk study and collection and management of the data was supported by programme grants from the Medical Research Council UK (G9502233, G0401527) and Cancer Research UK (C864/A8257, C864/A2883).This is the final version of the article. It first appeared from the BMJ Group via http://dx.doi.org/10.1136/bmjopen-2015-00946

The Dutch SCORE-based risk charts seriously underestimate the risk of cardiovascular disease.

INTRODUCTION: Dutch cardiovascular disease (CVD) prevention guidelines recommend the use of modified SCORE risk charts to estimate 10-year risk of fatal and nonfatal CVD (myocardial infarction, cerebrovascular disease and congestive heart failure). This combined risk is derived from the SCORE mortality risk using multipliers. These multipliers have been shown to underestimate overall CVD risk. We aimed to compare the current Dutch risk charts with charts that estimate a broader range of clinically relevant CVD using updated multipliers. METHODS: We constructed new risk charts for 10-year CVD using updated, recently published multipliers from the EPIC-Norfolk study, based on ratios of fatal CVD to clinically relevant CVD (fatal plus nonfatal CVD requiring hospitalisation for ischaemic heart disease, cardiac failure, cerebrovascular disease, peripheral artery disease, and aortic aneurysm). Our primary outcome was the proportion of the three risk categories, i. e. 'high risk' (>20% 10-year risk), 'intermediate risk' (10-19%) and 'low risk' (<10%) in the new risk charts as compared with the current risk charts. RESULTS: Applying the updated fatal CVD/clinical CVD multipliers led to a marked increase in the high-risk categories (109 (27%) vs. 244 (61%), (p < 0.001)), an absolute increase of 229%. Similarly, the number of low-risk categories decreased (190 (48%) vs. 81 (20%) (p < 0.001)). CONCLUSION: The current Dutch risk charts seriously underestimate the risk of clinical CVD, even in the first 10 years. Even when analyses are restricted to CVD events that required hospitalisation, true 10-year risks are more than double the currently estimated risks. Future guidelines may be revised to reflect these findings.This work was not supported by any institution or individuals. EPIC-Norfolk is supported by program grants from the Medical Research Council UK (MRC G0401527, MRC G0701863, MRC G1000143) and Cancer Research UK (CRUK 8257)

An Insight into Life at Geometric Zagora Provided by the Animal Bones

This thesis is a study of the animal bone distribution at the Geometric period settlement of Zagora (ca. 850-700 BC), on the island of Andros. The animal bones were excavated during the 1967-74 University of Sydney excavations and analysed in 1977 by a specialist who compiled a report of her findings. The report is currently in preparation for publication and is the primary source for this thesis. The data it provided was limited but enough could be extracted to identify patterns that permitted a tentative reconstruction of social life and the economy at Zagora. There is a paucity of excavated settlements from the Greek EIA and few of these have published faunal material, an essential element in reconstructing past lifeways. Those preserved settlements from which animal bones have been published are not extensive with good domestic contexts but usually sites of minimal extent. Hence, it has not been possible to conduct an analysis of the spatial distribution of animal bones from such a settlement. Zagora, being an extensive settlement containing mainly domestic structures, is therefore unique and the animal bone report provided the opportunity for such a study to be undertaken. A number of analyses were performed using both statistical and non-statistical methods. Through these it was discovered that there is a relationship between the animal size and the size of the architectural unit within which it was found. Similarly, there appeared to be a relationship between larger architecture and the presence of fish, postulated as being a pelagic species. The patterns observed were interpreted as evidence of ‘special’ meals with a larger than usual number of diners in attendance and hence the need for a larger space to host them. Using the animal bones’ distribution and architectural evidence it is proposed that feasting was an important event at Zagora, conducted at the household level to possibly reinforce bonds of kinship and friendship. The evidence also suggests that the H area could have been inhabited by people of better means than elsewhere in the settlement, particularly by the hypaethral sanctuary. Ideally the animal bones would have been studied in conjunction with associated artefacts, but this was not possible and so this would be something desirable to be performed in the near future. With 21st century excavation techniques, the future Zagora excavations should provide greater granularity in the faunal information obtained from the settlement to allow better precision in subsequent analyses

The descriptive epidemiology of accelerometer-measured physical activity in older adults.

BACKGROUND: Objectively measured physical activity between older individuals and between populations has been poorly described. We aimed to describe and compare the variation in accelerometry data in older UK (EPIC-Norfolk) and American (NHANES) adults. METHODS: Physical activity was measured by uniaxial accelerometry in 4,052 UK (49-91 years) and 3459 US older adults (49-85 years). We summarized physical activity as volume (average counts/minute), its underlying intensity distribution, and as time spent 809 counts/minute is used 18.7% of people reached the 30 min/day threshold. By comparison, 2.5% and 9.5% of American older adults accumulated activity at these levels, respectively. CONCLUSION: As assessed by objectively measured physical activity, the majority of older adults in this UK study did not meet current activity guidelines. Older adults in the UK were more active overall, but also spent more time being sedentary than US adults.This work was supported by programme grants from the Medical Research Council [G9502233; G0401527] and Cancer Research UK [C864/A8257]. A grant from Research into Ageing [262] funded the 3rd health check clinic. KW is supported by a British Heart Foundation Intermediate Basic Science Research Fellowship [FS/12/58/29709], and AJMC, SJG, NJW, and SB are supported by MRC programme grants [MC_UU_12015/3 and MC_UU_12015/4].This is the final version of the article. It was first available from BioMed Central via http://dx.doi.org/10.1186/s12966-015-0316-

Body Fat Percentage and the Long-term Risk of Fractures. The EPIC-Norfolk Prospective Population Cohort Study

Background: This cohort study aimed to determine the association between body fat percentage (BF%), incident fractures and calcaneal broadband ultrasound attenuation (BUA). Methods: Participants were drawn from the EPIC-Norfolk Prospective Population Cohort Study (median follow-up = 16.4 years). Cox models analysed the relationship between BF% and incident fractures (all and hip). Linear and restricted cubic spline (RCS) regressions modelled the relationship between BF% and BUA. Results: 14,129 participants (56.2 % women) were included. There were 1283 and 537 incident all and hip fractures respectively. The participants had a mean (standard deviation) age of 61.5 (9.0) years for women and 62.9 (9.0) years for men. Amongst men, BF% was not associated with incident all fractures. While BF% 23 % was associated with increased risk of hip fractures by up to 50 % (hazard ratio (95 % confidence interval) = 1.49 (1.06–2.12)). In women, BF% 35 % was not associated with this outcome. Higher BF% was associated with lower risk of incident hip fractures in women. Higher BF% was associated with higher BUA amongst women. Higher BF% up to ~23 % was associated with higher BUA amongst men. Conclusions: Higher BF% is associated with lower risk of fractures in women. While there was no association between BF% and all fractures in men, increasing BF% >23 % was associated with higher risk of hip fractures in men. This appears to be independent of estimated bone mineral density. Fracture prevention efforts need to consider wider physical, clinical, and environmental factors

Sex differences in the association between area deprivation and generalised anxiety disorder: British population study

OBJECTIVE Studies have shown that area-level deprivation measured by factors, such as, non-home ownership, non-car ownership, and household overcrowding, can increase the risk for mental disorders over and above individual-level circumstances, such as, education and social class. Whether area-level deprivation is associated with generalised anxiety disorder independent of personal circumstances, and whether this association is different between British women and men is unknown. DESIGN Large, population study. SETTING UK population-based cohort. PARTICIPANTS 30,445 people from the general population aged 40 years and older and living in England consented to participate at study baseline, and of these, 21,000 participants completed a structured health and lifestyle questionnaire used to capture generalised anxiety disorder. Area deprivation was measured in 1991 using Census data, and generalised anxiety disorder was assessed in 1996-2000. 10,275 women and 8,219 men had complete data on all covariates. MAIN OUTCOME MEASURE Past-year generalised anxiety disorder defined according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). RESULTS In this study, 2.5% (261/10,275) of women and 1.8% (145/8,219) of men had generalised anxiety disorder. Women living in the most deprived areas were over 60% more likely to develop anxiety than those living in areas that were not deprived (OR=1.63, 95%CI: 1.21 to 2.21; p=0.001), but this association between deprivation and generalised anxiety disorder was not apparent in men (OR=1.13, 95% CI: 0.72 to 1.77; p=0.598). CONCLUSION The absolute numbers of people living in deprived conditions are large worldwide. This, combined with a growing mental health burden means that the findings obtained in this study remain highly relevant. The World Health Organisation has emphasised the need to reduce social and health inequalities. Our findings provide a strong evidence base to this call, showing that the environment needs to be taken into account when developing mental health policy; gender is clearly an important factor when it comes to assessing the impacts of the environment, and promoting good mental health.This work was supported by the Medical Research Council UK (grant number G9502233) and Cancer Research UK (grant number SP2024- 0201 and SP2024-0204)

Problems in the treatment of malabsorption in CF

ABSTRACT. Several factors play a role in the cause of malabsorption in CF. Besides the enzyme deficiency in the secretion of the exocrine pancreas, decreased bile‐salt concentration in the gut may also be an important factor in the fat malabsorption. The contribution to the fat absorption by other lipases, such as lingual lipase and gastric lipase, remains to he proved. The therapeutic measures are only partly effective because of the breakdown of swalled enzymes by gastric acid. Some improvement is reached by using a new acid‐resistant coating for the enzyme supplement. Newly developed and essential for its success is the application of small coated particles to prevent retention in the stomach, and the easy breakdown of the coating in an alkaline solution. The treatment of the bile salt deficiency has not been successful until now. A trial with additional Tween 80, with the option of supplementing the detergent activity which was found to he successful in Crohn disease, was without marked success. Copyrigh

Urinary bisphenol A concentration and risk of future coronary artery disease in apparently healthy men and women

addresses: Epidemiology and Public Health Group, Peninsula College of Medicine and Dentistry, Barrack Road, Exeter, United Kingdom. [email protected]: Comparative Study; Journal Article; Research Support, Non-U.S. Gov'tThe endocrine-disrupting chemical bisphenol A (BPA) is widely used in food and beverage packaging. Higher urinary BPA concentrations were cross-sectionally associated with heart disease in National Health and Nutrition Examination Survey (NHANES) 2003-2004 and NHANES 2005-2006, independent of traditional risk factors.Medical Research Council UKCancer Research UKBritish Heart FoundationPeninsula Medical School, University of ExeterEuropean Regional Development FundEuropean Social Fund Convergence Programme for Cornwall and the Isles of ScillyNational Institute for Health Research Collaborations for Leadership in Applied Health Research and Car

Longitudinal associations between marine omega-3 supplement users and Coronary Heart Disease in a UK population-based cohort

Objectives: Assess the association between marine omega-3 polyunsaturated fatty acid (n 3 PUFA) intake from supplements, mainly cod liver oil, and coronary heart disease (CHD) mortality. Design: Prospective cohort study, with three exposure measurements over 22 y. Setting: Norfolk-based European Prospective Investigation into Cancer (EPIC-Norfolk, UK). Participants: 22,035 men and women from the general population, 39-79 y at recruitment. Exposure: Supplement use was assessed in three questionnaires (1993-1998; 2002-2004; 2004-2011). Participants were grouped into non-supplement users (NSU), n 3 PUFA supplement users (SU+n3) and non n 3 PUFA supplement users (SU n3). Cox regression adjusted for time-point specific variables: age, smoking, prevalent illnesses, BMI, alcohol consumption, physical activity and season and baseline assessments of sex, social class, education and dietary intake (7-day diet diary). Primary and secondary outcome measures: During a median of 19 y follow-up, 1562 CHD deaths were registered for 22,035 included participants. Results: Baseline supplement use was not associated with CHD mortality, but baseline food and supplement intake of n 3 PUFA was inversely associated with CHD mortality after adjustment for fish consumption. Using time-varying covariate analysis, significant associations were observed for SU+n3 (HR: 0.74, 95%CI: 0.66, 0.84), but not for SU n3 vs. NSU. In further analyses, the association for SU+n3 persisted in those who did not take other supplements (HR: 0.83, 95%CI: 0.71, 0.96) and those who did (HR: 0.74, 95%CI: 0.60, 0.91). Those who became SU+n3 over time or were consistent SU+n3 vs. consistent NSU had a lower hazard of CHD mortality; no association with CHD was observed in those who stopped using n 3 PUFA-containing supplements. Conclusions: Recent use of n 3 PUFA supplements was associated with a lower hazard of CHD mortality in this general population with low fish consumption. Residual confounding cannot be excluded, but the findings observed may be explained by postulated biological mechanisms and the results were specific to SU+n3.All authors report grants from Cancer Research UK programme grants (G0401527, G1000143) and grants from the Medical Research Council (MRC) programme grants (C864/A8257, C864/A14136) during the study. RHK is supported by a MRC Fellowship (MR/M014827/1)