List Size, Standards and Perfromance in General Practice - A Pilot Study in the South East Thames Region

This is a report of a piolt study carried out among 155 general practitioner trainers in South East Thames region. Similar pilot studies have been carried out among trainers in four other regions on England. Separate reports have been prepared for each of the five regions, together with a summary report comparing the findings among the regions. The pilot studies were funded by the DHSS and carried out by staff of the Health Services Research Unit at the University of Kent at Camterbury

Corrugation of Roads

We present a one dimensional model for the development of corrugations in roads subjected to compressive forces from a flux of cars. The cars are modeled as damped harmonic oscillators translating with constant horizontal velocity across the surface, and the road surface is subject to diffusive relaxation. We derive dimensionless coupled equations of motion for the positions of the cars and the road surface H(x,t), which contain two phenomenological variables: an effective diffusion constant Delta(H) that characterizes the relaxation of the road surface, and a function alpha(H) that characterizes the plasticity or erodibility of the road bed. Linear stability analysis shows that corrugations grow if the speed of the cars exceeds a critical value, which decreases if the flux of cars is increased. Modifying the model to enforce the simple fact that the normal force exerted by the road can never be negative seems to lead to restabilized, quasi-steady road shapes, in which the corrugation amplitude and phase velocity remain fixed.Comment: 20 pages, 8 figures, typos correcte

Ranking the importance of nuclear reactions for activation and transmutation events

Pathways-reduced analysis is one of the techniques used by the Fispact-II nuclear activation and transmutation software to study the sensitivity of the computed inventories to uncertainties in reaction cross-sections. Although deciding which pathways are most important is very helpful in for example determining which nuclear data would benefit from further refinement, pathways-reduced analysis need not necessarily define the most critical reaction, since one reaction may contribute to several different pathways. This work examines three different techniques for ranking reactions in their order of importance in determining the final inventory, comparing the pathways based metric (PBM), the direct method and one based on the Pearson correlation coefficient. Reasons why the PBM is to be preferred are presented.Comment: 30 pages, 10 figure

Investigation of social, demographic and health variations in the usage of prescribed and over-the-counter medicines within a large cohort (South Yorkshire, UK)

Objectives Prescribed and over-the-counter (non-prescribed) medicine usage has increased in recent years; however, there has been less investigation of the socioeconomic predictors of use. This has been due to a lack of data, especially for over-the-counter medicines. Our study aims to understand how prescribed and over-the-counter medicine patterns vary by demographic, social and health characteristics within a large population cohort. Design Cross-sectional data analysis. Setting South Yorkshire, UK. Participants 27 806 individuals from wave 1 of the Yorkshire Health Study (2010–2012). Measures Individuals self-reported each medicine they were taking and whether each was prescribed or not. The medicines were grouped into 14 categories (eg, cardiovascular system, infection, contraception). Negative binomial regression models were used to analyse the count of medicine usage. We included demographic (age, gender, ethnicity), social (education), health-related (body mass index, smoking, alcohol consumption, physical activity) factors and chronic health conditions (eg, stroke, anxiety and heart disease) in our analyses. Results 49% of men and 62% of women were taking medicine with the majority of this prescribed (88% and 83%, respectively). Health conditions were found to be positively associated with prescribed medicine usage, but mixed in their associated with over-the-counter medicines. Educational attainment was negatively associated with prescribed and positively associated with over-the-counter usage. Conclusions Our study addresses a dearth of evidence to provide new insights into how behaviours in medicine usage vary by demographic, social and health-related factors. Differences in over-the-counter medicine usage by educational attainment may help our understanding of the determinants of health inequalities

Depressed patients’ experiences with and perspectives on treatment provided by homeopaths. A qualitative interview study embedded in a trial

Introduction Depression is one of the clinical conditions patients most commonly consult homeopaths. This study therefore aimed to learn about patients’ experiences having this intervention. Methods A semi-structured qualitative interview study was nested within a randomised controlled trial to learn about depressed patients’ experiences with treatment provided by homeopaths. A purposive selection of adults with moderate to severe self-reported depression were included. Interviews were conducted post initial consultation and six months post-randomisation. Thematic analysis was used to develop themes describing participants’ experiences, thoughts and understandings. Results Forty-six interviews were carried out with 33 adults. Sixteen themes were developed and have been categorised under three main headings: 1) changed understanding of the intervention, with themes such as understanding the intervention as being adapted; 2) experiences with the consultation and the medication, such as caring support, trust and optimism arising from consultations with homeopaths; and 3) changes in state of health, such as improvement in mood, wellbeing and ability to cope, or little or no change, or transient adverse events. Conclusion This is the first qualitative study of depressed patients’ experiences with treatment provided by homeopaths. Results provide an insight into their experiences with consultations and homeopathic and antidepressant medication, their understanding of the intervention, and the changes in their state of health over time

Who are the obese? A cluster analysis exploring subgroups of the obese

Background Body mass index (BMI) can be used to group individuals in terms of their height and weight as obese. However, such a distinction fails to account for the variation within this group across other factors such as health, demographic and behavioural characteristics. The study aims to examine the existence of subgroups of obese individuals. Methods Data were taken from the Yorkshire Health Study (2010–12) including information on demographic, health and behavioural characteristics. Individuals with a BMI of ≥30 were included. A two-step cluster analysis was used to define groups of individuals who shared common characteristics. Results The cluster analysis found six distinct groups of individuals whose BMI was ≥30. These subgroups were heavy drinking males, young healthy females; the affluent and healthy elderly; the physically sick but happy elderly; the unhappy and anxious middle aged and a cluster with the poorest health. Conclusions It is important to account for the important heterogeneity within individuals who are obese. Interventions introduced by clinicians and policymakers should not target obese individuals as a whole but tailor strategies depending upon the subgroups that individuals belong to

Examining the incremental impact of long-standing health conditions on subjective well-being alongside the EQ-5D

Background: Generic preference-based measures such as the EQ-5D and SF-6D have been criticised for being narrowly focused on a sub-set of dimensions of health. Our study aims to explore whether long-standing health conditions have an incremental impact on subjective well-being alongside the EQ-5D. Methods: Using data from the South Yorkshire Cohort study (N = 13,591) collected between 2010 and 2012 on the EQ-5D, long-standing health conditions (self-reported), and subjective well-being measure – life satisfaction using a response scale from 0 (completely dissatisfied) to 10 (completely satisfied), we employed generalised logit regression models. We assessed the impact of EQ-5D and long-standing health conditions together on life satisfaction by examining the size and significance of their estimated odds ratios. Results: The EQ-5D had a significant association with life satisfaction, in which anxiety/depression and then self-care had the largest weights. Some long-standing health conditions were significant in some models, but most did not have an independent impact on life satisfaction. Overall, none of the health conditions had a consistent impact on life satisfaction alongside the EQ-5D. Conclusions: Out study suggests that the impact of long-standing health conditions on life satisfaction is adequately captured by the EQ-5D, although the findings are limited by reliance on self-reported conditions and a single item life satisfaction measure

Association between body mass index and health-related quality of life, and the impact of self-reported long-term conditions - cross-sectional study from the south Yorkshire cohort dataset

Background We sought to quantify the relationship between body mass index (BMI) and health-related quality (HRQoL) of life, as measured by the EQ-5D, whilst controlling for potential confounders. In addition, we hypothesised that certain long-term conditions (LTCs), for which being overweight or obese is a known risk factor, may mediate the association between BMI and HRQoL. Hence the aim of our study was to explore the association between BMI and HRQoL, first controlling for confounders and then exploring the potential impact of LTCs. Methods We used baseline data from the South Yorkshire Cohort, a cross-sectional observational study which uses a cohort multiple randomised controlled trial design. For each EQ-5D health dimension we used logistic regression to model the probability of responding as having a problem for each of the five health dimensions. All continuous variables were modelled using fractional polynomials. We examined the impact on the coefficients for BMI of removing LTCs from our model. We considered the self-reported LTCs: diabetes, heart disease, stroke, cancer, osteoarthritis, breathing problems and high blood pressure. Results The dataset used in our analysis had data for 19,460 individuals, who had a mean EQ-5D score of 0.81 and a mean BMI of 26.3 kg/m2. For each dimension, BMI and all of the LTCs were significant predictors. For overweight or obese individuals (BMI ≥ 25 kg/m2), each unit increase in BMI was associated with approximately a 3% increase in the odds of reporting a problem for the anxiety/depression dimension, a 8% increase for the mobility dimension, and approximately 6% for the remaining dimension s. Diabetes, heart disease, osteoarthritis and high blood pressure were identified as being potentially mediating variables for all of the dimensions. Conclusions Compared to those of a normal weight (18.5 < BMI < 25 kg/m2), overweight and obese individuals had a reduced HRQoL, with each unit increase in BMI associated with approximately a 6% increase in the odds of reporting a problem on any of the EQ-5D health dimensions. There was evidence to suggest that diabetes, heart disease, osteoarthritis and high blood pressure may mediate the association between being overweight and HRQoL