Management of antipsychotics in primary care: Insights from healthcare professionals and policy makers in the United Kingdom.

INTRODUCTION: Antipsychotic medication is increasingly prescribed to patients with serious mental illness. Patients with serious mental illness often have cardiovascular and metabolic comorbidities, and antipsychotics independently increase the risk of cardiometabolic disease. Despite this, many patients prescribed antipsychotics are discharged to primary care without planned psychiatric review. We explore perceptions of healthcare professionals and managers/directors of policy regarding reasons for increasing prevalence and management of antipsychotics in primary care. METHODS: Qualitative study using semi-structured interviews with 11 general practitioners (GPs), 8 psychiatrists, and 11 managers/directors of policy in the United Kingdom. Data was analysed using thematic analysis. RESULTS: Respondents reported competency gaps that impaired ability to manage patients prescribed antipsychotic medications, arising from inadequate postgraduate training and professional development. GPs lacked confidence to manage antipsychotic medications alone; psychiatrists lacked skills to address cardiometabolic risks and did not perceive this as their role. Communication barriers, lack of integrated care records, limited psychology provision, lowered expectation towards patients with serious mental illness by professionals, and pressure to discharge from hospital resulted in patients in primary care becoming 'trapped' on antipsychotics, inhibiting opportunities to deprescribe. Organisational and contractual barriers between services exacerbate this risk, with socioeconomic deprivation and lack of access to non-pharmacological interventions driving overprescribing. Professionals voiced fears of censure if a catastrophic event occurred after stopping an antipsychotic. Facilitators to overcome these barriers were suggested. CONCLUSIONS: People prescribed antipsychotics experience a fragmented health system and suboptimal care. Several interventions could be taken to improve care for this population, but inadequate availability of non-pharmacological interventions and socioeconomic factors increasing mental distress need policy change to improve outcomes. The role of professionals' fear of medicolegal or regulatory censure inhibiting antipsychotic deprescribing was a new finding in this study.

Health, economic, and equity consequences of future tobacco control policies in England: a microsimulation study.

BACKGROUND: Smoking still generates a huge, costly, and inequitable burden of disease. The UK tobacco-free generation target to reduce smoking prevalence to below 5% by 2030 will be missed if current trends continue. We aimed to determine whether additional policies could speed progress towards meeting the tobacco-free generation target. METHODS: We developed, calibrated, and validated a microsimulation model, IMPACTHINT simulating English adults aged 30-89 years from 2023 to 2072. The model included a detailed smoking history and quantified policy health outcomes including smoking prevalence and smoking-related diseases, economics, and equity. We simulated five scenarios: (1) baseline trends; (2) increasing the minimum age of access to tobacco to 21 years (MinAge21); (3) a 30% increase in tobacco duty (TaxUP); (4) improved smoking cessation services (ServicesUP); and (5) a combination of TaxUP and ServicesUP. We estimated the smoking prevalence, smoking-related diseases and cumulative cases prevented or postponed, and deaths. We evaluated the scenario cost-effectiveness from the societal perspective. Lastly, we analysed the results by deprivation quintile. We present in our findings cumulative cases prevented or postponed over 50 years. FINDINGS: None of the scenarios would reduce overall smoking prevalence to below 5% by 2030. However, that goal could be reached by 2035 under the TaxUP and the combination of TaxUP and ServicesUP scenarios, by 2037 under the ServicesUP scenario, or by 2038 under the MinAge21 and the baseline scenarios. By 2072, the combined scenario might reduce smoking-related diseases by 160 000 cases (95% CI 140 000-200 000), greatly exceeding the reductions by 140 000 cases (120 000-180 000) with TaxUP, 69 000 cases (53 000-86 000) with MinAge21, or 22 000 cases (14 000-31 000) with ServicesUP. Some 50% of all disease-years reduced by TaxUP would occur in the most deprived quintile. The most affluent quintile could reach the 5% goal sooner than the most deprived quintile (by 2032 for the least deprived vs 2038 for the most deprived), and it could reach the 5% target by 2030 under the combined TaxUP and ServicesUP scenario. Finally, all policies would save costs compared with the baseline trend. INTERPRETATION: Affluent groups will achieve the 5% tobacco-free goal a decade sooner than the most deprived. However, that goal could be achieved in all groups by 2035 through a 30% increase in tax and enhanced smoking cessation services. Our limitations included the uncertainties of any 50-year forecast. However, that long time-horizon can capture the potential policy benefits for younger age groups. FUNDING: Economic and Social Research Council.

Automatic Extraction of Research Themes in Epidemiological Criminology From PubMed Abstracts From 1946 to 2020: Text Mining Study.

BACKGROUND: The emerging field of epidemiological criminology studies the intersection between public health and justice systems. To increase the value of and reduce waste in research activities in this area, it is important to perform transparent research priority setting considering the needs of research beneficiaries and end users along with a systematic assessment of the existing research activities to address gaps and harness opportunities. OBJECTIVE: In this study, we aimed to examine published research outputs in epidemiological criminology to assess gaps between published outputs and current research priorities identified by prison stakeholders. METHODS: A rule-based method was applied to 23,904 PubMed epidemiological criminology abstracts to extract the study determinants and outcomes (ie, "themes"). These were mapped against the research priorities identified by Australian prison stakeholders to assess the differences from research outputs. The income level of the affiliation country of the first authors was also identified to compare the ranking of research priorities in countries categorized by income levels. RESULTS: On an evaluation set of 100 abstracts, the identification of themes returned an F1-score of 90%, indicating reliable performance. More than 53.3% (11,927/22,361) of the articles had at least 1 extracted theme; the most common was substance use (1533/11,814, 12.97%), followed by HIV (1493/11,814, 12.64%). The infectious disease category (2949/11,814, 24.96%) was the most common research priority category, followed by mental health (2840/11,814, 24.04%) and alcohol and other drug use (2433/11,814, 20.59%). A comparison between the extracted themes and the stakeholder priorities showed an alignment for mental health, infectious diseases, and alcohol and other drug use. Although behavior- and juvenile-related themes were common, they did not feature as prison priorities. Most studies were conducted in high-income countries (10,083/11,814, 85.35%), while countries with the lowest income status focused half of their research on infectious diseases (47/91, 52%). CONCLUSIONS: The identification of research themes from PubMed epidemiological criminology research abstracts is possible through the application of a rule-based text mining method. The frequency of the investigated themes may reflect historical developments concerning disease prevalence, treatment advances, and the social understanding of illness and incarcerated populations. The differences between income status groups are likely to be explained by local health priorities and immediate health risks. Notable gaps between stakeholder research priorities and research outputs concerned themes that were more focused on social factors and systems and may reflect publication bias or self-publication selection, highlighting the need for further research on prison health services and the social determinants of health. Different jurisdictions, countries, and regions should undertake similar systematic and transparent research priority-setting processes.

Identifying best modelling practices for tobacco control policy simulations: a systematic review and a novel quality assessment framework.

BACKGROUND: Policy simulation models (PSMs) have been used extensively to shape health policies before real-world implementation and evaluate post-implementation impact. This systematic review aimed to examine best practices, identify common pitfalls in tobacco control PSMs and propose a modelling quality assessment framework. METHODS: We searched five databases to identify eligible publications from July 2013 to August 2019. We additionally included papers from Feirman et al for studies before July 2013. Tobacco control PSMs that project tobacco use and tobacco-related outcomes from smoking policies were included. We extracted model inputs, structure and outputs data for models used in two or more included papers. Using our proposed quality assessment framework, we scored these models on population representativeness, policy effectiveness evidence, simulated smoking histories, included smoking-related diseases, exposure-outcome lag time, transparency, sensitivity analysis, validation and equity. FINDINGS: We found 146 eligible papers and 25 distinct models. Most models used population data from public or administrative registries, and all performed sensitivity analysis. However, smoking behaviour was commonly modelled into crude categories of smoking status. Eight models only presented overall changes in mortality rather than explicitly considering smoking-related diseases. Only four models reported impacts on health inequalities, and none offered the source code. Overall, the higher scored models achieved higher citation rates. CONCLUSIONS: While fragments of good practices were widespread across the reviewed PSMs, only a few included a 'critical mass' of the good practices specified in our quality assessment framework. This framework might, therefore, potentially serve as a benchmark and support sharing of good modelling practices.

An Analysis of PubMed Abstracts From 1946 to 2021 to Identify Organizational Affiliations in Epidemiological Criminology: Descriptive Study.

BACKGROUND: Epidemiological criminology refers to health issues affecting incarcerated and nonincarcerated offender populations, a group recognized as being challenging to conduct research with. Notwithstanding this, an urgent need exists for new knowledge and interventions to improve heath, justice, and social outcomes for this marginalized population. OBJECTIVE: To better understand research outputs in the field of epidemiological criminology, we examined the lead author's affiliation by analyzing peer-reviewed published outputs to determine countries and organizations (eg, universities, governmental and nongovernmental organizations) responsible for peer-reviewed publications. METHODS: We used a semiautomated approach to examine the first-author affiliations of 23,904 PubMed epidemiological studies related to incarcerated and offender populations published in English between 1946 and 2021. We also mapped research outputs to the World Justice Project Rule of Law Index to better understand whether there was a relationship between research outputs and the overall standard of a country's justice system. RESULTS: Nordic countries (Sweden, Norway, Finland, and Denmark) had the highest research outputs proportional to their incarcerated population, followed by Australia. University-affiliated first authors comprised 73.3% of published articles, with the Karolinska Institute (Sweden) being the most published, followed by the University of New South Wales (Australia). Government-affiliated first authors were on 8.9% of published outputs, and prison-affiliated groups were on 1%. Countries with the lowest research outputs also had the lowest scores on the Rule of Law Index. CONCLUSIONS: This study provides important information on who is publishing research in the epidemiological criminology field. This has implications for promoting research diversity, independence, funding equity, and partnerships between universities and government departments that control access to incarcerated and offending populations.

GroundsWell: Community-engaged and data-informed systems transformation of Urban Green and Blue Space for population health - a new initiative.

Natural environments, such as parks, woodlands and lakes, have positive impacts on health and wellbeing. Urban Green and Blue Spaces (UGBS), and the activities that take place in them, can significantly influence the health outcomes of all communities, and reduce health inequalities. Improving access and quality of UGBS needs understanding of the range of systems (e.g. planning, transport, environment, community) in which UGBS are located. UGBS offers an ideal exemplar for testing systems innovations as it reflects place-based and whole society processes , with potential to reduce non-communicable disease (NCD) risk and associated social inequalities in health. UGBS can impact multiple behavioural and environmental aetiological pathways. However, the systems which desire, design, develop, and deliver UGBS are fragmented and siloed, with ineffective mechanisms for data generation, knowledge exchange and mobilisation. Further, UGBS need to be co-designed with and by those whose health could benefit most from them, so they are appropriate, accessible, valued and used well. This paper describes a major new prevention research programme and partnership, GroundsWell, which aims to transform UGBS-related systems by improving how we plan, design, evaluate and manage UGBS so that it benefits all communities, especially those who are in poorest health. We use a broad definition of health to include physical, mental, social wellbeing and quality of life. Our objectives are to transform systems so that UGBS are planned, developed, implemented, maintained and evaluated with our communities and data systems to enhance health and reduce inequalities. GroundsWell will use interdisciplinary, problem-solving approaches to accelerate and optimise community collaborations among citizens, users, implementers, policymakers and researchers to impact research, policy, practice and active citizenship. GroundsWell will be shaped and developed in three pioneer cities (Belfast, Edinburgh, Liverpool) and their regional contexts, with embedded translational mechanisms to ensure that outputs and impact have UK-wide and international application.

Evaluating social and spatial inequalities of large scale rapid lateral flow SARS-CoV-2 antigen testing in COVID-19 management: An observational study of Liverpool, UK (November 2020 to January 2021).

BACKGROUND: Large-scale asymptomatic testing of communities in Liverpool (UK) for SARS-CoV-2 was used as a public health tool for containing COVID-19. The aim of the study is to explore social and spatial inequalities in uptake and case-detection of rapid lateral flow SARS-CoV-2 antigen tests (LFTs) offered to people without symptoms of COVID-19. METHODS: Linked pseudonymised records for asymptomatic residents in Liverpool who received a LFT for COVID-19 between 6th November 2020 to 31st January 2021 were accessed using the Combined Intelligence for Population Health Action resource. Bayesian Hierarchical Poisson Besag, York, and Mollié models were used to estimate ecological associations for uptake and positivity of testing. FINDINGS: 214 525 residents (43%) received a LFT identifying 5192 individuals as positive cases of COVID-19 (1.3% of tests were positive). Uptake was highest in November when there was military assistance. High uptake was observed again in the week preceding Christmas and was sustained into a national lockdown. Overall uptake were lower among males (e.g. 40% uptake over the whole period), Black Asian and other Minority Ethnic groups (e.g. 27% uptake for 'Mixed' ethnicity) and in the most deprived areas (e.g. 32% uptake in most deprived areas). These population groups were also more likely to have received positive tests for COVID-19. Models demonstrated that uptake and repeat testing were lower in areas of higher deprivation, areas located further from test sites and areas containing populations less confident in the using Internet technologies. Positive tests were spatially clustered in deprived areas. INTERPRETATION: Large-scale voluntary asymptomatic community testing saw social, ethnic, digital and spatial inequalities in uptake. COVID-19 testing and support to isolate need to be more accessible to the vulnerable communities most impacted by the pandemic, including non-digital means of access. FUNDING: Department of Health and Social Care (UK) and Economic and Social Research Council.

How does vulnerability to COVID-19 vary between communities in England? Developing a Small Area Vulnerability Index (SAVI).

BACKGROUND: During the initial wave of the COVID-19 epidemic in England, several population characteristics were associated with increased risk of mortality-including, age, ethnicity, income deprivation, care home residence and housing conditions. In order to target control measures and plan for future waves of the epidemic, public health agencies need to understand how these vulnerabilities are distributed across and clustered within communities. METHODS: We performed a cross-sectional ecological analysis across 6789 small areas in England. We assessed the association between COVID-19 mortality in each area and five vulnerability measures relating to ethnicity, poverty, prevalence of long-term health conditions, living in care homes and living in overcrowded housing. Estimates from multivariable Poisson regression models were used to derive a Small Area Vulnerability Index. RESULTS: Four vulnerability measures were independently associated with age-adjusted COVID-19 mortality. Each SD increase in the proportion of the population (1) living in care homes, (2) admitted to hospital in the past 5 years for a long-term health condition, (3) from an ethnic minority background and (4) living in overcrowded housing was associated with a 28%, 19% 8% and 11% increase in age-adjusted COVID-19 mortality rate, respectively. CONCLUSION: Vulnerability to COVID-19 was noticeably higher in the North West, West Midlands and North East regions, with high levels of vulnerability clustered in some communities. Our analysis indicates the communities who will be most at risk from a second wave of the pandemic.

Cardiovascular Risk and Risk Factor Management in Type 2 Diabetes Mellitus: A Population-Based Cohort Study Assessing Sex Disparities

BACKGROUND: With recent changes in the United Kingdom's clinical practice for diabetes mellitus care, contemporary estimates of sex disparities in cardiovascular risk and risk factor management are needed. METHODS: In this retrospective cohort study, using the Clinical Practice Research Datalink linked to hospital and death records for people in England, we identified 79 985 patients with incident type 2 diabetes mellitus (T2DM) between 2006 to 2013 matched to 386 547 patients without diabetes mellitus. Sex-stratified Cox models were used to assess cardiovascular risk. RESULTS: Compared with women without T2DM, women with T2DM had a higher cardiovascular event risk (adjusted hazard ratio, 1.20 [95% confidence interval, 1.12-1.28]) with similar corresponding data in men (hazard ratio, 1.12 [1.06-1.19]), leading to a nonsignificant higher relative risk in women (risk ratio, 1.07 [0.98-1.17]). However, some important sex differences in the management of risk factors were observed. Compared with men with T2DM, women with T2DM were more likely to be obese, hypertensive, and have hypercholesterolemia, but were less likely to be prescribed lipid-lowering medication and angiotensin-converting enzyme inhibitors, especially if they had cardiovascular disease. CONCLUSIONS: Compared with men developing T2DM, women with T2DM do not have a significantly higher relative increase in cardiovascular risk, but ongoing sex disparities in prescribing should prompt heightened efforts to improve the standard and equity of diabetes mellitus care in women and men.

Disparities in mortality among 25-44-year-olds in England: a longitudinal, population-based study.

BACKGROUND: Since the mid-1990s, excess mortality has increased markedly for adults aged 25-44 years in the north compared with the south of England. We examined the underlying causes of this excess mortality and the contribution of socioeconomic deprivation. METHODS: Mortality data from the Office of National Statistics for adults aged 25-44 years were aggregated and compared between England's five most northern versus five most southern government office regions between Jan 1, 1981, and Dec 31, 2016. Poisson regression models, adjusted for age and sex, were used to quantify excess mortality in the north compared with the south by underlying cause of death (accidents, alcohol related, cardiovascular disease and diabetes, drug related, suicide, cancer, and other causes). The role of socioeconomic deprivation, as measured by the 2015 Index of Multiple Deprivation, in explaining the excess and regional variability was also explored. FINDINGS: A mortality divide between the north and south appeared in the mid-1990s and rapidly expanded thereafter for deaths attributed to accidents, alcohol misuse, and drug misuse. In the 2014-16 period, the northern excess was incidence rate ratio (IRR) 1·47 (95% CI 1·39-1·54) for cardiovascular reasons, 2·09 (1·94-2·25) for alcohol misuse, and 1·60 (1·51-1·70) for drug misuse, across both men and women aged 25-44 years. National mortality rates for cardiovascular deaths declined over the study period but a longstanding gap between north and south persisted (from 33·3 [95% CI 31·8-34·8] in 1981 to 15·0 [14·0-15·9] in 2016 in the north vs from 23·5 [22·3-24·8] to 9·9 [9·2-10·5] in the south). Between 2014 and 2016, estimated excess numbers of death in the north versus the south for those aged 25-44 years were 1881 (95% CI 726-2627) for women and 3530 (2216-4511) for men. Socioeconomic deprivation explained up to two-thirds of the excess mortality in the north (IRR for northern effect reduced from 1·15 [95% CI 1·14-1·15; unadjusted] to 1·05 [1·04-1·05; adjusted for Index of Multiple Deprivation]). By 2016, in addition to the persistent north-south gap, mortality rates in London were lower than in all other regions, with IRRs ranging from IRR 1·13 (95% CI 1·12-1·15) for the East England to 1·22 (1·20-1·24) for the North East, even after adjusting for deprivation. INTERPRETATION: Sharp relative rises in deaths from cardiovascular reasons, alcohol misuse and drug misuse in the north compared with the south seem to have created new health divisions between England's regions. This gap might be due to exacerbation of existing social and health inequalities that have been experienced for many years. These divisions might suggest increasing psychological distress, despair, and risk taking among young and middle-aged adults, particularly outside of London. FUNDING: Medical Research Council and Wellcome Trust.

Increasing socioeconomic gap between the young and old: temporal trends in health and overall deprivation in England by age, sex, urbanity and ethnicity, 2004-2015.

BACKGROUND: At a low geographical level, little is known about the associations between population characteristics and deprivation, and their trends, which would be directly affected by the house market, labour pressures and government policies. We describe temporal trends in health and overall deprivation in England by age, sex, urbanity and ethnicity. METHODS: Repeated cross-sectional whole population study for England, 2004-2015, at a low geographical level (average 1500 residents). We calculated weighted medians of the Index of Multiple Deprivation (IMD) for each subgroup of interest. RESULTS: Over time, we observed increases in relative deprivation for people aged under 30, and aged 30-59, while median deprivation decreased for those aged 60 or over. Subgroup analyses indicated that relative overall deprivation was consistently higher for young adults (aged 20-29) and infants (aged 0-4), with increases in deprivation for the latter. Levels of overall deprivation in 2004 greatly varied by ethnicity, with the lowest levels observed for White British and the highest for Blacks. Over time, small reductions were observed in the deprivation gap between White British and all other ethnic groups. Findings were consistent across overall IMD and its health and disability subdomain, but large regional variability was also observed. CONCLUSIONS: Government policies, the financial crisis of 2008, education funding and the increasing cost of houses relative to real wages are important parameters in interpreting our findings. Socioeconomic deprivation is an important determinant of health and the inequalities this work highlights may have significant implications for future fiscal and healthcare policy.

Geographical epidemiology of health and overall deprivation in England, its changes and persistence from 2004 to 2015: a longitudinal spatial population study.

BACKGROUND: Socioeconomic deprivation is a key determinant for health. In England, the Index of Multiple Deprivation (IMD) is a widely used composite measure of deprivation. However, little is known about its spatial clustering or persistence across time. METHODS: Data for overall IMD and its health domain were analysed for 2004-2015 at a low geographical area (average of 1500 people). Levels and temporal changes were spatially visualised for the whole of England and its 10 administrative regions. Spatial clustering was quantified using Moran's I, correlations over time were quantified using Pearson's r. RESULTS: Between 2004 and 2015 we observed a strong persistence for both overall (r=0.94) and health-related deprivation (r=0.92). At the regional level, small changes were observed over time, but with areas slowly regressing towards the mean. However, for the North East, North West and Yorkshire, where health-related deprivation was the highest, the decreasing trend in health-related deprivation reversed and we noticed increases in 2015. Results did not support our hypothesis of increasing spatial clustering over time. However, marked regional variability was observed in both aggregate deprivation outcomes. The lowest autocorrelation was seen in the North East and changed very little over time, while the South East had the highest autocorrelation at all time points. CONCLUSIONS: Overall and health-related deprivation patterns persisted in England, with large and unchanging health inequalities between the North and the South. The spatial aspect of deprivation can inform the targeting of health and social care interventions, particularly in areas with high levels of deprivation clustering.

North-South disparities in English mortality1965-2015: longitudinal population study.

BACKGROUND: Social, economic and health disparities between northern and southern England have persisted despite Government policies to reduce them. We examine long-term trends in premature mortality in northern and southern England across age groups, and whether mortality patterns changed after the 2008-2009 Great Recession. METHODS: Population-wide longitudinal (1965-2015) study of mortality in England's five northernmost versus four southernmost Government Office Regions - halves of overall population. MAIN OUTCOME MEASURE: directly age-sex adjusted mortality rates; northern excess mortality (percentage excess northern vs southern deaths, age-sex adjusted). RESULTS: From 1965 to 2010, premature mortality (deaths per 10 000 aged <75 years) declined from 64 to 28 in southern versus 72 to 35 in northern England. From 2010 to 2015 the rate of decline in premature mortality plateaued in northern and southern England. For most age groups, northern excess mortality remained consistent from 1965 to 2015. For 25-34 and 35-44 age groups, however, northern excess mortality increased sharply between 1995 and 2015: from 2.2% (95% CI -3.2% to 7.6%) to 29.3% (95% CI 21.0% to 37.6%); and 3.3% (95% CI -1.0% to 7.6%) to 49.4% (95% CI 42.8% to 55.9%), respectively. This was due to northern mortality increasing (ages 25-34) or plateauing (ages 35-44) from the mid-1990s while southern mortality mainly declined. CONCLUSIONS: England's northern excess mortality has been consistent among those aged <25 and 45+ for the past five decades but risen alarmingly among those aged 25-44 since the mid-90s, long before the Great Recession. This profound and worsening structural inequality requires more equitable economic, social and health policies, including potential reactions to the England-wide loss of improvement in premature mortality.

Demographics of dogs, cats, and rabbits attending veterinary practices in Great Britain as recorded in their electronic health records.

BACKGROUND: Understanding the distribution and determinants of disease in animal populations must be underpinned by knowledge of animal demographics. For companion animals, these data have been difficult to collect because of the distributed nature of the companion animal veterinary industry. Here we describe key demographic features of a large veterinary-visiting pet population in Great Britain as recorded in electronic health records, and explore the association between a range of animal's characteristics and socioeconomic factors. RESULTS: Electronic health records were captured by the Small Animal Veterinary Surveillance Network (SAVSNET), from 143 practices (329 sites) in Great Britain. Mixed logistic regression models were used to assess the association between socioeconomic factors and species and breed ownership, and preventative health care interventions. Dogs made up 64.8% of the veterinary-visiting population, with cats, rabbits and other species making up 30.3, 2.0 and 1.6% respectively. Compared to cats, dogs and rabbits were more likely to be purebred and younger. Neutering was more common in cats (77.0%) compared to dogs (57.1%) and rabbits (45.8%). The insurance and microchipping relative frequency was highest in dogs (27.9 and 53.1%, respectively). Dogs in the veterinary-visiting population belonging to owners living in least-deprived areas of Great Britain were more likely to be purebred, neutered, insured and microchipped. The same association was found for cats in England and for certain parameters in Wales and Scotland. CONCLUSIONS: The differences we observed within these populations are likely to impact on the clinical diseases observed within individual veterinary practices that care for them. Based on this descriptive study, there is an indication that the population structures of companion animals co-vary with human and environmental factors such as the predicted socioeconomic level linked to the owner's address. This 'co-demographic' information suggests that further studies of the relationship between human demographics and pet ownership are warranted.

Making Medication Data Meaningful: Illustrated with Hypertension.

We demonstrate, with application to hypertension management, an algorithm for reconstructing therapeutic decisions from electronic primary care medication prescribing records. These decisions concern the initiation, termination and alteration of therapy, and have further utility in: monitoring patient adherence to medication; care pathway analysis including process mining; advanced phenotype construction; audit and feedback; and in measuring care quality.

Kin of coauthorship in five decades of health science literature.

Family background-kinship-can propagate careers. The evidence for academic nepotism is littered with complex associations and disputed causal inferences. Surname clustering, albeit with very careful consideration of surnames' flows across regions and time periods, can be used to reflect family ties. We examined surname patterns in the health science literature, by country, across five decades. Over 21 million papers indexed in the MEDLINE/PubMed database were analyzed. We identified relevant country-specific kinship trends over time and found that authors who are part of a kin tend to occupy central positions in their collaborative networks. Just as kin build potent academic networks with their own resources, societies may do well to provide equivalent support for talented individuals with fewer resources, on the periphery of networks.

Cardiovascular screening to reduce the burden from cardiovascular disease: microsimulation study to quantify policy options.

OBJECTIVES:  To estimate the potential impact of universal screening for primary prevention of cardiovascular disease (National Health Service Health Checks) on disease burden and socioeconomic inequalities in health in England, and to compare universal screening with alternative feasible strategies. DESIGN:  Microsimulation study of a close-to-reality synthetic population. Five scenarios were considered: baseline scenario, assuming that current trends in risk factors will continue in the future; universal screening; screening concentrated only in the most deprived areas; structural population-wide intervention; and combination of population-wide intervention and concentrated screening. SETTING:  Synthetic population with similar characteristics to the community dwelling population of England. PARTICIPANTS:  Synthetic people with traits informed by the health survey for England. MAIN OUTCOME MEASURE:  Cardiovascular disease cases and deaths prevented or postponed by 2030, stratified by fifths of socioeconomic status using the index of multiple deprivation. RESULTS:  Compared with the baseline scenario, universal screening may prevent or postpone approximately 19 000 cases (interquartile range 11 000-28 000) and 3000 deaths (-1000-6000); concentrated screening 17 000 cases (9000-26 000) and 2000 deaths (-1000-5000); population-wide intervention 67 000 cases (57 000-77 000) and 8000 deaths (4000-11 000); and the combination of the population-wide intervention and concentrated screening 82 000 cases (73 000-93 000) and 9000 deaths (6000-13 000). The most equitable strategy would be the combination of the population-wide intervention and concentrated screening, followed by concentrated screening alone and the population-wide intervention. Universal screening had the least apparent impact on socioeconomic inequalities in health. CONCLUSIONS:  When primary prevention strategies for reducing cardiovascular disease burden and inequalities are compared, universal screening seems less effective than alternative strategies, which incorporate population-wide approaches. Further research is needed to identify the best mix of population-wide and risk targeted CVD strategies to maximise cost effectiveness and minimise inequalities.