Real-world evaluation of the impact of statin intensity on adherence and persistence to therapy: A Scottish population-based study.

AIM: To assess associations between statin intensity and adherence, persistence and discontinuation of statin therapy in Scotland. METHOD: Retrospective cohort study, using linked electronic health records covering a period from January 2009 to December 2016. The study cohort included adult patients (≥18 years) newly initiating statins within Greater Glasgow and Clyde, Scotland. Study outcomes comprised adherence, discontinuation and persistence to treatment, stratified by three exposure groups (high, moderate and low intensity). Discontinuation and persistence were calculated using the refill-gap and anniversary methods, respectively. Proportion of days covered (PDC) was used as a proxy for adherence. Kaplan-Meier survival curves and Cox proportional hazard models were used to evaluate discontinuation, and associations between adherence/persistence and statin intensity were assessed using logistic regression. RESULTS: A total of 73 716 patients with a mean age of 61.4 ± 12.6 years were included; the majority (88.3%) received moderate intensity statins. Discontinuation rates differed between intensity levels, with high-intensity patients less likely to discontinue treatment compared to those on moderate intensity (prior cardiovascular disease [CVD]: HR 0.43 [95% CI 0.34-0.55]; no prior CVD: 0.80 [0.74-0.86]). Persistence declined over time, and high-intensity patients had the highest persistence rates. Overall, 52.6% of patients were adherent to treatment (PDC ≥ 80%), but adherence was considerably higher among high-intensity patients (63.7%). CONCLUSION: High-intensity statins were associated with better persistence and adherence to treatment, but overall long-term persistence and adherence remain a challenge, particularly among patients without prior CVD. This needs addressing.

Rehabilitation doxa and practitioner judgment. An analysis of symbolic violence on health care provision in the Scottish prison system / Doxa da rehabilitação e o julgamento professional. Uma análise da violência simbólica na provisão de cuidados em saúde no sistema prisional escocês

Abstract This paper presents an analysis of the symbolic conditions which govern health care provision in the Scottish prison system. The paper considers the wider context of Scottish prisons, where health care provision follows a similar structure both in juvenile and adult prisons. Our intention is to provoke a debate about the doxa (Bourdieu, 1977), which underlies decision making in respect of health care in prison, in a political environment where pragmatism, allied to the 'pathologisation' of social policies, health and criminal justice has been a hegemonic force.

Resumo Este artigo apresenta uma análise das condições simbólicas que governam a provisão de saúde nos sistemas prisional escocês. O artigo considera o contexto ampliado do sistema prisonal escocês, onde a provisão de saúde segue uma estrutura similar tanto nas unidades juvenis quanto nas de adultos. Nossa intenção é provocar um debate sobre a doxa (Bourdieu, 1977) que sustenta as tomadas de decisão sobre provisão de saúde nas prisões, onde o contexto político marcado pelo pragmatismo, aliado à 'patologização' das políticas sociais, de saúde e de justiça criminal, tem sido uma força hegemônica.

O planejamento integrado de bacia hidrográfica e uso do solo na Escócia / Water basin management plan integrated in spatial plans in Scotland

RESUMO A implementação da Diretiva da Água 2000/60/EC demandou a articulação entre a gestão da água e a gestão territorial na comunidade europeia, fomentando a integração entre diferentes níveis de planejamento, como o regional, aplicado na escala da bacia hidrográfica, e o local, aplicado em âmbito municipal. Na Escócia, a integração entre os diferentes setores e escalas de planejamento é conduzida pela aplicação da Avaliação Ambiental Estratégica (AAE). Neste artigo, foram comparados os procedimentos e etapas de elaboração de dois instrumentos de planejamento territorial realizados para a mesma área: o Plano de Bacia Hidrográfica da Escócia para 2009/2015 e sua AAE e o Plano de Desenvolvimento Local de Glasgow para 2010/2015 e sua respectiva AAE. Como resultado, as diferentes características dos instrumentos de planejamento analisados influenciam nos objetivos e no nível de detalhamento utilizado pelas AAEs, cujos resultados conduziram gradativamente à integração dos planos. Como conclusão, o uso da AAE mostrou-se efetivo para propiciar a integração dos diferentes instrumentos de planejamento, atendendo aos requisitos da Diretiva da Água.

ABSTRACT The Water Directive 2000/60/EC regards the water basin management plans integrated in spatial plans in the European community, affecting the regional and local planning. In Scotland, the Strategic Environmental Assessment is used to combine distinct sectors and planning scales. This paper compared the procedures and steps of spatial planning for the same area: Scottish River Basin Management Plan 2009/2015 and Local Development Plan for Glasgow 2010/2015, with their Strategic Environmental Assessment as well. As a result, features of each planning tools affect the aims and details of Strategic Environmental Assessment, which conducts gradually the planning integration. The practice of Strategic Environmental Assessment is useful regarding the Water Directive objectives.

A reassessment of world population trends.

This reassessment is limited to observations concerning trends in mortality and fertility and concerning longrun prospects for population growth. Recorded changes in mortality are compared with 3 projections made many years ago. Projections of European mortality made in 1941-42 understated by a wide margin the actual increase in expectation of life because of unforeseen technological changes in the prevention and cure of fatal disease. On the other hand, a projection made in 1955 for India, foreseeing a rapid rise in the 1950s and slower progress later on because of the exhaustion of the easier gains, appears to have been accurate and also to depict the prospects in other populations of relatively high mortality and low income. A different projection of life expectancy in Mexico was also quite close to actual changes in Mexican mortality; it was based on a universal curve constructed to represent how life expectancy rises, increasing ever more slowly as it approaches an upper limit. This curve (1 for each sex), constructed for projection of Mexican mortality, is employed as a standard of comparison for mortality changes in many countries. A number have followed the standard for females very closely for more than 3 decades; in developed countries, male life expectancy has generally fallen short of the standard. The almost universal low fertility in developed countries contrasts with the great diversity of levels and trends of fertility in developing countries, some of which retain undiminished high fertility and others of which have recently attained rates of childbearing as low as in the developed areas. Instances of surprisingly little change and surprisingly rapid change in fertility are described. In the future, growth of populations of developed countries will probably be slight; the future rate of increase in the developing areas depends on the unpredictable timing and pace of childbearing reduction in populations where fertility remains high. In the long run, world population growth may resume its typical pattern of moderate growth interrupted by catastrophic setbacks.