Cross sectional survey of effectiveness of lipid lowering drugs in reducing serum cholesterol concentration in patients in 17 general practices

ObjectiveTo compare the effectiveness of lipid lowering drugs in lowering serum cholesterol concentrations.DesignCross sectional study.Setting17 practices within 17 primary care groups in Trent region, United Kingdom.ParticipantsPatients aged 35 years or over taking lipid lowering drugs and with at least two serum cholesterol concentrations recorded on computer.Results1353 of 2469 (54.8%) patients receiving lipid lowering treatment had a last recorded serum cholesterol concentration of ⩽5 mmol/l. Significantly more patients taking statins achieved the target value for serum cholesterol (5 mmol/l) than those taking fibrates (1307 (57%) v 46 (26%); P<0.0001). Atorvastatin and simvastatin were the most effective drugs in achieving the target. Significant differences were found between lipid lowering drugs for the pretreatment serum cholesterol concentration, the most recent cholesterol concentration, and the associated percentage reduction. Atorvastatin and simvastatin achieved the greatest percentage reduction in serum cholesterol concentrations (30.1%, 95% confidence interval 28.8% to 31.4%, and 28.0%, 26.7% to 29.3%, respectively). Although the mean serum cholesterol concentrations in this unselected population tended to be higher than those in clinical trials, the percentage reduction was consistent with the trials.ConclusionThe ability of individual statins to lower serum cholesterol concentration varied, with atorvastatin and simvastatin being the most effective. The percentage reductions agreed with those of randomised controlled trials indicating likely benefits in unselected patients in primary care. As the initial serum cholesterol concentrations were higher than those in randomised controlled trials, target serum cholesterol values of ⩽5 mmol/l may be unrealistic even for patients taking the most efficacious drugs. Also, the higher initial levels could mean that the absolute reduction in cardiovascular risk in primary care patients is greater than thought.

What is already known on this topic

Statins in patients with coronary heart disease help reduce further cardiovascular events and improve survivalThis seems to be a class effect of statins, although there may be important differences in effectiveness between themLess than half of patients in the community who take lipid lowering drugs achieve target serum cholesterol values

What this study adds

Statins vary in their ability to lower serum cholesterol concentration, with atorvastatin and simvastatin achieving the best resultsThe percentage reductions agreed with those found in randomised controlled trialsSince the initial serum cholesterol concentrations were higher than in trials, absolute risk reductions in primary care patients may be greater than thoughtTarget values of ⩽5 mmol/l may be unrealistic even for patients on the most efficacious drugs, because the initial mean cholesterol values of primary care patients are higher than those of patients in trials     

Doctors' use of electronic medical records systems in hospitals: cross sectional survey

ObjectivesTo compare the use of three electronic medical records systems by doctors in Norwegian hospitals for general clinical tasks.DesignCross sectional questionnaire survey. Semistructured telephone interviews with key staff in information technology in each hospital for details of local implementation of the systems.Setting32 hospital units in 19 Norwegian hospitals with electronic medical records systems.Participants227 (72%) of 314 hospital doctors responded, equally distributed between the three electronic medical records systems.ResultsMost tasks listed in the questionnaire (15/23) were generally covered with implemented functions in the electronic medical records systems. However, the systems were used for only 2-7 of the tasks, mainly associated with reading patient data. Respondents showed significant differences in frequency of use of the different systems for four tasks for which the systems offered equivalent functionality. The respondents scored highly in computer literacy (72.2/100), and computer use showed no correlation with respondents'' age, sex, or work position. User satisfaction scores were generally positive (67.2/100), with some difference between the systems.ConclusionsDoctors used electronic medical records systems for far fewer tasks than the systems supported.

What is already known on this topic

Electronic information systems in health care have not undergone systematic evaluation, and few comparisons between electronic medical records systems have been madeGiven the information intensive nature of clinical work, electronic medical records systems should be of help to doctors for most clinical tasks

What this study adds

Doctors in Norwegian hospitals reported a low level of use of all electronic medical records systemsThe systems were mainly used for reading patient data, and doctors used the systems for less than half of the tasks for which the systems were functionalAnalyses of actual use of electronic medical records provide more information than user satisfaction or functionality of such records systems     

Differences in need for antihypertensive drugs among those aware and unaware of their hypertensive status: a cross sectional survey

Peripheral arterial disease (PAD) is a common, progressive manifestation of atherothrombotic vascular disease, which should be managed no different to cardiac disease. Indeed, there is growing evidence that PAD patients are a high risk group, although still relatively under-detected and under treated. This is despite the fact that PAD patients are an increased mortality rate comparable to those with pre-existing or established cardiovascular disease [myocardial infarction, stroke]. With a holistic approach to atherothrombotic vascular disease, our management of PAD can only get better.     

Obesity, weight status and employability: Empirical evidence from a French national survey

We investigate the relationship between employability and obesity, particularly how obesity and overweight are associated with the percentage of working years spent unemployed and the ability to regain employment. Data for adults who responded to the 2003 Decennial Health Survey collected by the French National Institute of Statistics and Economic Studies revealed that the percentage of time spent unemployed during working years is significantly higher for each kg/m2 deviation from the mean body mass index (BMI) attained at age 20 and that the probability of regaining employment after a period of unemployment is much lower.     

Association of dietary and serum selenium concentrations with glucose level and risk of diabetes mellitus: A cross sectional study of national health and nutrition examination survey, 1999-2006

BackgroundThe associations among dietary selenium intake, serum selenium concentration, plasma glucose and glycosylated hemoglobin levels, and diabetes risk remain controversial. This study aimed to evaluate these associations in adults from the United States.MethodsWe conducted a cross-sectional study of participants aged 18 years and older who participated in the National Health and Nutrition Examination Survey. Between 1999 and 2006, a total of 41,474 participants were initially included in this study. Multivariable linear or logistic regression analysis was used to investigate the association between dietary selenium intake and serum selenium concentrations, glucose level, and diabetes risk.ResultsThe average age of the participants was 30.32 ± 23.95 years, and 48.72 % were men. Their mean dietary selenium intake and mean serum selenium concentration were 98 ± 55 μg per day and 129 ± 22 ng/mL, respectively. Compared with t he lowest quartile of dietary selenium intake, the highest quartile was associated with elevated plasma glucose levels (β = 2.412, 95 % confidence interval [CI]: 0.420, 4.403, P = 0.018), glycosylated hemoglobin levels (β = 0.080, 95 % CI: 0.041, 0.119, P < 0.001), and diabetes risk (odds ratio [OR] = 2.139, 95 % CI: 1.763, 2.596, P < 0.001). Higher serum selenium was also associated with increased plasma glucose levels (β = 12.454, 95 % CI: 4.122, 20.786, P = 0.003) and glycosylated hemoglobin levels (β = 0.326, 95 % CI: 0.187, 0.465, P < 0.001). A generalized additive model with a spline curve suggested a nonlinear relationship between dietary selenium intake, serum selenium and glucose levels, and diabetes risk.ConclusionsDietary selenium intake and serum selenium were positively associated with elevated levels of plasma glucose and glycosylated hemoglobin, and the relationships were nonlinear. Additional selenium supplementation for patients with diabetes may not be recommended.     

Extent of regretted sexual intercourse among young teenagers in Scotland: a cross sectional survey

This cross sectional survey determined the extent of regretted sexual intercourse among young teenagers in Scotland. Using a questionnaire, data were obtained from 7395 third-year pupils (3365 boys and 3730 girls) aged 13 years and 6 months to 14 years and 9 months in 24 nondenominational state secondary schools. Regretted sexual intercourse, measured on a three-point scale, was analyzed by ordinal logistic regression. The data revealed that 18% (661) of boys and 15.4% (576) of girls had experienced sexual intercourse, of which 74.8% occurred since their 13th birthday. Boys, compared with girls, reported higher levels of regret. For boys, higher levels of regret were significantly associated with having exerted pressure to have sex. On multivariate analysis, reports of being pressured, exerting pressure, not having planned sexual intercourse with partner, and high levels of parental monitoring were significantly related to girls' regret. For women, regret seemed to be related to lack of control. Sex education should focus on assisting young people to develop relationship and negotiation skills. In addition, making teenagers aware of potential emotional and relationship consequences of early sexual intercourse may delay first intercourse.     

Birth weight of offspring and insulin resistance in late adulthood: cross sectional survey

ObjectiveTo investigate the association between birth weight of offspring and mothers'' insulin resistance in late adulthood.DesignCross sectional survey.SettingGeneral practitioner''s surgeries in 23 towns in Great Britain.Participants4286 women aged 60-79 years.ResultsBirth weight of offspring was inversely related to maternal insulin resistance in late adulthood. For each 1 kg higher birth weight of offspring, women had a 15% reduction in the odds of being in the fourth with highest insulin resistance, compared to other fourths (odds ratio 0.85; 95% confidence interval 0.71 to 1.00). This increased to 27% (0.73; 0.60 to 0.90) after adjusting data for potential confounders. A U shaped relation between birth weight of offspring and diabetes in older age was found; women with the lightest and heaviest offspring had the highest prevalence of diabetes.ConclusionsBirth weight of offspring is inversely related to the mother''s insulin resistance in late adulthood, despite the association of glucose intolerance during pregnancy with heavier offspring at birth. Common genetic factors contribute to the relation between birth weight and risk of cardiovascular disease and diabetes in adults.

What is already known on this topic

Small birth weight is related to increased risk of cardiovascular disease and diabetes in adulthood; the underlying mechanisms are unclearSmall birth weight of offspring is related to parental cardiovascular disease, suggesting that common genetic factors affect birth weight and the risk of disease in adulthoodGenetic factors associated with the metabolism of insulin are plausible in linking birth weight and cardiovascular disease (the fetal insulin hypothesis)

What this study adds

Birth weight of offspring is inversely related to maternal insulin resistance in older ageGenetic factors related to both insulin resistance and birth weight explain at least part of the association between birth weight and risk of cardiovascular disease and diabetes in adulthood     

Quality of web based information on treatment of depression: cross sectional survey

ObjectivesTo evaluate quality of web based information on treatment of depression, to identify potential indicators of content quality, and to establish if accountability criteria are indicators of quality.DesignCross sectional survey.ResultsAlthough the sites contained useful information, their overall quality was poor: the mean guideline, issues, and global scores were only 4.7 (range 0-13) out of 43, 9.8 (6-14) out of 17, and 3 (0.5-7.5) out of 10 respectively. Sites typically did not cite scientific evidence in support of their conclusions. The guideline score correlated with the two other quality of content measures, but none of the content measures correlated with the Silberg accountability score. Content quality was superior for sites owned by organisations and sites with an editorial board.ConclusionsThere is a need for better evidence based information about depression on the web, and a need to reconsider the role of accountability criteria as indicators of site quality and to develop simple valid indicators of quality. Ownership by an organisation and the involvement of a professional editorial board may be useful indicators. The study methodology may be useful for exploring these issues in other health related subjects.