Estimating the incidence, prevalence and true cost of asthma in the UK: Secondary analysis of national stand-alone and linked databases in England, Northern Ireland, Scotland and Wales-a study protocol

Introduction Asthma is now one of the most common long-term conditions in the UK. It is therefore important to develop a comprehensive appreciation of the healthcare and societal costs in order to inform decisions on care provision and planning. We plan to build on our earlier estimates of national prevalence and costs from asthma by filling the data gaps previously identified in relation to healthcare and broadening the field of enquiry to include societal costs. This work will provide the first UK-wide estimates of the costs of asthma. In the context of asthma for the UK and its member countries (ie, England, Northern Ireland, Scotland and Wales), we seek to: (1) produce a detailed overview of estimates of incidence, prevalence and healthcare utilisation; (2) estimate health and societal costs; (3) identify any remaining information gaps and explore the feasibility of filling these and (4) provide insights into future research that has the potential to inform changes in policy leading to the provision of more cost-effective care.

Methods and analysis Secondary analyses of data from national health surveys, primary care, prescribing, emergency care, hospital, mortality and administrative data sources will be undertaken to estimate prevalence, healthcare utilisation and outcomes from asthma. Data linkages and economic modelling will be undertaken in an attempt to populate data gaps and estimate costs. Separate prevalence and cost estimates will be calculated for each of the UK-member countries and these will then be aggregated to generate UK-wide estimates.

Ethics and dissemination Approvals have been obtained from the NHS Scotland Information Services Division's Privacy Advisory Committee, the Secure Anonymised Information Linkage Collaboration Review System, the NHS South-East Scotland Research Ethics Service and The University of Edinburgh's Centre for Population Health Sciences Research Ethics Committee. We will produce a report for Asthma-UK, submit papers to peer-reviewed journals and construct an interactive map.

Are the differences in adulthood ill-health across the North-South divide and between Scotland and England also evident in early childhood health indicators?

Regional differences in adult morbidity and mortality within England (i.e., north-south divide or gradient) and between England and Scotland (i.e., Scottish effect) are only partly explained by adult levels of socioeconomic status or risk factors. This suggests variation in early life, and is supported by the fetal origins and life-course literature which posits that birth outcomes and subsequent, cumulative exposures influence adult health. However, no studies have examined the north-south gradient or Scottish effect in health in the earliest years of life. The aims of the study were: i) to examine health indicators in English and Scottish children at birth and age three to establish whether regional differences exist; and ii) to establish whether observed changes in child health at age three were attributable to birth and/or early life environmental exposures. Respondents included 10,639 biological Caucasian mothers of singleton children recruited to the Millennium Cohort Study (MCS) in the year 2000. Outcome variables were: gestational age and birth weight, and height, body mass index (BMI), and externalising behavioural problems at age three. Region/country was categorised as: South (reference), Midlands, North (England), and Scotland. Respondents provided information on child, maternal, household, and socioeconomic characteristics. Results indicated no significant regional variations for gestational age or birth weight. At age three there was a north-south gradient for externalising behaviour and a north-south divide in BMI which attenuated on adjustment. However, a north-south divide in height was not fully explained by adjustment. There was also evidence of a ‘Midlands effect’, with increased likelihood of shorter stature and behaviour problems. Results showed a Scottish effect for height and BMI in the unadjusted models, and height in the adjusted model, but a decreased likelihood of behaviour problems. Findings indicated no regional differences in health at birth, but some regional variation at age three supports the cumulative life-course model.

Women, letter-writing and the life of the mind in England, c.1650-1750

Drawing on national and regional letter collections dating from the late seventeenth and early eighteenth centuries, this article explores women's experiences of the life of the mind through an analysis of their letter-writing. This study also highlights the shortcomings of the compartmentalised nature of scholarship on women's writing and intellectual lives and proposes the letter both as a beneficial historical source and methodological tool for research on women's mental worlds. By employing an inclusive definition of intellectual and creative life, and eschewing traditional benchmarks of achievement, this article contends that women took a full part in the cultures of knowledge of their time. 

England, Neo-Latin, and the Continental Journey: Linguistic and Textual Itineraries

This chapter examines the ramifications of continental travel and associated epistolary communication for English poets of the period. It argues that recourse to neo-Latin, the universal language of diplomacy, served not only to establish a sense of shared space—linguistic, cultural, generic—between England and the continent, but also to signal self-conscious differences (climatic, geographical, historical, political) between England and her continental peers. Through an investigation of a range of ‘performances’ on stages that were ‘academic’, poetic, autobiographical, and epistolographic, it assesses the central role of neo-Latin as a language that underwent a series of textual itineraries. These ‘itineraries’ manifest themselves in a number of ways. Neo-Latin as a shared linguistic medium can facilitate, and quite uniquely so, intertextual engagement with the classics, but now ancient Rome, its language, its mythology, its hierarchy of genres, are viewed through a seventeenth-century lens and appropriated by poets in both England and Italy to describe contemporary events, whether personal, or political. Close examination of the neo-Latin poetry of Milton and Marvell reveals, it is argued, a self-fashioning coloured by such textual itineraries and interchanges. The absorption and replication of continental literary and linguistic methodologies (the academic debate; the etymological play of Marinism; the hybridity of neo-Latin and Italian voices) reveal in short a linguistic and textual reciprocity that gave birth to something very new.

Marine or estuarine radiocarbon reservoir corrections for mollusks? A case study from a medieval site in the south of England

Mollusk shells are frequently radiocarbon dated and provide reliable calibrated age ranges when the regional marine reservoir correction is well-established. For mollusks from an estuarine environment the reservoir correction may be significantly different than the regional marine reservoir correction due to the input of bedrock or soil derived carbonates. Some mollusk species such as oysters are tolerant of a significant range of salinities which makes it difficult to determine which reservoir correction is appropriate. A case study is presented of an anomalous radiocarbon age for an oyster shell paint dish found in the fabric of the ruined nave walls of St Mary's Church, Shoreham-by-Sea, West Sussex, England. Stable isotopes (delta O-18 and delta C-13) were used to establish the type of environment in which the oyster had lived. Paired marine and terrestrial samples from a nearby medieval site were radiocarbon dated to provide an appropriate reservoir correction.