ObjectivesTo describe the uptake and outputs of the National Health Service Health Check (NHSHC) programme in England.DesignObservational study.SettingNational primary care data extracted directly by NHS Digital from 90% of general practices (GP) in England.ParticipantsIndividuals aged 40–74 years, invited to or completing a NHSHC between 2012 and 2017, defined using primary care Read codes.InterventionThe NHSHC, a structured assessment of non-communicable disease risk factors and 10-year cardiovascular disease (CVD) risk, with recommendations for behavioural change support and therapeutic interventions.ResultsDuring the 5-year cycle, 9 694 979 individuals were offered an NHSHC and 5 102 758 (52.6%) took up the offer. There was geographical variation in uptake between local authorities across England ranging from 25.1% to 84.7%. Invitation methods changed over time to incorporate greater digitalisation, opportunistic delivery and delivery by third-party providers.The population offered an NHSHC resembled the English population in ethnicity and deprivation characteristics. Attendees were more likely to be older and women, but were similar in terms of ethnicity and deprivation, compared with non-attendees. Among attendees, risk factor prevalence reflected population survey estimates for England. Where a CVD risk score was documented, 25.9% had a 10-year CVD risk ≥10%, of which 20.3% were prescribed a statin. Advice, information and referrals were coded as delivered to over 2.5 million individuals identified to have risk factors.ConclusionThis national analysis of the NHSHC programme, using primary care data from over 9.5 million individuals offered a check, reveals an uptake rate of over 50% and no significant evidence of inequity by ethnicity or deprivation. To maximise the anticipated value of the NHSHC, we suggest continued action is needed to invite more eligible people for a check, reduce geographical variation in uptake, prioritise engagement with non-attendees and promote greater use of evidence-based interventions especially where risk is identified.

The polymerase chain reaction (PCR) was used to identify and quantify all fungal pathogens of wheat (Triticum aestivum) stem bases in nine field experiments at three locations in England. The main aim was to apply quantitative PCR to provide robust data on the efficacy of new fungicides against the individual components of the stem-base disease complex. Cyprodinil most effectively controlled eyespot by decreasing both pathogens, Tapesia yallundae and T. acuformis (the most widespread species), and sometimes contributed to increased yields. Prochloraz controlled eyespot less consistently, its effectiveness dependent mainly on the presence of T. yallundae or on rainfall events soon after application. Azoxystrobin contributed to yield increases most consistently. Although it decreased sharp eyespot and its pathogen, Rhizoctonia cerealis, these effects were insufficient to account for much of the yield increases. The effects of fungicides on eyespot were sometimes greatest on the most susceptible cultivars. Amounts of Tapesia DNA were usually consistent with cultivar susceptibility ratings. The only pathogens of brown foot rot present in significant amounts were Microdochium nivale vars nivale and majus. They appeared not to affect yield or to respond greatly to fungicides. The susceptibility of cultivars to these pathogens was sometimes similar to their susceptibility to eyespot, suggesting that they may respond to the same host resistance genes or may in some cases be secondary colonisers of eyespot-infected plants.

Diagnostic and quantitative polymerase chain reaction (PCR) provided clarification of the causes of symptoms and the extent of infection by eyespot (Tapesia spp.) and sharp eyespot (Rhizoctonia cerealis) on winter wheat at early growth stages. Disease assessments made before stem extension, when decisions to apply fungicides are usually made, often did not agree with the pathogen diagnoses using PCR, suggesting that such early visual diagnoses may be unreliable. Visual and PCR diagnoses made on stems in summer generally supported each other, but there were often discrepancies in relating disease severity to amounts of pathogen present when determined by regression analyses of incidence or severity of symptoms on amount of pathogen DNA. Mixed symptoms caused by different pathogens may sometimes have been confounded. Relationships between symptoms and DNA of eyespot pathogens were less clear on some cultivars, often those with least disease. Sharp eyespot symptoms had a stronger relationship to DNA of its pathogen. Significant regressions often accounted for a small percentage of the variance, suggesting either that pathogens not assayed were contributing to symptoms or that lesions were in some cases persisting longer into the season than pathogen DNA. The frequency of pathogen detection before stem extension was a poor predictor of the amounts of pathogen DNA measured later in the season.

Objective-To develop and test a cardiac prevention and rehabilitation programme for achieving sustained lifestyle, risk factor, and therapeutic targets in patients presenting for the first time with exertional angina, acute coronary syndromes, or coronary revascularisation. Design-A descriptive study. Setting-A hospital based 12 week outpatient programme. Interventions-A multiprofessional family based programme of lifestyle and risk factor modification. Main outcome measures-Non-smoking status, body mass index, blood pressure, plasma cholesterol, use of prophylactic drugs. Results-158 patients (82% of 194 possible cases) were recruited over 15 months, with 72% completing the programme. Targets for achieving non-smoking status, blood pressure < 140/90 mm Hg, and total cholesterol < 4.8 mmol/l were achieved in 92%, 73%, and 62%, respectively, and the proportion on aspirin, blockers, and lipid lowering treatment was 95%, 58%, and 64% on referral back to general practice for continuing care. Conclusions-A comprehensive cardiac prevention and rehabilitation programme can be oVered to all patients presenting for the first time with coronary heart disease, including those with exertional angina who are normally managed in primary care. Lifestyle, risk factor, and therapeutic targets can be successfully achieved in most patients with such a hospital based programme. (Heart 2001;85:533-538)

Seeds ni Polygonum lapathifolium from several sources or after certain treatments were subjected to various periods of moist chilling and then incubated for 3 weeks, during which time the numbers that germinated were recorded.Populations from different localities differed in both seed weight and in the response of the seeds to chilling, but no relationships between the response and theenvironment of the locality of origin were found. Seeds from individual plants and from single inflorescences within populations also varied in both seed weight and germination with and without chilling. Application of dichlorprop to the parent plants was found to affect seed weight and % germination, the effect varying with both population and dose.Etudes sur des espices de mauvaises herbes du genre Polygonum L, IV. Variations du poids et des modalites de germination des semences chez P. lapathifolium L.Resum^. Des semences de Polygonum lapathifolium provenant de plusieurs origines ou ayant subi certains traitements furent soumises A l'action du froid et de l'humiditi pendant des periodes variables, puis mises a germer pendant 3 semaines durant lesquelles les nombres dc graines germte furent not^es.Les populations provenant de differentes localit^s accusaient des difT^rences a la fois quant au poids des semences et quant a leur reaction au froid, mais il ne fut pas possible de mettre en Evidence des relations entre les reactions observees et la locality d'origine. Dans les populations, les semences issues d'une meme plante ou d'une meme inflorescence prdsenterent aussi des differences dans les poids de semences et dans les pourcentages de germination avec et sans refroidissement. II fut constate qu'une application de dichlorprop sur les plantes meres avait un effet sur le poids des semences et sur leur pourcentage de germination, cet elFet variant a la fois avec la population et avec la dose.