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Port Glasgow, United Kingdom

Egan M.,Medical Research Council Chief Scientist Office | Katikireddi S.V.,Medical Research Council Chief Scientist Office | Kearns A.,University of Glasgow | Tannahill C.,Glasgow Center for Population Health | And 2 more authors.
American Journal of Public Health

Objectives. We took advantage of a 2-intervention natural experiment to investigate the impacts of neighborhood demolition and housing improvement on adult residents' mental and physical health. Methods. We identified a longitudinal cohort (n = 1041, including intervention and control participants) by matching participants in 2 randomly sampled cross-sectional surveys conducted in 2006 and 2008 in 14 disadvantaged neighborhoods of Glasgow, United Kingdom. We measured residents' selfreported health with Medical Outcomes Study Short Form Health Survey version 2 mean scores. Results. After adjustment for potential confounders and baseline health, mean mental and physical health scores for residents living in partly demolished neighborhoods were similar to the control group (mental health, b = 2.49; 95% confidence interval [CI] = -1.25, 6.23; P = .185; physical health, b = -0.24; 95% CI = -2.96, 2.48; P = .859). Mean mental health scores for residents experiencing housing improvement were higher than in the control group (b = 2.41; 95% CI = 0.03, 4.80; P = .047); physical health scores were similar between groups (b = -0.66; 95% CI = -2.57, 1.25; P = .486). Conclusions. Our findings suggest that housing improvement may lead to small, short-term mental health benefits. Physical deterioration and demolition of neighborhoods do not appear to adversely affect residents' health. Source

McKechnie C.C.,Glasgow Center for Population Health
Medical Humanities

This paper aims to provide an initial response to Angela Woods’s endeavour to ‘(re)ignite critical debates around this topic’ in her recent essay ‘The limits of narrative: provocations for the medical humanities’ (Medical Humanities 2011). Woods’s essay challenges the validity of the notion of the narrative self through her discussion and use of Galen Strawson’s seminal ‘Against narrativity’ (2004). To some extent in dialogue with Woods, this article will examine three exploratory concepts connected with the topic. First, it will explore ways in which we might seek to re-place narrative at the centre of the philosophy of good medicine and medical practice by reassessing the role of the narratee in the narrative process. Second, it will reconsider the three alternative forms of expression Woods puts forward as non-narrative —metaphor, phenomenology and photography—as narrative. Finally, and connected to the first two areas of discussion, it will reflect on ways in which narrative might be used to interpret illness and suffering in medical humanities contexts. What I hope to show, in relation to Woods’s work on this subject, is that in order to be interpreted (indeed interpretable) the types of non- narrative representation and communication she discusses in fact require a narrative response. We employ narratology to engage with illness experience because narrative is so fundamental to meaning-making that it is not just required, it is an inherent human response to creative outputs we encounter. This is a quite different approach to the question of narrativity in the medical humanities, and it is therefore related to, but not entirely hinged upon, the work that Woods has done, but it is intended to spark further discussion across the emergent discipline. © 2014, BMJ Publishing Group. All rights reserved. Source

Mactier H.,Neonatal Unit | Shipton D.,Glasgow Center for Population Health | Dryden C.,Wishaw General Hospital | Tappin D.M.,University of Glasgow

Aim: To determine if reduced fetal growth in infants of opioid-dependent mothers prescribed methadone maintenance in pregnancy is explained by cigarette smoking or socio-economic deprivation. Design: Retrospective cohort study. Setting: Inner-city maternity unit in Scotland. Participants: A total of 366 singleton infants of methadone-prescribed opioid-dependent mothers compared with the Scottish birth population (n=103366) as a whole. Measurements: Primary outcome measures were birth weight and head circumference. Findings: In infants of methadone-prescribed opioid-dependent mothers mean birth weight was 259g [95% confidence interval (CI) 214-303g; P<0.0001] less, and mean head circumference 1.01cm (95% CI 0.87-1.15cm; P<0.0001) less than in controls, allowing for gestation, cigarette smoking, area deprivation, infant sex and maternal age and parity. This represents an adjusted difference of -0.61 (95% CI -0.52--0.71; P<0.0001) Z-score in mean birth weight and -0.77 (95% CI -0.66--0.89; P<0.0001) Z-score in mean head circumference. Conclusions: Reduced fetal growth in infants of opioid-dependent mothers prescribed methadone maintenance in pregnancy is not fully explained by cigarette smoking, area deprivation, maternal age or parity. © 2013 Society for the Study of Addiction. Source

Graham P.,Glasgow Western Infirmary | Walsh D.,Glasgow Center for Population Health | McCartney G.,NHS Health Scotland
Public Health

Background: The extent to which the higher level of mortality seen in Glasgow compared with other UK cities is solely attributable to socio-economic deprivation has been the focus of much discussion recently. Some authors have suggested that poorer health in the city may be influenced by issues related to its history of religious sectarianism. In order to investigate this further, this study compared deprivation and mortality between Glasgow and Belfast, a similar post-industrial city, but one with a considerably more pronounced sectarian divide. Objectives: To compare the deprivation and mortality profiles of the two cities; to assess the extent to which any differences in mortality can be explained by differences in area-based measures of deprivation; and to examine whether these analyses shed any light on the 'sectarianism' hypothesis for Glasgow's excess mortality relative to elsewhere in the UK. Study design and methods: Replicating the methodology of a recent study comparing deprivation and mortality in Glasgow, Liverpool and Manchester, rates of 'income deprivation' for 2005 were calculated for every small area across the two cities (average population size: 1810 in Belfast; 1650 in Glasgow). Standardized mortality ratios were calculated for the period 2003-2007 for Glasgow relative to Belfast, standardizing for age, gender and income deprivation decile. Results: While total levels of deprivation were slightly higher in Glasgow than in Belfast (24.8% of Glasgow's population were income deprived in 2005 compared with 22.4% in Belfast), Belfast was more unequal in terms of its distribution of deprivation across the city. After standardizing for age, sex and deprivation, all-cause mortality in Glasgow was 27% higher for deaths under 65 years of age and 18% higher for deaths at all ages. Higher all-cause mortality in Glasgow was shown in the majority of sub-analyses (i.e. for most age groups, both sexes and across the majority of deprivation deciles). Analyses of particular causes of death showed significantly higher mortality in Glasgow relative to Belfast for all conditions examined except 'external causes'. Notably higher mortality was evident for drug-related poisonings and alcohol-related causes among men in both cities. With a small number of exceptions, the results were very similar to those shown for Glasgow in comparison with Liverpool and Manchester. Conclusions: Area-based deprivation did not explain the higher mortality in Glasgow in comparison with Belfast. Belfast has a more profound history of sectarianism, and similar climatic conditions, to Glasgow. If these factors were to be important in explaining the high mortality in Glasgow, the question arises as to why they have not produced similar effects in Belfast. © 2012 The Royal Society for Public Health. Source

McQuarrie E.P.,Glasgow Renal and Transplant Unit | Mackinnon B.,Glasgow Renal and Transplant Unit | McNeice V.,Glasgow Center for Population Health | Fox J.G.,Glasgow Renal and Transplant Unit | Geddes C.C.,Glasgow Renal and Transplant Unit
Kidney International

Chronic kidney disease is more common in areas of socioeconomic deprivation, but the relationship with the incidence and diagnosis of biopsy-proven renal disease is unknown. In order to study this, all consecutive adult patients undergoing renal biopsy in West and Central Scotland over an 11-year period were prospectively analyzed for demographics, indication, and histologic diagnosis. Using the Scottish Index of Multiple Deprivation, 1555 eligible patients were separated into quintiles of socioeconomic deprivation according to postcode. Patients in the most deprived quintile were significantly more likely to undergo biopsy compared with patients from less deprived areas (109.5 compared to 95.9 per million population/year). Biopsy indications were significantly more likely to be nephrotic syndrome, or significant proteinuria without renal impairment. Patients in the most deprived quintile were significantly more likely to have glomerulonephritis. There was a significant twofold increase in the diagnosis of IgA nephropathy in the patients residing in the most compared with the least deprived postcodes not explained by the demographics of the underlying population. Thus, patients from areas of socioeconomic deprivation in West and Central Scotland are significantly more likely to undergo native renal biopsy and have a higher prevalence of IgA nephropathy © 2013 International Society of Nephrology. Source

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