Assessment of nutritional stress in famine burials using stable isotope analysis.

OBJECTIVES: We compared δ15 N and δ13 C values from bone and dentine collagen profiles of individuals interred in famine-related and attritional burials to evaluate whether individuals in medieval London who experienced nutritional stress exhibit enriched nitrogen in bone and tooth tissue. Dentine profiles were evaluated to identify patterns that may be indicative of famine during childhood and were compared with the age of enamel hypoplasia (EH) formation to assess whether isotopic patterns of undernutrition coincide with the timing of physiological stress. MATERIALS AND METHODS: δ15 N and δ13 C isotope ratios of bone collagen were obtained from individuals (n = 128) interred in attritional and famine burials from a medieval London cemetery (c. 1120-1539). Temporal sequences of δ15 N and δ13 C isotope profiles for incrementally forming dentine collagen were obtained from a subset of these individuals (n = 21). RESULTS: Results indicate that individuals from attritional graves exhibit significantly higher δ15 N values but no significant differences were found between burial types for the sexes. Analyses of dentine profiles reveal that a lower proportion of famine burials exhibit stable dentine profiles and that several exhibit a pattern of opposing covariance between δ15 N and δ13 C. EH were also observed to have formed during or after the opposing covariance pattern for some individuals. CONCLUSIONS: The results of this study may reflect differences in diet between burial types rather than nutritional stress. Though nutritional stress could not be definitively identified using bone and dentine collagen, the results from dentine analysis support previous observations of biochemical patterns associated with nutritional stress during childhood.

"I don't know how I'm still standing" a Bakhtinian analysis of social housing and health narratives in East London.

Housing is a significant determinant of health and substandard housing is a public health issue. East London has long had a shortage of social and affordable housing, worsened in recent years by a combination of stressors. In one of East London's most deprived boroughs, Newham, changes brought about by the 2011 Localism Act and the unique demands of being the host Olympic borough in 2012 have brought considerable pressures to bear on social infrastructure. This paper examines how these pressures were experienced by local residents via their narratives of social housing and health. The data reported here are from a qualitative study comprising two waves of data collection. Narrative family interviews and go-along interviews were conducted with 40 Newham residents at wave one and 28 at wave two. A narrative analysis with a Bakhtinian interpretation was undertaken. This revealed that residents framed experiences of social housing in terms of an inherent system-level ideology based on notions of need and waiting. A particularly striking feature of this ideology was the extent to which descriptions of ill health and impairment were implicated in constructions of housing need; participants directly attributed a range of health complaints to their housing predicaments, including stress, depression, cancer scares, panic attacks and loss of sleep. Understanding the contested ideology of social housing can illuminate both the dynamic processes of social exclusion and the ways in which its subjects seek to resist it.

Minority status and mental distress: a comparison of group density effects.

BACKGROUND: It has been observed that mental disorders, such as psychosis, are more common for people in some ethnic groups in areas where their ethnic group is less common. We set out to test whether this ethnic density effect reflects minority status in general, by looking at three situations where individual characteristics differ from what is usual in a locality. METHOD: Using data from the South East London Community Health study (n = 1698) we investigated associations between minority status (defined by: ethnicity, household status and occupational social class) and risk of psychotic experiences, common mental disorders and parasuicide. We used a multilevel logistic model to examine cross-level interactions between minority status at individual and neighbourhood levels. RESULTS: Being Black in an area where this was less common (10%) was associated with higher odds of psychotic experiences [odds ratio (OR) 1.34 95% confidence interval (CI) 1.07-1.67], and attempted suicide (OR 1.84 95% CI 1.19-2.85). Living alone where this was less usual (10% less) was associated with increased odds of psychotic experiences (OR 2.18 95% CI 0.91-5.26), while being in a disadvantaged social class where this was less usual (10% less) was associated with increased odds of attempted suicide (OR 1.33 95% CI 1.03-1.71). We found no evidence for an association with common mental disorders. CONCLUSIONS: The relationship between minority status and mental distress was most apparent when defined in terms of broad ethnic group but was also observed for individual household status and occupational social class.

Ethnic inequalities in the use of secondary and tertiary mental health services among patients with obsessive-compulsive disorder.

BACKGROUND: Obsessive-compulsive disorder (OCD) has similar prevalence rates across ethnic groups. However, ethnic minorities are underrepresented in clinical trials of OCD. It is unclear whether this is also the case in clinical services. AIMS: To explore whether ethnic minorities with OCD are underrepresented in secondary and tertiary mental health services in the South London and Maudsley (SLaM) NHS Foundation Trust. METHOD: The ethnic distribution of patients with OCD seen between 1999 and 2013 in SLaM (n = 1528) was compared with that of the general population in the catchment area using census data. A cohort of patients with depression (n = 22 716) was used for comparative purposes. RESULTS: Ethnic minorities with OCD were severely underrepresented across services (-57%, 95% CI -62% to -52%). The magnitude of the observed inequalities was significantly more pronounced than in depression (-29%, 95% CI -31% to -27%). CONCLUSIONS: There is a clear need to understand the reasons behind such ethnic inequalities and implement measures to reduce them.

Implementation of a routine HIV testing policy in an acute medical setting in a UK general hospital: a cross-sectional study.

OBJECTIVES: To report the implementation and outcomes of a routine opt-out HIV testing policy in an acute medical unit (AMU) of a district general hospital in an area of high diagnosed HIV prevalence. METHODS: Since July 2011, all patients aged 16-79 years attending AMU were offered an HIV test as a hospital policy. Consenting and arranging the test was carried out by general medical staff, with training and motivational support by local HIV specialists. A retrospective cross-sectional review was conducted: testing rate and outcomes of those testing HIV seropositive were determined by review of hospital data systems and case notes. RESULTS: Over a 21-month period, there were 12 682 admissions; 4122 (32.5%) had HIV tests. 20 patients (0.48%) were diagnosed with HIV; 17 (85%) of them were new diagnoses. Compared with those patients targeted as a result of clinical suspicion of HIV (n=6), patients who were diagnosed solely due to the scheme (n=14) had higher baseline CD4 counts (median 111 vs 313 cells/mm(3); p=0.01). Two patients had renal disease which improved on antiretroviral therapy. Two long-term defaulters to HIV care with very advanced disease have re-engaged resulting in excellent clinical outcomes. 11 patients are now on treatment with undetectable HIV viral loads. One contact tested HIV positive. CONCLUSIONS: Our experience shows that routine opt-out testing can be delivered and sustained by general medical staff in an AMU with no money spent other than laboratory processing of the test. We believe that success and sustainability of this policy is due to the high level of commitment from and ownership by the AMU staff, particularly nurses. Ongoing support and motivation from the HIV team has facilitated the delivery of this policy.

Ethnic disparities in the oral health of three- to four-year-old children in East London.

AIM: To report ethnic differences related to caries experience among three- to four-year-old children living in three of the most deprived boroughs in the UK in Inner North East London: Tower Hamlets, Hackney and Newham. METHODS: This cross-sectional survey used a cluster sampling study design following the British Association for the Study of Community Dentistry protocol. Twenty nurseries from each borough were randomly selected and all three- to four-year-old children in selected nurseries were invited to participate (n = 2,434). Calibrated dentists examined children. Demographic information was obtained from schools. RESULTS: One thousand, two hundred and eighty-five children were examined in 60 nurseries (response rate = 52.8%). Twenty-four percent of three- to four-year-old children had caries experience (mean dmft = 0.92). Few children (2.1%) had filled teeth. Children living in Hackney had significantly lower dmft scores (mean = 0.63) than children living in Newham (mean = 1.06) and Tower Hamlets (mean = 1.06). White European (mean = 1.91), Bangladeshi (mean = 1.05) and Pakistani (mean = 1.11) children had a significantly higher number of untreated carious teeth than White British children (mean = 0.56). CONCLUSION: Preschool children from a White Eastern European, Bangladeshi and Pakistani background are likely to experience significantly poorer oral health than their White British counterparts. These findings have profound implications for commissioning dental services and oral health promotion.

Trends in risk factor prevalence and management before first stroke: data from the South London Stroke Register 1995-2011.

BACKGROUND AND PURPOSE: Vascular risk factors are suboptimally managed internationally. This study investigated time trends in risk factors diagnosed before stroke and their treatment, and factors associated with appropriate medication use. METHODS: A total of 4416 patients with a first stroke were registered in the population-based South London Stroke Register from 1995 to 2011. Previously diagnosed risk factors and usual medications were collected from patients' primary care and hospital records. Trends and associations were assessed using multivariate logistic regression. RESULTS: Seventy-two percent of patients were diagnosed previously with 1 or more risk factors; 30% had diagnosed risk factors that were untreated. Hypercholesterolemia increased significantly during the study period; myocardial infarction and transient ischemic attack prevalences decreased. Antiplatelet prescription increased in atrial fibrillation (AF), myocardial infarction, and transient ischemic attack (AF, 37%-51%, P<0.001; myocardial infarction, 48%-69%, P<0.001; transient ischemic attack, 49%-61%, P=0.015). Anticoagulant prescription for AF showed a nonsignificant increase (12%-23%; P=0.059). Fewer older patients with AF were prescribed anticoagulants (age, >85 versus <65 years; adjusted relative risk, 0.19; 95% confidence interval, 0.08-0.41). Black ethnicity (adjusted relative risk, 1.17; 95% confidence interval, 1.10-1.23) and female sex (adjusted relative risk, 1.09; 95% confidence interval, 1.03-1.15) were associated with increased antihypertensive drug prescription; other medications did not vary by ethnicity or sex. CONCLUSIONS: Antiplatelet and cholesterol-lowering treatment prescribing have improved significantly over time; however, only a minority with AF received anticoagulants, and this did not improve significantly. Overall, 30% of strokes occurred in patients with previously diagnosed but untreated risk factors.

Sensing design and workmanship: the haptic skills of shoppers in eighteenth-century London.

This article explores how eighteenth-century shoppers understood the material world around them. It argues that retail experiences exposed shoppers to different objects, which subsequently shaped their understanding of this world. This article builds on recent research that highlights the importance of shop environments and browsing in consumer choice. More particularly, it differentiates itself by examining the practice of handling goods in shops and arguing that sensory interaction with multiple goods was one of the key means by which shoppers comprehended concepts of design and workmanship. In doing so, it affirms the importance of sensory research to design history. The article focuses on consumer purchases of ceramic objects and examines a variety of sources to demonstrate the role of haptic skills in this act. It shows how different literary sources described browsing for goods in gendered and satirical terms and then contrasts these readings against visual evidence to illustrate how handling goods was also represented as a positive act. It reads browsing as a valued practice requiring competence, patience and haptic skills. Through an examination of diary sources, letters and objects this article asks what information shoppers gained from touching various objects. It concludes by demonstrating how repetitive handling in search of quality meant that shoppers acquired their own conception of what constituted workmanship and design.

Public attitudes towards people with intellectual disabilities: a qualitative comparison of white British & South Asian people.

BACKGROUND: National and international polices promote the acceptance, integration and inclusion of people with intellectual disabilities into mainstream society. However, there is little systematic research into general population attitudes towards people with intellectual disabilities, and even less research, which considers the impact of culture on attitudes. The aim of this study was to explore how young people from White British and South Asian backgrounds differ in their attitudes towards people with intellectual disabilities and above all, how they arrive at their beliefs. MATERIALS AND METHOD: A qualitative design utilizing focus groups and individual interviews with White British and South Asian adolescents aged 16-19 years (N = 61) was employed. Questionnaire data were collected to compare this sample to findings from a larger study run concurrently (Attitudes to people with intellectual disabilities: a cross cultural study. Thesis, University College London). Interview and focus group data were analysed using thematic analysis. RESULTS: Thematic analysis yielded five themes and pointed to widespread confusion about the concept of 'intellectual disability', not helped by the continuing invisibility of people with intellectual disabilities in the media. Participants expressed many positive beliefs, yet closer analysis revealed that underlying these may be more ambivalent or even hostile attitudes. Key differences between the two cultural groups are discussed. CONCLUSIONS: The findings highlight the need for raising public awareness and the importance of culturally sensitive support.

The decline of adult smallpox in eighteenth-century London.

Smallpox was probably the single most lethal disease in eighteenth-century Britain, but was a minor cause of death by the mid-nineteenth century. Although vaccination was crucial to the decline of smallpox, especially in urban areas, from the beginning of the nineteenth century, it remains disputed the extent to which smallpox mortality declined before vaccination. Analysis of age-specific changes in smallpox burials within the large west London parish of St Martin-in-the-Fields revealed a precipitous reduction in adult smallpox risk from the 1770s, and this pattern was duplicated in the east London parish of St Dunstan's. Most adult smallpox victims were rural migrants, and such a drop in their susceptibility is consistent with a sudden increase in exposure to smallpox in rural areas. We investigated whether this was due to the spread of inoculation, or an increase in smallpox transmission, using changes in the age patterns of child smallpox burials. Smallpox mortality rose among infants, and smallpox burials became concentrated at the youngest ages, suggesting a sudden increase in infectiousness of the smallpox virus. Such a change intensified the process of smallpox endemicization in the English population, but also made cities substantially safer for young adult migrants.

The decline of adult smallpox in eighteenth-century London: a commentary.

This article is a response to Davenport, Schwarz, and Boulton's article, 'The decline of adult smallpox in eighteenth-century London'. It introduces new data on the parish of St Mary Whitechapel which casts doubt on the pattern of the age incidence of smallpox found by Davenport et al. However, it is concluded that there was a decline in adult smallpox in London, accompanied by a concentration of the disease among children under the age of five. Davenport et al.'s argument that the shift in the age incidence was due to the endemicization of smallpox in England is challenged, with an alternative view that these age changes can be accounted for by the practice of inoculation, both in the hinterland southern parishes of England and in London itself. A detailed discussion is carried out on the history of inoculation in London for the period 1760­1812. It is suggested that inoculation became increasingly popular in this period, rivalling in popularity the practice of vaccination. This was associated with a class conflict between the medical supporters of Jenner and the general population, with many of the latter being practitioners of the old inoculation.

Language, foreign nationality and ethnicity in an English prison: implications for the quality of health and social research.

BACKGROUND: More than one in 10 of all prisoners in England and Wales are Foreign Nationals. This article discusses whether the research applications to one London prison are aimed at understanding a prisoner population characterised by significant multinational and multilingual complexity. METHODS: We studied all accessible documents relating to research undertaken at a women's prison between 2005 and 2009 to assess the involvement of Foreign National prisoners and women with limited English. The source of information was prison research applications and protocols. We also looked at available final research reports and journal articles. RESULTS: Two key findings emerged from this study. First, studies at this prison frequently excluded Foreign National prisoners and women with limited English. Second, Foreign National prisoners were often clustered as a homogeneous category in the research reports reviewed. This is despite their diverse cultural backgrounds, their variable immigration status and their differing competence in English, all of which affect their lives. CONCLUSIONS: The failure to include and/or identify social subgroups of the population can undermine the value of research, including, in the case of the study prison, funded health research. This can compromise associated needs assessments and service delivery, particularly important in already disadvantaged populations; this may encourage and/or perpetuate a range of health inequalities. There is a pressing need to examine cultural exclusion in other health and criminal justice settings, to assess the ways in which-and the extent to which-such exclusion may compromise the merit of proposed and completed health and social research.

New series for agricultural prices in London, 1770­1914.

New annual series for the prices of major agricultural commodities sold in London markets between 1770 and 1914 are presented. These series are based on bimonthly observations drawn from newspaper market reports. The products covered are wheat, barley (grinding and malting), oats, potatoes, hay, butter, beef, mutton, and pork. Annual prices are calculated for both calendar and production years. The new series are compared to existing series.

The experience of pregnancy and childbirth for unmarried mothers in London, 1760-1866.

This article explores the experience of pregnancy and childbirth for unmarried mothers in the metropolis in the eighteenth and nineteenth centuries. It draws upon, in particular, the infanticide cases heard at the Old Bailey between 1760 and 1866. Many of the women in these records found themselves alone and afraid as they coped with the pregnancy and birth of their first child. A great deal is revealed about the birthing body: the ambiguity surrounding the identification of and signs of pregnancy, labour and delivery, the place of birth and the degree of privacy, and the nature of, and dangers associated with, solitary childbirth.

Prescribing in general practice for people with coronary heart disease; equity by age, sex, ethnic group and deprivation.

OBJECTIVE: Differences in drug prescribing for coronary heart disease have previously been identified by age, sex and ethnic group. Set in the UK, our study utilises routinely collected data from 98 general practices serving a socially diverse population in inner East London, to examine differences in prescribing rates among patients aged 35 years and over with coronary heart disease. DESIGN: 10,933 patients aged 35 years or more, with recorded coronary heart disease, from 98 practices in two Primary Care Trusts (PCT) in East London during 2009/2010 were included for this cross-sectional study. Multivariable logistic regression was used to assess the odds of prescribing for recommended coronary heart disease drugs by age, sex, ethnicity, social deprivation, co-morbidity and recorded reasons for not prescribing. RESULTS: Women are prescribed fewer recommended coronary heart disease drugs than men; Black African/Caribbean patients are prescribed fewer lipid modifying drugs and other cardiovascular drugs than White patients. Patients over age 84 are prescribed fewer lipid modifying drugs and beta blockers than patients aged 45-54. South Asian patients had the highest levels of prescribing and higher prevalence of coronary heart disease and diabetes co-morbidity. No difference in prescribing rates by social deprivation was found. DISCUSSION: Overall levels of prescribing are high but small differences between sex and ethnic groups remain and prescribing may be inequitable for women, for Black/African Caribbeans and at older ages. These differences were not explained by recorded intolerance, contraindications or declining treatment.

Vauxhall's post-industrial pleasure gardens: "death wish" and hedonism in 21st-century London.

In recent years Vauxhall in south London has been transformed and rebranded as an urban leisure zone for gay men. Disused railway arches and warehouses have been converted into nightclubs and a significant night-time economy has developed rivalling Soho's existing gay village. However, with its commodified forms of public sex and high levels of recreational drug use, Vauxhall's club scene looks rather different from the British gay villages of the 1990s. This article examines how the area's nightlife entrepreneurs have capitalised on the recent liberalisation of licensing laws while drawing on the historical associations with the Vauxhall Pleasure Gardens (1660-1859) in attempts to market the area as a site of embedded hedonism. Overall, the aesthetic and cultural themes of Vauxhall's club scene seem to contradict earlier assumptions about the desexualisation and sanitisation of contemporary gay culture.

Gavarni at the casino: reflections of class and gender in the visual culture of 1848.

Drawing on cultural history and opposing the idea that British visual culture in 1848 has nothing interesting to say about class, politics, and revolution, this article examines a depiction of the London dance-hall Laurent's Casino by Guillaume-Sulpice Chevalier, better known as Paul Gavarni, made to accompany as essay by Albert Smith for the collaborative work "Gavarni in London" (1849). The image appeared against the backdrop of revolutions abroad, and just weeks after rioting in Trafalgar Square. Reconstructing the location of the casino, the history of the venue, the entertainments enjoyed there, and description of its patrons - the gent and his female counterpart - reveals the dynamic performance of class enacted there, and contemporary reactions to that performance.

Cosmopolitanism, geographical imaginaries and belonging in North London.

Cosmopolitanism has been described as the cultural habitus of globalisation. It is therefore, albeit defined somewhat loosely, often associated with ethnically diverse, global cities. This paper considers the extent to which London engenders cosmopolitan values amongst its residents. It draws on survey data from the LOCAL MULTIDEM study of minorities' political participation to address these themes. The analysis examines perceptions of respect, belonging and geographical imaginaries - amongst established minorities and the ethnic majority - in north London. It is argued that cosmopolitan ethics are transformative and dialectical and, critically, cannot remain the preserve of the privileged in multi-ethnic neighbourhoods. The analysis presented demonstrates that a sense of belonging and cosmopolitan imaginaries are not evenly accessed by different ethnic groups; notably, that Bangladeshi Londoners who are born and bred in the city are less likely to appropriate these discourses than Caribbean, Indian or White residents.

Parish apprenticeship and the old poor law in London.

This article offers an examination of the patterns and motivations behind parish apprenticeship in late eighteenth- and early nineteenth-century London. It stresses continuity in outlook from parish officials binding children, which involved placements in both the traditional and industrializing sectors of the economy. Evidence on the ages, employment types, and locations of 3,285 pauper apprentices bound from different parts of London between 1767 and 1833 indicates a variety of local patterns. The analysis reveals a pattern of youthful age at binding, a range of employment experiences, and parish-specific links to particular trades and manufactures.

Stuart London's standard of living: re-examining the Settlement of Tithes of 1638 for rents, income, and poverty.

The Settlement of Tithes of 1638 can be tested for biases in its London rents. Even so, it proves to be a relatively good source for seventeenth-century London, and for calculating associated median and mean rents, as well as a Gini coefficient of inequality for the distribution of resources. Through other evidence in the Settlement, rent/income ratios for London can be approximated, and from them estimates made of London's median income. Median rents and income also allow estimates of the percentage of Londoners in poverty. Though the last is inevitably disputable, the estimate holds up well to testing by other evidence.