The Reshaping Care for Older People programme and changes in unscheduled hospital care: Analysis of routinely collected hospital data.

OBJECTIVE: This study examines mean length of stay (LOS) and rates of emergency bed days during the course of the Reshaping Care for Older People (RCOP) programme in Glasgow City. METHODS: An ecological small-area study design was used. Standardised monthly rates of bed days and LOS were calculated, between April 2011 and March 2015, for residents of Glasgow City aged 65 years and over. Multilevel negative binomial models for the square root of each outcome nested by datazone were created, adjusting for sex, 5-year age group, area-level deprivation, season, month and month squared. Relative index of inequality (RII) and slope index of inequality (SII) were calculated for each year and the trend was examined. RESULTS: The rate of bed days first rose then fell during the study period, while LOS first fell then rose. Relative risk (RR) of an additional bed day was greater for males (RR=1.14 (1.12, 1.16)) and increased with increasing age group. There was no gender difference in LOS. Bed days per head of population first increased then fell; for 12-month period RR=1.01 (0.98, 1.05) and for 12-month period squared, RR=0.999 (0.999, 0.999). RII and SII for rate of bed days per head of population were significant, though not for LOS. SII for bed days per head of population did not change significantly over time, while RII reduced at the 87% level of confidence. CONCLUSIONS: The results suggest a reduction in secondary care use by older people during the RCOP programme, and a possible reduction in socioeconomic inequalities in bed days in the longer term.

Growing up in Glasgow: the social context of adolescence.

The adolescent population of Glasgow, the city with the highest mortality in the UK, has a higher prevalence of risk behaviours than elsewhere in Scotland. Previous research has highlighted the importance of social context in interpreting such differences. Contextual variables from the 2010 Health Behaviour in School-aged Children Scotland survey were analysed. Glaswegian adolescents were more likely to live in low socioeconomic status, single-parent or step-families, or with neither parent in employment, less likely to share family meals, more likely to buy lunch outside school, and spend time with friends after school and in the evenings. They also had a poorer perception of their local neighbourhood. Family affluence only partially explained these differences.

Geographic and socioeconomic variations in adolescent toothbrushing: a multilevel cross-sectional study of 15 year olds in Scotland.

BACKGROUND: This study examined urban-rural and socioeconomic differences in adolescent toothbrushing. METHODS: The data were modelled using logistic multilevel modelling and the Markov Chain Monte Carlo method of estimation. Twice-a-day toothbrushing was regressed upon age, family affluence, family structure, school type, area-level deprivation and rurality, for boys and girls separately. RESULTS: Boys' toothbrushing was associated with area-level deprivation but not rurality. Variance at the school level remained significant in the final model for boys' toothbrushing. The association between toothbrushing and area-level deprivation was particularly strong for girls, after adjustment for individuals' family affluence and type of school attended. Rurality too was independently significant with lower odds of brushing teeth in accessible rural areas. CONCLUSION: The findings are at odds with the results of a previous study which showed lower caries prevalence among children living in rural Scotland. A further study concluded that adolescents have a better diet in rural Scotland. In total, these studies highlight the need for an examination into the relative importance of diet and oral health on caries, as increases are observed in population obesity and consumption of sugars.

Socioeconomic and geographic inequalities in adolescent smoking: a multilevel cross-sectional study of 15 year olds in Scotland.

The objective of the study was to present socioeconomic and geographic inequalities in adolescent smoking in Scotland. The international literature suggests there is no obvious pattern in the geography of adolescent smoking, with rural areas having a higher prevalence than urban areas in some countries, and a lower prevalence in others. These differences are most likely due to substantive differences in rurality between countries in terms of their social, built and cultural geography. Previous studies in the UK have shown an association between lower socioeconomic status and smoking. The Scottish Health Behaviour in School-aged Children study surveyed 15 year olds in schools across Scotland between March and June of 2010. We ran multilevel logistic regressions using Markov chain Monte Carlo method and adjusting for age, school type, family affluence, area level deprivation and rurality. We imputed missing rurality and deprivation data using multivariate imputation by chained equations, and re-analysed the data (N = 3577), comparing findings. Among boys, smoking was associated only with area-level deprivation. This relationship appeared to have a quadratic S-shape, with those living in the second most deprived quintile having highest odds of smoking. Among girls, however, odds of smoking increased with deprivation at individual and area-level, with an approximate dose-response relationship for both. Odds of smoking were higher for girls living in remote and rural parts of Scotland than for those living in urban areas. Schools in rural areas were no more or less homogenous than schools in urban areas in terms of smoking prevalence. We discuss possible social and cultural explanations for the high prevalence of boys' and girls' smoking in low SES neighbourhoods and of girls' smoking in rural areas. We consider possible differences in the impact of recent tobacco policy changes, primary socialization, access and availability, retail outlet density and the home environment.

Trends in adolescent eating behaviour: a multilevel cross-sectional study of 11-15 year olds in Scotland, 2002-2010.

BACKGROUND: Improving the diet of the Scottish population has been a government focus in recent years. Health promotion is known to be more effective in affluent groups. Alongside trends in eating behaviour, changes in socioeconomic inequalities must be monitored. METHODS: Eating behaviour data from the 2002, 2006 and 2010 Scotland Health Behaviour in School-Aged Children survey were modelled using multilevel linear modelling. RESULTS: Fruit and vegetable consumption increased between 2002 and 2010 by 0.26 and 0.27 days per week, respectively, while consumption of sweets, chips and crisps fell by 0.73, 1.25 and 0.99 days per week, respectively. An overall healthy eating score, calculated by summing food item weekly consumption, increased significantly (at 95% level of significance) over this period. Fruit and vegetable consumption was more frequent among children with high family affluence (individual measure of socioeconomic status), while consumption of crisps and chips was less frequent. When an interaction term was added between year and family affluence, this was not significant for any outcome. Variance at the education authority and school levels remained significant for all outcomes. CONCLUSIONS: Adolescent eating behaviours in Scotland have improved over time across the family affluence scale gradient as a whole, with persistent inequalities. Alongside population programmes, initiatives directed at more deprived groups are required.

Glasgow smiles better: an examination of adolescent mental well-being and the 'Glasgow effect'.

BACKGROUND: The existence of a negative 'Glasgow effect' on health has been much disputed. Previously, Glasgow's poor health was believed to be due to high levels of poverty. However, more recent studies investigating adult health outcomes have shown an effect over and above that of deprivation. OBJECTIVES: To examine the existence of a 'Glasgow effect' on mental well-being and subjective health of an adolescent sample. STUDY DESIGN: Data from the 2006 Health Behaviour in School-Aged Children cross-sectional survey were analyzed. METHODS: Data were modelled using multilevel logistic and linear modelling for the following outcomes: happiness, confidence, feeling left out, self-rated health, multiple health complaints (MHC), life satisfaction and health-related quality of life (KIDSCREEN-10). The models were further adjusted for family affluence and family status, as proxy measures of socio-economic status. RESULTS: The proportions of pupils that reported being very happy, always confident and never left out were greater among pupils in Glasgow compared with pupils in the rest of Scotland, as were mean life satisfaction and KIDSCREEN scores. Frequencies of MHC and subjective health were not significantly different in Glasgow compared with the rest of Scotland. Similar results were observed following the modelling procedures, adjusting for age, sex, grade and school type (state or independent), for all outcomes other than life satisfaction, and effect sizes increased further after adjustment for family affluence and family status. The odds of a pupil in Glasgow being very happy, for example, were 1.48 [credible interval (CI) 1.19-1.83] those of a pupil outside Glasgow. After adjustment for family affluence and family status, the odds were 1.59 (CI 1.28-1.98). An interaction term between Glasgow and grade was not significant for all mental well-being outcomes, although there was some suggestion that a negative Glasgow effect on self-rated health is emerging by Secondary 4. CONCLUSIONS: The Glasgow effect may not be all bad. The findings suggest that mental well-being is more prevalent in Glasgow compared with the rest of Scotland during adolescence. Further research is recommended to investigate the Glasgow effect during this life stage.

Inequalities in toothbrushing among adolescents in Scotland 1998-2006.

The aim of this study was to examine trends in toothbrushing and inequalities in toothbrushing among girls and boys in Scotland between 1998 and 2006. A secondary aim was to investigate the association between the health promoting school (HPS) initiative and toothbrushing. Data from the Health Behaviour in School-aged Children 1998, 2002 and 2006 surveys were analysed using multilevel logistic regression for boys and girls aged 11, 13 and 15 years. Girls' twice-a-day toothbrushing increased with age while that of boys' remained stable. Toothbrushing increased significantly between 1998 and 2006 for all but 15-year-old girls. Family structure was significantly associated with toothbrushing for 11-year-old boys and 13-year-old boys and girls. Socio-economic inequalities in toothbrushing were significant for both boys and girls at all ages. Largest inequalities were seen among 13-year-old girls and 15-year-old boys. Inequalities persisted over time for all but 15-year-old boys who saw a significant reduction between 1998 and 2006. The HPS initiative in schools in deprived areas was associated with increased odds of twice-a day toothbrushing among 11-year-old boys and 15-year-old girls.

Vibrio vulnificus septicemia in a patient with the hemochromatosis HFE C282Y mutation.

Vibrio vulnificus is an extremely invasive gram-negative bacillus found in marine waters that causes overwhelming bacteremia and shock that is associated with high mortality. Impaired iron metabolism has been implicated in the susceptibility to V vulnificus bacterial infections. We report a case of fatal V vulnificus sepsis in a 56-year-old man who died within 1 to 3 days after consuming raw seafood. At autopsy, he was found to have micronodular cirrhosis and iron overload. Postmortem genetic analysis revealed the presence of the hemochromatosis gene (HFE) C282Y mutation. To our knowledge, this is this first documented fatal case of V vulnificus infection in a patient proven to carry the HFE C282Y mutation. Because this patient was heterozygous for the major hereditary hemochromatosis mutation and was not previously diagnosed with clinical iron overload, the spectrum of clinical susceptibilities to V vulnificus infection may include carriers of the C282Y mutation.

Intravenous ancrod for treatment of acute ischemic stroke: the STAT study: a randomized controlled trial. Stroke Treatment with Ancrod Trial.

CONTEXT: Approved treatment options for acute ischemic stroke in the United States and Canada are limited at present to intravenous tissue-type plasminogen activator, but bleeding complications, including intracranial hemorrhage, are a recognized complication. OBJECTIVE: To evaluate the efficacy and safety of the defibrinogenating agent ancrod in patients with acute ischemic stroke. DESIGN: The Stroke Treatment with Ancrod Trial (STAT), a randomized, parallel-group, double-blind, placebo-controlled trial conducted between August 1993 and January 1998. SETTING: Forty-eight centers, primarily community hospitals, in the United States and Canada. PATIENTS: A total of 500 patients with an acute or progressing ischemic neurological deficit were enrolled and included in the intent-to-treat analysis. INTERVENTIONS: Patients were randomly assigned to receive ancrod (n=248) or placebo (n =252) as a continuous 72-hour intravenous infusion beginning within 3 hours of stroke onset, followed by infusions lasting approximately 1 hour at 96 and 120 hours. The ancrod regimen was designed to decrease plasma fibrinogen levels to 1.18 to 2.03 micromol/L. MAIN OUTCOME MEASURES: The primary efficacy end point was functional status, with favorable functional status defined as survival to day 90 with a Barthel Index of 95 or more or at least the prestroke value, compared by treatment group. Primary safety variables included symptomatic intracranial hemorrhage and mortality. RESULTS: Favorable functional status was achieved by more patients in the ancrod group (42.2%) than in the placebo group (34.4%; P=.04) by the prespecified covariate-adjusted analysis. Mortality was not different between treatment groups (at 90 days, 25.4% for the ancrod group and 23% for the placebo group; P=.62), and the proportion of severely disabled patients was less in the ancrod group than in the placebo group (11.8% vs 19.8%; P=.01). The favorable functional status observed with ancrod vs placebo was consistent in all subgroups defined for age, stroke severity, sex, prestroke disability, and time to treatment (< or = 3 or > 3 hours after stroke onset). There was a trend toward more symptomatic intracranial hemorrhages in the ancrod group vs placebo (5.2% vs 2.0%; P=.06), as well as a significant increase in asymptomatic intracranial hemorrhages (19.0% vs 10.7%; P=.01). CONCLUSION: In this study, ancrod had a favorable benefit-risk profile for patients with acute ischemic stroke.