Measuring the impact of a Chronic Obstructive Pulmonary Disease Community Respiratory Programme on emergency admissions to hospital: a controlled interrupted time series analysis.

BACKGROUND: A community respiratory service was implemented in the North West of Glasgow (NW) in January 2013, as part of the Reshaping Care for Older People programme (RCOP). This study aimed to measure the impact of the service on older people's emergency admissions (EAs) to hospital. METHODS: EAs to hospital with a primary diagnosis of COPD (COPD EAs) per 1,000 population aged 65 years+ in NW were compared before and after onset of the service with a 6-month phase-in period, using segmented linear regression. South and North East Glasgow (S + NE) was the control-an area with no such service in place. The model adjusted for the rate of all-cause EAs to control for the impact of other localised RCOPP initiatives. Autoregressive terms and a Fourier term to adjust for seasonality were included in the model. RESULTS: Prior to implementation of the respiratory service, increases in COPD EAs over time were evident in NW. Adjusting for changes in COPD EAs in NE + S, an additional reduction of -0.04 (-0.03, -0.05) per 1,000 population per month was observed in NW following the phase-in, so that by March 2015, the predicted reduction due to the respiratory service was -0.85 COPD EAs per 1,000 population, a relative reduction of 34.3%. No significant changes in admissions with COPD as a secondary diagnosis (COPD5 EAs) were observed, suggesting that the intervention had no impact on these. CONCLUSIONS: The community respiratory service was associated with a significant reduction in the rate of COPD EAs among older people and no change in COPD5 EAs.

Measuring the impact of step down intermediate care on delayed discharge: an interrupted time series analysis.

BACKGROUND: Intermediate care (IC) acts as a bridging service between hospital and home, for those deemed medically fit for discharge but who are delayed in hospital. The aim of this study was to measure the effect of IC and a 72-hour discharge target on days delayed. METHODS: Rate of days delayed per 1000 population aged 75 years+ in Glasgow City was compared before and after onset of IC with a 6-month phase-in period, using segmented linear regression. Inverclyde and West Dunbartonshire (IWD) was a control. Autoregressive and moving average terms were included in the model, as well as a Fourier term to adjust for seasonality. RESULTS: Prior to IC, rate of days delayed increased in both Glasgow City and the rest of Scotland. There was a large reduction in rate of days delayed in Glasgow during the phase-in period, greater than the rest of Scotland but comparable with that observed in IWD, with subsequent increases thereafter. Adjusting for changes in IWD, the impact of IC and the discharge target in Glasgow City was a level change of -15.20 (95% CI -17.52 to -12.88) and a trend change of -0.29 (95% CI -0.55 to -0.02). This is equivalent to a predicted reduction due to IC of -16.04 days delayed per 1000 population per month, in June 2016, and a relative reduction of 35%. CONCLUSION: IC and the 72-hour discharge target were associated with a reduction in days delayed. Rate of days delayed continued to increase over time, although at a slower rate than if IC had not been implemented.

Measuring the impact of a public awareness campaign to increase Welfare Power of Attorney registrations in Scotland.

Objective: to measure the impact of the 'My Power of Attorney' media campaign on the number of new power of attorney (POA) registrations in Scotland. Setting: POA registrations in Scotland processed by the Office of the Public Guardian during January 2010 to June 2015. Methods: multilevel Poisson models for POA registrations nested by council and annual quarter were run using Markov chain Monte Carlo methods, adjusting for time, campaign (variable ranging between 0 and 5 dependent on intensity of campaign measured by the number of media platforms received) and offset term mid-year population estimate for those aged 25 years+/65 years+. Results: POA registrations saw a reduction between 2010 and 2011 but overall, increased between 2010 and 2015. POA registrations rose by 33.3% in Glasgow City between 2013 and 2014, when the campaign began, while the rest of Scotland saw a rise of 17.3%. When the data were modelled, Relative Risk (RR) of a POA registration increased with increasing intensity of campaign, so that in an area in receipt of the full campaign was RR = 1.31 (1.28, 1.34) that of an area with no campaign. Between council variation persisted after adjustment for campaign (Variance = 0.041 (0.011)). Conclusions: during the period of the campaign, area-level increases in POA registrations were observed associated with the 'My Power of Attorney' timing and location, in an approximate dose-response relationship with campaign intensity, suggesting that this is likely to be due to the campaign that began in Glasgow City.

Reshaping Care for Older People: Trends in emergency admissions to hospital during a period of simultaneous interventions in Glasgow City, April 2011-March 2015.

This study describes trends in emergency admissions (EAs) in Glasgow City during a period when interventions were designed and implemented, aimed at shifting the balance from institutional to community-based care. Standardised monthly rates of EAs between April 2011 and March 2015 were calculated, for residents of Glasgow City aged 65 years and over. Multilevel zero-inflated Negative Binomial models for EAs nested by datazone were created, adjusting for sex, 5-year age group, area-level deprivation (SIMD quintile), season, month and month squared. Models were also run for EAs by cause, for three causes: chronic obstructive pulmonary disease (COPD), falls and dementia. The rate of EAs first rose then fell during the study period. When modelled, RRs for month (RR for month 12 relative to month 1 and 95% CI=1.02 (0.99, 1.06)) and month squared (RR=0.999 (0.998, 0.999)) indicated a rise in admissions until February 2012, followed by a fall. Risk of admission was greater for males and increased with increasing age group. The risk of going into hospital for those from SIMD 5 (most affluent) was 0.58 (0.56, 0.59) relative to those from SIMD 1 (most deprived). Socioeconomic inequalities were particularly great for COPD-related admissions, where RR for SIMD 5 was 0.25 (0.23, 0.28) times that of SIMD 1. An interaction term between month and SIMD was not significant for any outcome. For dementia-related EAs there was a suggestion that inequalities may be reducing over time. EAs for those aged 65 years and more reduced during the Change Fund period, with similar relative reductions observed across all deprivation quintiles.

The use of parental occupation in adolescent health surveys. An application of ISCO-based measures of occupational status.

BACKGROUND: Recent research has emphasised that the challenge in researching socioeconomic differences in adolescent health cross-nationally lies in providing valid and comparable measures of socioeconomic position (SEP) across regions. This study aims to examine measures of occupational status derived from the International Standard Classification of Occupations (ISCO), alongside commonly used affluence measures in association with adolescent self-rated health (SRH). METHODS: Data were from the 2005/2006 'Health Behaviour in School-aged Children study' (HBSC); 27 649 individuals aged 11, 13 and 15 years from Germany, Macedonia, Norway, Turkey, Wales and Scotland. Three occupational scales were compared: the International Socioeconomic Index of Occupational Status (ISEI), the Standard International Occupational Prestige Scale (SIOPS) and the Erikson-Goldthorpe-Portocarero class categories (EGP). Correlation analyses compared these occupational scales with the family affluence scale (FAS) and a family well-off measure, while logistic regression assessed the association between occupational scales and poor SRH. Multiple imputation techniques investigated possible bias arising from parental occupation missingness. RESULTS: Moderate correlations existed between occupational scales and FAS and family well-off. Socioeconomic inequalities in poor SRH were found for ISEI, SIOPS and EGP in all regions, independent of FAS and family well-off. Models of imputed data sets did not alter the results. The relationship between SEP and SRH was therefore not biased by high levels of missing values for ISCO. CONCLUSIONS: ISCO-based indicators of occupational status in cross-national self-administered adolescent health surveys were found to be robust measures of SEP in adolescence. These measure different aspects of SEP independent of FAS and family well-off.

No mean city: adolescent health and risk behaviours in a UK urban setting.

BACKGROUND: The adult population of Glasgow has worse health than in the rest of Scotland, only partially explained by deprivation. Little is known about the health of young Glaswegians. METHODS: The 2010 Health Behaviour in School-aged Children survey data were analysed using multilevel modelling to compare outcomes in Glasgow relative to the rest of Scotland. RESULTS: Glasgow adolescents had similar or better self-reported health on some measures--e.g. adjusting for age and sex, OR for 'very happy' was 0.93 (95% CI = (0.75, 1.14))--and the beta coefficient for positive GHQ-12 was 2.79 (0.72, 4.85) compared with the rest of Scotland. However, many health aspects were worse in Glasgow especially for eating and sedentary behaviour, subjective health and aggression, e.g. the OR for 'daily consumption of vegetables' was 0.59 (0.46, 0.77), of reporting 'excellent health' was 0.66 (0.50, 0.87); headaches was 1.40 (1.09, 1.80); however drinking alcohol in the past week was lower (OR 0.71 (0.50, 0.99)) and smoking, similar. Adjustment for family affluence and school type marginally attenuated the association with Glasgow. CONCLUSIONS: The worse health experienced by Glasgow adults is only partially seen among young people in Glasgow; however, these are seen at the youngest ages in the study.

Urban-rural differences in adolescent eating behaviour: a multilevel cross-sectional study of 15-year-olds in Scotland.

OBJECTIVE: Improving the diet of the Scottish population has been a government focus in recent years. Population health is known to vary between geographies; therefore alongside trends and socio-economic inequalities in eating behaviour, geographic differences should also be monitored. DESIGN: Eating behaviour data from the 2010 Scotland Health Behaviour in School-aged Children survey were modelled using multilevel linear and logistic modelling. SETTING: Data were collected in schools across urban and rural Scotland. SUBJECTS: Schoolchildren aged 15 years. RESULTS: Adolescents living in remote rural Scotland had the highest consumption frequency of vegetables (on average consumed on 6·68 d/week) and the lowest consumption frequency of sweets and crisps (on 4·27 and 3·02 d/week, respectively). However, it was not in the major four cities of Scotland (Glasgow, Edinburgh, Dundee and Aberdeen) but in the geography described by the classification 'other urban' areas (large towns of between 10 000 and 125 000 residents) that adolescents had the poorest diet. Deprivation and rurality were independently associated with food consumption for all but fruit consumption. Sharing a family meal, dieting behaviour, food poverty and breakfast consumption did not differ by rurality. Variance at the school level was significant for fruit and vegetable consumption frequencies and for irregular breakfast consumption, regardless of rurality. CONCLUSIONS: Young people from rural areas have a healthier diet than those living in urban areas. The eating behaviours examined did not explain these differences. Future research should investigate why urban-rural differences exist for consumption frequencies of 'healthy' and 'unhealthy' foods.

Socio-environmental influences on physical activity among young people: a qualitative study.

This multi-methods qualitative study aimed to identify environmental factors that influence physical activity participation among young people in Edinburgh, Scotland. School pupils (aged 11-13 years) took part using photography, computer blogs, maps and focus group discussions (FGDs). Eleven computer sessions (n = 131) and 14 FGDs (n = 63) took place. Factors influencing physical activity behaviour included proximity and access to local facilities, family and peers and the school physical activity environment. A variety of facilitators and barriers to participation were also reported. Most notable was the importance of cost and value for money when choosing physical activities which, although more evident among pupils attending schools in areas of low socio-economic status (SES), was relevant across all SES groups. Reporting easy access to sports facilities was more common among pupils attending schools from high/medium SES. Use of greenspace for physical activity was reported among pupils from all schools, but was more common among those from low SES schools. Pupils were, in general, satisfied with the facilities available at school, but felt time for physical education could be increased. Findings may help inform interventions, aimed at promoting physical activity at local level.

Family structure and breakfast consumption of 11-15 year old boys and girls in Scotland, 1994-2010: a repeated cross-sectional study.

BACKGROUND: The benefits of breakfast during childhood and adolescence have been reported previously though few studies have considered family structure inequalities in breakfast consumption. The proportion of young people living in non-traditional family types has increased in recent years, strengthening the need to describe and monitor the impact of the changing family unit on adolescent breakfast consumption. This study aimed to describe changes in daily breakfast consumption among adolescents in Scotland between 1994 and 2010, while also considering family structure inequalities, and the degree to which these have changed over time. METHODS: Data from the 1994, 1998, 2002, 2006 and 2010 Scottish Health Behaviour in School-aged Children (HBSC) surveys were analysed using logistic multilevel regression models for binary outcome variable daily breakfast consumption. RESULTS: Daily breakfast consumption among adolescents increased between 1994 and 2010, although there were differences by age and sex. In fact those aged over 14.5 years saw decreases in breakfast consumption, and girls saw significantly larger increases than boys. Daily breakfast consumption was more prevalent among adolescents from 'both parent' families, with lowest prevalence among those from single parent families. Trends in daily breakfast consumption between 1994 and 2010 also varied by family structure. While prevalence of daily breakfast consumption increased among those living with 'both parents', the largest proportion of the population, prevalence decreased over time among adolescents of single parent families, and particularly among those living with their father. CONCLUSIONS: Family structure inequalities in daily breakfast consumption increased between 1994 and 2010, while breakfast consumption across the population as a whole increased. As the proportion of young people living in an alternative family structure continues to grow it is important to understand why these inequalities have increased and how these may be overcome. Possible reasons for family structure inequalities and their increase in recent years are discussed.

Irregular breakfast consumption in adolescence and the family environment: underlying causes by family structure.

Data from the 2002, 2006 and 2010 Scottish Health Behaviour in School-aged Children (HBSC) surveys were analysed using logistic multilevel regression for outcome variable irregular breakfast consumption (IBC). IBC prevalence in Scotland was higher among young people from reconstituted and single parent families, and particularly single father families. Family characteristics, found previously to be associated with breakfast consumption, such as number of siblings, perceived parenting, parental involvement and family affluence, differed by family structure. Family structure inequalities in IBC existed, also after adjustment for year and child's sex, age, grade and ethnicity. Across all family structures, IBC was more prevalent at the older age groups, among those who had difficult communication with their parents, and where household routines were infrequent. Greater number of siblings and lower family affluence were associated with higher odds of IBC in single mother and both parent families, while having a second home was associated with higher odds in reconstituted households. Fair parenting and being close to at least one parent was associated with reduced odds of IBC in single mother households, while being close to all parents was in single father households. In single mother homes, having a working mother was also positively associated with IBC. Family structure differences should be considered when addressing irregular breakfast consumption in adolescence.

Adolescent risk behaviours and mealtime routines: does family meal frequency alter the association between family structure and risk behaviour?

Family structure is associated with a range of adolescent risk behaviours, with those living in both parent families generally faring best. This study describes the association between family structure and adolescent risk behaviours and assesses the role of the family meal. Data from the 2006 Health Behaviour in School-Aged Children survey were modelled using Multilevel Binomial modelling for six risk behaviour outcomes. Significantly more children from 'both parent' families ate a family meal every day and fewer 'hardly ever or never' did. Family structure was associated with boys' and girls' smoking, drinking, cannabis use and having sex and with girls' fighting. Frequency of eating a family meal was associated with a reduced likelihood of all risk behaviours among girls and all but fighting and having sex among boys. Eating a family meal regularly nullified the association between family structure and drinking alcohol for boys and girls and cannabis use for boys and reduced the effect size of alternative family structures on boys having sex and smoking. The family meal, associated with a reduced likelihood of many adolescent risk behaviours, reduces or eliminates the association with family structure and may therefore help to overcome inequalities in adolescent risk behaviours.

Associations between the school environment and adolescent girls' physical activity.

This paper explores school sports facility provision, physical education allocation and opportunities for physical activity and their association with the number of days adolescent girls participate in at least 60 min of moderate-vigorous physical activity per week (MVPAdays). Data were collected through self-administered questionnaires from Scottish secondary school girls (n = 1978) and head teachers (n = 123) participating in the Health Behaviour in School-aged Children 2005/06 study. The best predictor of adolescent girls' MVPAdays was hours allocated to PE in fourth year of secondary school (ß = 0.27, 95% CI 0.06-0.48). Having shower facilities resulted in decreased MVPA (ß = -0.51, CI -0.90 to -0.12), as did providing less than two team sports clubs (ß = -0.69, CI -1.28 to -0.10), compared with schools who provided four or more. Compared with schools with no after school clubs, girls who attended schools with activities at least 1 day per week were likely to have increased MVPAdays. PE allocation and extra-curricular clubs are likely to be of greater importance to girls' participation than school facilities per se. This study demonstrates how schools can maximize their environment to increase girls' PA and offers encouraging findings for those with limited sports facilities.

Parental and peer influences on physical activity among Scottish adolescents: a longitudinal study.

BACKGROUND: This study investigated parental and peer influences on physical activity, examining gender and developmental differences during early-mid adolescence. METHODS: A 5-year longitudinal study tracking physical activity (measured by PAQ-C) among adolescents (n = 641) from final year of primary (P7) to fourth year of secondary school (S4). Peer support, peer socializing, parental support, and independent play were assessed. Logistic regression predicted physical activity, by year and gender, in relation to social influences. RESULTS: Boys reported higher physical activity, peer support, paternal support, and independent play than girls. Among both genders, peer, paternal, and maternal support decreased with age, whereas independent play increased. Time with friends was particularly important. Among high socializers (P7), odds of being active were over 3 times those of low socializers [boys: 3.53 (95% CI 1.77, 7.04), girls: 3.27 (95% CI 1.80, 5.92)]. Baseline physical activity was also a strong predictor among early secondary boys (OR 3.90 95% CI 2.10, 7.24) and girls (OR 4.15, 95% CI 2.00, 8.62). Parental support was less important than peer influences; only same-sex parental support remained significant in multivariables models. CONCLUSIONS: Parents and peers have important influences on adolescent physical activity. Significant gender and developmental effects are apparent through early-mid adolescence.

Urban-rural differences in dental caries of 5-year old children in Scotland.

Previous research suggests there are significant differences between urban and rural areas in Scotland for health outcomes including heart disease, cancer and self reported health. The aim of this study was to describe the contemporary urban/rural variation in obvious decay experience amongst 5-year-olds in Scotland. Scotland was split into 6 geographies, ranging from 'The 4 Cities' (Glasgow, Edinburgh, Dundee and Aberdeen) to 'Remote Rural' areas. Data derived from the 2007/08 National Dental Inspection Programme, representative of the whole of Scotland, were modelled using Bayesian multilevel zero-inflated Negative Binomial and multilevel Poisson modelling, adjusting for age, sex and deprivation. The outcome variables modelled were d(3)mft (carious, extracted or filled deciduous teeth), d(3)t (carious teeth), mt (missing teeth, extracted due to caries) and ft (filled teeth). The proportion of 5-year old children in Scotland with d(3)mft = 0 was 58% in 2008. Adjusting for age and sex, the odds of a child in a Remote Rural area having d(3)mft>0 was 0.52 that of a city dweller. However, when deprivation was included in the model, the odds of having d(3)mft >0 rose to 0.74. The odds of d(3)mft>0 in 'Accessible Rural' areas also remained significantly lower than in the 4 Cities after adjustment for deprivation. For those with d(3)mft>0, the relative risk of additional d(3)mft was also significantly lower in Remote Rural areas, however this was explained by deprivation, while in Accessible Rural areas this remained significant even after adjustment for deprivation. The odds of having any extractions was lower in Rural areas, even after adjustment for deprivation, while the Care Index (ft/d(3)mft) was higher in Remote Towns. Deprivation, therefore, accounted for much but not all of the geographical difference in d(3)mft which exist in Scotland. Children in Remote and Rural areas appear to have better dental health and a higher proportion of filled teeth when compared with those living in Cities. Possible reasons for these differences and recommendations for future research are discussed.

Adolescent toothbrushing and the home environment: sociodemographic factors, family relationships and mealtime routines and disorganisation.

OBJECTIVES: Previous studies have shown that sociodemographic factors are associated with adolescent toothbrushing. While there has been some investigation of parental modelling of oral health behaviour and the association between parental support and oral health, there has been no investigation of the home environment and its effect on oral health behaviour. The current study examines variables related to the family, including mealtime routines and family relationships to determine the best predictors of adolescent toothbrushing. METHODS: Data from the 2006 Health Behaviour in School-Aged Children Survey were modelled using logistic univariate and multivariable modelling with outcome variable twice-a-day toothbrushing. RESULTS: Higher family socioeconomic and affluence were significantly associated with greater odds of toothbrushing twice a day or more. Family structure was also significantly associated with girls' toothbrushing. However, under the multivariable model, eating breakfast was found to be the best predictor of twice-a-day toothbrushing among boys and girls. The next best predictor of boys' toothbrushing was eating family meals and of girls' toothbrushing, never going to bed hungry, followed by family affluence for both boys and girls. Under the multivariable model, family structure was no longer significantly associated with girls' toothbrushing. CONCLUSIONS: The study shows that the family and home environment should play a central role in the promotion of oral health, through mealtime routines, incorporating a fair parenting style and developing open and positive family relationships. Not only are these strongly associated with twice a day toothbrushing but, unlike sociodemographic factors, they may be relatively easy to adopt.

Socioeconomic differences in second-hand smoke exposure among children in Scotland after introduction of the smoke-free legislation.

BACKGROUND: To examine the impact of the Scottish smoke-free legislation on social inequalities in secondhand smoke (SHS) exposure among primary school children. METHODS: Comparison of nationally representative, cross-sectional, class-based surveys carried out in the same schools before and after legislation. Participants were 2532 primary school children (primary 7; aged around 11 y) surveyed in January 2006 (before legislation) and 2389 in January 2007 (after legislation). Outcome measures were salivary cotinine concentrations, self-reported family socioeconomic classification (family SEC) and family affluence scale (FAS). RESULTS: After adjusting for number of smoking parents, mean cotinine concentration varied significantly across both family SEC and FAS groups, and increased significantly stepwise from high to low family SEC/FAS. Mean cotinine fell in all family SEC/FAS groups after legislation. The relative drop in mean cotinine was equal across all family SEC/FAS groups. Adding an interaction term between survey-year and family SEC/FAS to the model showed an increase in inequalities over time, but was only significant at the 93% level using FAS and 73% using family SEC. CONCLUSION: Inequalities in SHS exposure exist among 11-year-old children in Scotland. Smoke-free legislation has reduced exposure to SHS among all children. Although the greatest absolute reduction in cotinine is observed in the lowest SEC/FAS group, cotinine levels remain highest for this group and there is a suggestion of possible increases in inequalities, which may warrant longer-term monitoring.

Mental well-being and subjective health of 11- to 15-year-old boys and girls in Scotland, 1994-2006.

BACKGROUND: Promoting young people's mental well-being and reducing socioeconomic inequalities are priority areas for WHO and the Scottish Government. This article describes changes in the subjective health and mental well-being of adolescents living in Scotland between 1994 and 2006, and investigates socioeconomic inequalities in mental well-being and subjective health over time. METHODS: Data from the 1994, 1998, 2002 and 2006 Health Behaviour in School-aged Children surveys were analysed using Multilevel Binomial modelling. RESULTS: Boys and younger adolescents scored more favourably on measures of confidence, happiness, helplessness and feeling left out than girls and older adolescents. Multiple health complaints (MHC) were also more prevalent among girls than boys. Significant increases over time were observed for all mental well-being measures among girls and for all but confidence among boys. Similarly, there was a significant decrease in odds of MHC over time for both boys and girls. There were no socioeconomic inequalities in any of the five outcomes in 1998. However by 2006, socioeconomic inequalities in young people's happiness, confidence and MHC emerged, while inequalities in girls' helplessness also approached significance. Between 1998 and 2006 significant increases in socioeconomic inequalities in happiness and MHC were observed and increases in feeling left out also approached significance. CONCLUSIONS: Adolescent mental well-being and subjective health in Scotland is improving. However, gender differences persist and socioeconomic inequalities are emerging for some measures, suggesting that a longer term monitoring of mental well-being and subjective health in Scotland is required.

Inequalities in dental caries of 5-year-old children in Scotland, 1993-2003.

BACKGROUND: Previous research suggests there are significant differences between socio-economic groups in prevalence and amount of decayed missing and filled primary teeth (d3mft). The aim of this study was to describe the variation in obvious tooth decay experience amongst 5-year olds in Scotland and to look at the association between d3mft and deprivation in Scotland. METHODS: Data derived from 1993 to 2003 National Dental Inspection Programme were modelled using Bayesian multilevel zero-inflated Negative Binomial models, adjusting for age, sex and the deprivation. RESULTS: Deprivation is positively and significantly associated with having d3mft; the odds of a child in DepCat 7 (most deprived) having d3mft in 1993 were 7.49 (5.03-11.15) that of a child in DepCat 1 (most affluent). Inequalities in the prevalence of d3mft have reduced and in 2003 the odds of a child in DepCat 7 having d3mft were 4.60 (3.47-6.14) that of a child in DepCat 1. However, socio-economic inequalities in the amount of d3mft for those with d3mft have seen no reduction and have in fact increased between 1993 and 2003, with this increase approaching significance. CONCLUSION: While socio-economic inequalities in prevalence of children with d3mft have decreased in recent years, socio-economic inequalities in the amount of d3mft for those with d3mft persist. This suggests that improvements are only seen for those children with the potential for low d3mft. High d3mft persists among children from more deprived areas. The national target conceals this apparent inconsistency.

Fluoride rinsing and dental health inequalities in 11-year-old children: an evaluation of a supervised school-based fluoride rinsing programme in Edinburgh.

OBJECTIVES: Previous studies have shown that fluoride mouthrinsing programmes are effective in reducing caries among children and adolescents. National surveys of child dental health in the UK confirm that there is variation in oral health. In particular, children of low socioeconomic status in Scotland have a disproportionately high share of dental disease. This study aimed to evaluate an existing school-based fluoride mouthrinsing programme on dental caries in populations stratified by socioeconomic status. METHODS: A random sample of 1333 children surveyed by the National Dental Inspection Programme with average age 11.4 years was included in the study. Caries prevalence data were collected for the 661 rinsers and 672 nonrinsers. Chi-squared tests and t-tests were carried out to test differences in proportion and in mean D(3)MFT, respectively. The data were modelled using multilevel logistic regression, adjusting for age, sex, deprivation and rinse status. RESULTS: There is a strong negative association between deprivation and prevalence of D(3)MFT = 0. There is no significant difference in prevalence of D(3)MFT between rinsers and nonrinsers, however, mean D(3)MFT is greater for nonrinsers within each deprivation category. After adjusting for age, sex and deprivation, the odds of a tooth being decayed missing or filled for a child who rinsed are 0.79 (0.64, 0.98) compared with those of a child who did not. CONCLUSIONS: Fluoride rinsing can be effectively targeted at children from deprived areas through school-based initiatives. There are some difficulties in recruiting all children from the more deprived backgrounds, but overall reductions in D(3)MFT were observed.

Urban-rural inequalities in ischemic heart disease in Scotland, 1981-1999.

OBJECTIVES: We sought to describe the pattern and magnitude of urban-rural variation in ischemic heart disease (IHD) in Scotland and to examine the associations among IHD health indicators, level of rurality, and degree of socioeconomic deprivation. METHODS: We used routine population and health data on the population aged 40-74 years between 1981 and 1999 and living in 826 small areas (average population=5600) in Scotland. Three IHD health indicators-mortality rates (deaths per 100,000 population), rates of continuous hospital stays (discharges per 100,000 population), and rates of mortality in the hospital or within 28 days of discharge (MH+) were analyzed with multilevel Poisson models. A 4-level rurality classification was used: urban areas, remote small towns, accessible rural areas, and remote rural areas. RESULTS: Rates of mortality, continuous hospital stays, and MH+ increased with area socioeconomic deprivation. After adjustment for population age, gender, and deprivation, the relative risk of IHD mortality in remote rural areas was similar to that of urban areas in 1981; the relative risk of a continuous hospital stay was significantly lower (relative risk [RR] = 0.70; 95% confidence interval [CI] = 0.64, 0.76) and the relative risk of MH+ was higher (RR=1.18; 95% CI=1.04, 1.35) in remote rural areas. Mortality and MH+ declined for all ruralities over time. However, MH+ remains highest in remote rural areas and remote towns. CONCLUSIONS: Low standardized ratios of IHD continuous hospital stays and mortality in remote rural areas mask health problems among rural populations. Although absolute and relative differences between urban and rural rates of MH+ have diminished, the relative risk of MH+ remains high in remote rural areas.