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Biomedical subjects

Alastair H Leyland

Publications and source records attributed to Alastair H Leyland.

12 recordsLinked to original sources
PubMed2006

Effects of Sure Start local programmes on children and families: early findings from a quasi-experimental, cross sectional study.

OBJECTIVE: To evaluate the effects of Sure Start local programmes (SSLPs) on children and their families. To assess whether variations in the effectiveness of SSLPs are due to differences in implementation. DESIGN: Quasi-experimental cross sectional study using interviews with mothers and cognitive assessment of children aged 36 months who speak English. SETTING: Socially deprived communities in England: 150 communities with ongoing SSLPs and 50 comparison communities. PARTICIPANTS: Mothers of 12,575 children aged 9 months and 3927 children aged 36 months in SSLP areas; mothers of 1509 children aged 9 months and 1101 children aged 36 months in comparison communities. OUTCOME MEASURES: Mothers' reports of community services and local area, family functioning and parenting skills, child health and development, and verbal ability at 36 months. RESULTS: Differences between SSLP areas and comparison areas were limited, small, and varied by degree of social deprivation. SSLPs had beneficial effects on non-teenage mothers (better parenting, better social functioning in children) and adverse effects on children of teenage mothers (poorer social functioning) and children of single parents or parents who did not work (lower verbal ability). SSLPs led by health services were slightly more effective than other SSLPs. CONCLUSION: SSLPs seem to benefit relatively less socially deprived parents (who have greater personal resources) and their children but seem to have an adverse effect on the most disadvantaged children. Programmes led by health services seem to be more effective than programmes led by other agencies.

Child Development↗
PubMed2006

Homicides involving knives and other sharp objects in Scotland, 1981-2003.

BACKGROUND: Homicide rates have been increasing in Scotland, and homicides involving knives are of particular concern. METHODS: and results We use mortality and population data from 1981 to 2003 to calculate smoothed, standardized mortality rates for all homicides and homicides involving knives and other sharp objects, for all of Scotland and separately for Glasgow. Over half of homicides where the victim was male involved the use of a knife. Over 20 years, the homicide rate rose 83%, whilst that involving knives increased by 164%. CONCLUSION: The rapid increase in homicide involving knives is becoming a public health problem. Proposed changes to legislation are unlikely to halt this rise.

Adolescent↗
PubMed2006

Spatial clustering of mental disorders and associated characteristics of the neighbourhood context in Malmö, Sweden, in 2001.

STUDY OBJECTIVE: Previous research provides preliminary evidence of spatial variations of mental disorders and associations between neighbourhood social context and mental health. This study expands past literature by (1) using spatial techniques, rather than multilevel models, to compare the spatial distributions of two groups of mental disorders (that is, disorders due to psychoactive substance use, and neurotic, stress related, and somatoform disorders); and (2) investigating the independent impact of contextual deprivation and neighbourhood social disorganisation on mental health, while assessing both the magnitude and the spatial scale of these effects. DESIGN: Using different spatial techniques, the study investigated mental disorders due to psychoactive substance use, and neurotic disorders. PARTICIPANTS: All 89,285 persons aged 40-69 years residing in Malmö, Sweden, in 2001, geolocated to their place of residence. MAIN RESULTS: The spatial scan statistic identified a large cluster of increased prevalence in a similar location for the two mental disorders in the northern part of Malmö. However, hierarchical geostatistical models showed that the two groups of disorders exhibited a different spatial distribution, in terms of both magnitude and spatial scale. Mental disorders due to substance consumption showed larger neighbourhood variations, and varied in space on a larger scale, than neurotic disorders. After adjustment for individual factors, the risk of substance related disorders increased with neighbourhood deprivation and neighbourhood social disorganisation. The risk of neurotic disorders only increased with contextual deprivation. Measuring contextual factors across continuous space, it was found that these associations operated on a local scale. CONCLUSIONS: Taking space into account in the analyses permitted deeper insight into the contextual determinants of mental disorders.

Adult↗
PubMed2005

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.

Aged↗
PubMed2005

Does the primary school attended influence self-reported health or its risk factors in later life? Aberdeen Children of the 1950s Study.

BACKGROUND: Adult health and its determinants are influenced by the environment in childhood. The school attended is known to affect the health behaviours of pupils while still at school. Little is known about the long-term influence of school attended on health. METHODS: A total of 7,095 respondents (mean age 47 years) to a follow-up questionnaire who attended primary school in Aberdeen, UK, provided information on self-reported health; self-reported high blood pressure; GHQ-4; smoking status; alcohol intake; and obesity. Variance partition coefficients (VPCs) summarized the variation in adult health outcomes and behaviours across schools. Multilevel logistic regression was used to estimate the contribution of school to variation in the outcomes taking into account individual-level and school-level factors. RESULTS: There was some variation across schools in the proportion of adults reporting poor self-rated health (VPC = 0.020) and smoking (0.019). Higher VPCs were found for factors potentially confounded with school: paternal social classes (I&II) (0.45) and gender (0.44). Age at leaving secondary education (0.28) and income (0.10) varied across schools. The effects of primary school diminished after adjusting for individual-level childhood risk factors. The further addition of adult risk factors attenuated these childhood effects. After full adjustment there was no effect of the primary school attended for high blood pressure, current smoking, alcohol intake, and obesity, and negligible effects for the other outcomes. CONCLUSIONS: Contrary to our expectations, we found little evidence of any relationship between primary school and adult self-reported health or behaviour. This is surprising given the extent to which characteristics known to be associated with adult health were clustered within schools.

Alcohol Drinking↗
PubMed2005

A comparison of health inequalities in urban and rural Scotland.

Previous research suggests that there are significant differences in health between urban and rural areas. Health inequalities between the deprived and affluent in Scotland have been rising over time. The aim of this study was to examine health inequalities between deprived and affluent areas of Scotland for differing ruralities and look at how these have changed over time. Postcode sectors in Scotland were ranked by deprivation and the 20% most affluent and 20% most deprived areas were found using the Carstairs indicator and male unemployment. Scotland was then split into 4 rurality types. Ratios of health status between the most deprived and most affluent areas were investigated using all cause mortality for the Scottish population, 1979-2001. These were calculated over time for 1979-1983, 1989-1993, 1998-2001. Multilevel Poisson modelling was carried out for all of Scotland excluding Grampian to assess inequalities in the population. There was an increase in inequalities between 1981 and 2001, which was greatest in remote rural Scotland for both males and females; however, male health inequalities remained higher in urban areas throughout this period. In 2001 female health inequalities were higher in remote rural areas than urban areas. Health inequalities amongst the elderly (age 65+) in 2001 were greater in remote rural Scotland than urban areas for both males and females.

Adult↗
PubMed2005

Urban/rural inequalities in suicide in Scotland, 1981-1999.

Although suicide accounts for a small percentage of deaths in Scotland (1.4% in 1999), it has been steadily increasing over the last two decades. In the US, Australia, England and Wales the greatest rises in suicide for this time period, occurred in rural areas. This study describes the pattern and magnitude of urban/rural variation in suicide in Scotland, examines methods of suicide within differing geographies and looks at trends in suicides over time. Scotland is split into four rurality types. Suicide data for all areas of Scotland (apart from Grampian which underwent changes in postcode sector boundaries in 1996) are investigated using Standardised Mortality Ratios (SMRs) and multilevel Poisson modelling, adjusting for age, sex and deprivation. SMRs for 1981-85, 1989-93 and 1995-99 are created across the four geographies, using the populations of Scotland in 1983, 1991 and 1997 as the standard populations (SMR=100). The highest rates in 1995-99 are seen in "remote rural" areas, SMR=125 (95% confidence interval 107-146). Models adjusted for age and deprivation show significantly greater risk of male suicide in remote rural areas relative to urban areas and significantly lower risk of female suicide in accessible rural areas. The method of suicide varies across ruralities for both males and females. The study considers how the relationship between suicides and rurality varies over time and how methods of suicide vary across different ruralities. The steepest rises in suicide amongst men, adjusting for age and deprivation, were seen to occur in accessible rural areas, however highest rates remain in remote rural areas.

Adult↗
PubMed2005

Socioeconomic gradients in the prevalence of cardiovascular disease in Scotland: the roles of composition and context.

OBJECTIVE: To investigate whether occupational social class and area deprivation are independently associated with the prevalence of cardiovascular disease (CVD) conditions after adjustment for smoking status. DESIGN: Stratified multistage random sample analysed using multilevel logistic regression. PARTICIPANTS: 8804 adults aged 18-74 at time of interview in 1998-1999, clustered in 312 small areas. The outcome considered was a self report of doctor diagnosis of one of a number of CVD conditions. The survey also provided information concerning the respondent's occupational social class and current smoking status. The Carstairs score (based on the 1991 census) was used to describe small area deprivation. MAIN RESULTS: The gradient in CVD prevalence across individual social class was attenuated and became insignificant when area deprivation was considered. The aggregation of individual social class and smoking to the area level increased the correlation with disease prevalence at the individual level. CONCLUSIONS: Although there is a relation between socioeconomic status and CVD prevalence in Scotland, the relation is dominated by area deprivation. When externally validated deprivation measures are not available, aggregated individual characteristics may show a contextual (as compared with compositional) relation.

Adolescent↗
PubMed2005

Empirical Bayes methods for disease mapping.

This paper reviews empirical Bayes methods for disease mapping. A distinction is made between spatial models (which take into account the geographical distribution of disease) and nonspatial models. Several estimators are presented, and methods of estimation are described. Empirical Bayes methods are compared with full Bayes methods, and we argue that both have their place.

Algorithms↗
PubMed2003

Multilevel modelling and public health policy.

BACKGROUND: Multilevel modelling is a statistical technique that extends ordinary regression analysis to the situation where the data are hierarchical. Such data form an increasingly common evidence base for public health policy, and as such it is important that policy makers should be aware of this methodology. METHOD: This paper therefore lays out the a basic description of multilevel modelling, discusses the problems of alternative approaches, and details the relevance for public health policy before describing which levels are relevant and illustrating the different kinds of hypotheses that can be tested using multilevel modelling. A series of examples is used throughout the paper. These relate to regional variations in the incidence of heart disease, the allocation of health resources, the relationship between neighbourhood disorder and mental health, the demand-control model in occupational health, and a school intervention to prevent cardiovascular disease.

Community Health Services↗