Does labour market disadvantage help to explain why childhood circumstances are related to quality of life at older ages? Results from SHARE

There is robust evidence that childhood circumstances are related to quality of life in older ages, but the role of possible intermediate factors is less explored. In this paper, we examine to what extent associations between deprived childhood circumstances and quality of life at older ages are due to experienced labour market disadvantage during adulthood. Analyses are based on the Survey of Health Ageing and Retirement in Europe (SHARE), with detailed retrospective information on individual life courses collected among 10,272 retired men and women in 13 European countries (2008-2009). Our assumption is that those who have spent their childhood in deprived circumstances may also have had more labour market disadvantage with negative consequences for quality of life beyond working life. Results demonstrate that advantaged circumstances during childhood are associated with lower levels of labour market disadvantage and higher quality of life in older ages. Furthermore, results of multivariate analyses support the idea that part of the association between childhood circumstances and later quality of life is explained by labour market disadvantage during adulthood

Distribution of GPs in Scotland by age, gender and deprivation

General practice in the UK is widely reported to be in crisis, with particular concerns about recruitment and retention of family doctors. This study assessed the distribution of GPs in Scotland by age, gender and deprivation, using routinely available data. We found that there are more GPs (and fewer patients per GP) in the least deprived deciles than there are in the most deprived deciles. Furthermore, there are a higher proportion of older GPs in the most deprived deciles. There are also important gender differences in the distribution of GPs. We discuss the implications of these findings for policymakers and practitioners

Some social and physical correlates of intergenerational social mobility: evidence from the west of Scotland Collaborative Study

Mainstream sociological studies of intergenerational social mobility have emphasised social factors such as education and the material and cultural resources of the family of origin as the main influences on the chances and direction of social mobility. Medical sociology in contrast has been more interested in its physical correlates such as height and health status. Data from the West of Scotland Collaborative study allow an examination of the relationship between social mobility and both social and physical factors. Height, education and material circumstances in the family of origin, indexed as the number of siblings, were each independently associated with the chances of both upward and downward social mobility in this dataset. In each case the net effect of this social mobility was to constrain the social distribution of these variables. Any role which these factors may play in indirect health selection, it is argued, cannot account for social class differences in adult health

Adverse socioeconomic conditions in childhood and cause specific adult mortality: prospective observational study

<b>Objective:</b> To investigate the association between social circumstances in childhood and mortality from various causes of death in adulthood. Design: Prospective observational study. Setting: 27 workplaces in the west of Scotland. <b>Subjects:</b> 5645 men aged 35-64 years at the time of examination. <b>Main outcome measures:</b> Death from various causes. <b>Results:</b> Men whose fathers had manual occupations when they were children were more likely as adults to have manual jobs and be living in deprived areas. Gradients in mortality from coronary heart disease, stroke, lung cancer, stomach cancer, and respiratory disease were seen (all P<0.05), generally increasing from men whose fathers had professional and managerial occupations (social class I and II) to those whose fathers had semiskilled and unskilled manual occupations (social class IV and V). Relative rates of mortality adjusted for age for men with fathers in manual versus non-manual occupations were 1.52 (95% confidence interval 1.24 to 1.87) for coronary heart disease, 1.83 (1.13 to 2.94) for stroke, 1.65 (1.12 to 2.43) for lung cancer, 2.06 (0.93 to 4.57) for stomach cancer, and 2.01 (1.17 to 3.48) for respiratory disease. Mortality from other cancers and accidental and violent death showed no association with fathers' social class. Adjustment for adult socioeconomic circumstances and risk factors did not alter results for mortality from stroke and stomach cancer, attenuated the increased risk of coronary heart disease and respiratory disease, and essentially eliminated the association with lung cancer. <b>Conclusions:</b> Adverse socioeconomic circumstances in childhood have a specific influence on mortality from stroke and stomach cancer in adulthood, which is not due to the continuity of social disadvantage throughout life. Deprivation in childhood influences risk of mortality from coronary heart disease and respiratory disease in adulthood, although an additive influence of adulthood circumstances is seen in these cases. Mortality from lung cancer, other cancer, and accidents and violence is predominantly influenced by risk factors that are related to social circumstances in adulthood

Challenging the single-story narrative: a balanced learning and teaching of Africa

This practitioner research was designed to challenge the single story narrative that is frequently used to depict the African continent. Africa is often inaccurately presented as a single ‘country’ suffering from poverty, drought, corruption and reliant on aid. A new scheme of work, incorporating Africa into the Year 8 Development unit of the geography curriculum, was the focus of this academic intervention. The aims were to address the misconceptions and prejudicial understandings held by students about Africa, to explore the role of geography teachers in tackling the dangers of single stories, to highlight the importance of decolonising the content of the geography curriculum, and explore the extent to which students have developed a more balanced knowledge and understanding of Africa. Preliminary and post intervention surveys were completed by all Year 8 students. An unstructured interview was conducted with teachers in the geography department prior to the implementation of the intervention, whilst semi-structured interviews were conducted following the teaching of the new scheme of work. Unstructured interviews were also conducted with colleagues in the history and music departments to establish how they have started to decolonise their curricula. Semi-structured interviews were conducted with two small focus groups of students. Findings suggest that the geography teachers became more reflective about curriculum design and pedagogy. The post-intervention surveys provide evidence to suggest that most students developed their knowledge and understanding of Africa, whilst recognising the harmful impact that single stories may have on entrenching misconceptions

Interventions targeted at primary care practitioners to improve the identification and referral of patients with co-morbid obesity: a realist review protocol

<b>Background </b>Obesity is one of the most significant public health challenges in the developed world. Recent policy has suggested that more can be done in primary care to support adults with obesity. In particular, general practitioners (GPs) and practice nurses (PNs) could improve the identification and referral of adults with obesity to appropriate weight management services. Previous interventions targeted at primary care practitioners in this area have had mixed results, suggesting a more complex interplay between patients, practitioners, and systems. The objectives of this review are (i) to identify the underlying ‘programme theory’ of interventions targeted at primary care practitioners to improve the identification and referral of adults with obesity and (ii) to explore how and why GPs and PNs identify and refer individuals with obesity, particularly in the context of weight-related co-morbidity. This protocol will explain the rationale for using a realist review approach and outline the key steps in this process. <p></p> <b>Methods</b> Realist review is a theory-led approach to knowledge synthesis that provides an explanatory analysis aimed at discerning what works, for whom, in what circumstances, how, and why. In this review, scoping interviews with key stakeholders involved in the planning and delivery of adult weight management services in Scotland helped to inform the identification of formal theories - from psychology, sociology, and implementation science - that will be tested as the review progresses. A comprehensive search strategy is described, including scope for iterative searching. Data analysis is outlined in three stages (describing context-mechanism-outcome configurations, exploring patterns in these configurations, and developing and testing middle-range theories, informed by the formal theories previously identified), culminating in the production of explanatory programme theory that considers individual, interpersonal, and institutional/systems-level components. <p></p> <b>Discussion </b>This is the first realist review that we are aware of looking at interventions targeted at primary care practitioners to improve the weight management of adults with obesity. Engagement with stakeholders at an early stage is a unique feature of realist review. This shapes the scope of the review, identification of candidate theories and dissemination strategies. The findings of this review will inform policy and future interventions. Systematic review registration PROSPERO CRD4201400939

Poverty Safari: Understanding the Anger of Britain's Underclass

No abstract available

The role of primary care in adult weight management: qualitative interviews with key stakeholders in weight management services

Background: Primary care has a key role to play in the prevention and management of obesity, but there remain barriers to engagement in weight management by primary care practitioners. The aim of this study was to explore the views of key stakeholders in adult weight management services on the role of primary care in adult weight management. Methods: Qualitative study involving semi-structured interviews with nine senior dietitians involved in NHS weight management from seven Scottish health boards. Transcripts were analysed using an inductive thematic approach. Results: A range of tensions were apparent within three key themes: weight management service issues, the role of primary care, and communication with primary care. For weight management services, these tensions were around funding, the management model of obesity, and how to configure access to services. For primary care, they were around what primary care should be doing, who should be doing it, and where this activity should fit within wider weight management policy. With regard to communication between weight management services and primary care, there were tensions related to the approach taken (locally adapted versus centralised), the message being communicated (weight loss versus wellbeing), and the response from practitioners (engagement versus resistance). Conclusions: Primary care can do more to support adult weight management, but this requires better engagement and communication with weight management services, to overcome the tensions highlighted in this study. This, in turn, requires more secure, sustained funding. The example of smoking cessation in the UK, where there is a network of well-resourced NHS Stop Smoking Services, accessible via different means, could be a model to follow