The impact of place on suicidal behaviour

This chapter provides a rapid evidence review of empirical studies, from the UK and Republic of Ireland, that have examined associations between suicidal behaviour (suicide and non-fatal self harm) and area-level deprivation. Five electronic databases (Medline, Embase, PsycINFO, Social Sciences Citation Index and EconLit) were searched from 2005 to 2015. Eighteen studies were included; one was a cohort study, eight were repeat cross-sectional studies and nine were cross sectional studies. Overall, these studies found a strong association between area-level deprivation and suicidal behaviour: as area-level deprivation increased, so did suicidal behaviour. The chapter contextualises these results by applying insights from the wider geographical literature about health and place, leading to the identification of potential mechanisms (‘suicidogenic’ pathways) underpinning the association between area-level deprivation and suicidal behaviour. These mechanisms include compositional factors (the characteristics of people living in deprived areas, such as marital status) and contextual factors (the nature of the places themselves, such as the social environment). It concludes by reflecting on the implications for policy, practice and research, suggesting that, as there is a socio-spatial gradient in suicidal behaviours, every local area should have a suicide prevention strategy and action plan and that deprived areas should have additional support via a proportionate universalism approach to reducing geographical inequalities in suicide

Defying the odds: A mixed-methods study of health resilience in deprived areas of England

Previous studies have identified an area-level association between socio-economic deprivation and poorer population health. However, some recent studies have suggested that some areas exhibit better health outcomes than would be expected given their level of deprivation. This has been conceptualised in terms of 'health resilience'. This study is the first to explore area-level 'health resilience' at different geographical scales and by using mixed-methods. Regression Tree Classification was used to identify local areas (Local Authority Districts and Census Area Statistical Wards) in England that performed relatively well in terms of mortality (premature mortality 1998-2003) or morbidity (2001 Census measures of self-reported general and limiting long-term illness) despite experiencing long term deprivation (Townsend scores 1971-2001). Five Local Authority Districts (LADs) and 90 Census Area Statistical Wards (CASWARDS) exhibited 'health resilience' in terms of self-reported health, three LADs and 88 CASWARDS for limiting long-term illness, and three LADs and 62 CASWARDS for premature mortality. Potential mechanisms underpinning this resilience were explored using focus groups and in-depth interviews in one case study area in the North East of England. This suggested that for this case study area, place attachment, the natural environment and social capital may have played a role in mediating the detrimental health effects of long term deprivation. The study concludes by exploring the implications of these findings within the context of the study limitations and by outlining future avenues for research and policy

Area-level socioeconomic disadvantage and suicidal behaviour in Europe: a systematic review

The relationship between adverse individual socio-economic circumstances and suicidal behaviour is well established. However, the impact of adverse collective circumstances - such as the socio-economic context where people live - is less well understood. This systematic review explores the extent to which area-level socioeconomic disadvantage is associated with inequalities in suicidal behaviour and self-harm in Europe. We performed a systematic review (in MEDLINE, Embase, PsycINFO, EconLit and Social Sciences Citation Index) from 2005 to 2015. Observational studies were included if they were based in Europe and had a primary suicidal behaviour and self-harm outcome, compared at least two areas, included an area-level measure of socio-economic disadvantage and were published in the English language. The review followed The Joanna Briggs Institute guidelines for quality appraisal. We identified 27 studies (30 papers) from 14 different European countries. There was a significant association (in 25/27 studies, all of which were rated as of medium or high quality) between socioeconomic disadvantage and suicidal behaviour (and self-harm), particularly for men, and this was a consistent finding across a variety of European countries. Socio-economic disadvantage was found to have an independent effect in several studies whilst others found evidence of mediating contextual and compositional factors. There is strong evidence of an association between suicidal behaviours (and self-harm) and area-level socio-economic disadvantage in Europe, particularly for men. Suicide prevention strategies should take this into account.

Smarter choices ?changing the way we travel. Case study reports

This report accompanies the following volume:Cairns S, Sloman L, Newson C, Anable J, Kirkbride A and Goodwin P (2004)Smarter Choices ? Changing the Way We Travel. Report published by theDepartment for Transport, London, available via the ?Sustainable Travel? section ofwww.dft.gov.uk, and from http://eprints.ucl.ac.uk/archive/00001224/

Smarter choices - changing the way we travel

Summary: In recent years, there has been growing interest in a range of initiatives, which are now widelydescribed as 'soft' transport policy measures. These seek to give better information and opportunities,aimed at helping people to choose to reduce their car use while enhancing the attractiveness ofalternatives. They are fairly new as part of mainstream transport policy, mostly relativelyuncontroversial, and often popular. They include:. Workplace and school travel plans;. Personalised travel planning, travel awareness campaigns, and public transport information andmarketing;. Car clubs and car sharing schemes;. Teleworking, teleconferencing and home shopping.This report draws on earlier studies of the impact of soft measures, new evidence from the UK andabroad, case study interviews relating to 24 specific initiatives, and the experience of commercial,public and voluntary stakeholders involved in organising such schemes. Each of the soft factors isanalysed separately, followed by an assessment of their combined potential impact.The assessment focuses on two different policy scenarios for the next ten years. The 'high intensity'scenario identifies the potential provided by a significant expansion of activity to a much morewidespread implementation of present good practice, albeit to a realistic level which still recognisesthe constraints of money and other resources, and variation in the suitability and effectiveness of softfactors according to local circumstances. The 'low intensity' scenario is broadly defined as aprojection of the present (2003-4) levels of local and national activity on soft measures.The main features of the high intensity scenario would be. A reduction in peak period urban traffic of about 21% (off-peak 13%);. A reduction of peak period non-urban traffic of about 14% (off-peak 7%);. A nationwide reduction in all traffic of about 11%.These projected changes in traffic levels are quite large (though consistent with other evidence onbehavioural change at the individual level), and would produce substantial reductions in congestion.However, this would tend to attract more car use, by other people, which could offset the impact ofthose who reduce their car use unless there are measures in place to prevent this. Therefore, thoseexperienced in the implementation of soft factors locally usually emphasise that success depends onsome or all of such supportive policies as re-allocation of road capacity and other measures toimprove public transport service levels, parking control, traffic calming, pedestrianisation, cyclenetworks, congestion charging or other traffic restraint, other use of transport prices and fares, speedregulation, or stronger legal enforcement levels. The report also records a number of suggestionsabout local and national policy measures that could facilitate the expansion of soft measures.The effects of the low intensity scenario, in which soft factors are not given increased policy prioritycompared with present practice, are estimated to be considerably less than those of the high intensityscenario, including a reduction in peak period urban traffic of about 5%, and a nationwide reductionin all traffic of 2%-3%. These smaller figures also assume that sufficient other supporting policies areused to prevent induced traffic from eroding the effects, notably at peak periods and in congestedconditions. Without these supportive measures, the effects could be lower, temporary, and perhapsinvisible.Previous advice given by the Department for Transport in relation to multi-modal studies was that softfactors might achieve a nationwide traffic reduction of about 5%. The policy assumptionsunderpinning this advice were similar to those used in our low intensity scenario: our estimate isslightly less, but the difference is probably within the range of error of such projections.The public expenditure cost of achieving reduced car use by soft measures, on average, is estimated atabout 1.5 pence per car kilometre, i.e. £15 for removing each 1000 vehicle kilometres of traffic.Current official practice calculates the benefit of reduced traffic congestion, on average, to be about15p per car kilometre removed, and more than three times this level in congested urban conditions.Thus every £1 spent on well-designed soft measures could bring about £10 of benefit in reducedcongestion alone, more in the most congested conditions, and with further potential gains fromenvironmental improvements and other effects, provided that the tendency of induced traffic to erodesuch benefits is controlled. There are also opportunities for private business expenditure on some softmeasures, which can result in offsetting cost savings.Much of the experience of implementing soft factors is recent, and the evidence is of variable quality.Therefore, there are inevitably uncertainties in the results. With this caveat, the main conclusion isthat, provided they are implemented within a supportive policy context, soft measures can besufficiently effective in facilitating choices to reduce car use, and offer sufficiently good value formoney, that they merit serious consideration for an expanded role in local and national transportstrategy.AcknowledgementsWe gratefully acknowledge the many contributions made by organisations and individuals consultedas part of the research, and by the authors of previous studies and literature reviews which we havecited. Specific acknowledgements are given at the end of each chapter.We have made extensive use of our own previous work including research by Lynn Sloman funded bythe Royal Commission for the Exhibition of 1851 on the traffic impact of soft factors and localtransport schemes (in part previously published as 'Less Traffic Where People Live'); and by SallyCairns and Phil Goodwin as part of the research programme of TSU supported by the Economic andSocial Research Council, and particularly research on school and workplace travel plans funded bythe DfT (and managed by Transport 2000 Trust), on car dependence funded by the RAC Foundation,on travel demand analysis funded by DfT and its predecessors, and on home shopping funded byEUCAR. Case studies to accompany this report are available at: http://eprints.ucl.ac.uk/archive/00001233

Pole Dancing: 3D Morphs for Tree Drawings

We study the question whether a crossing-free 3D morph between two straight-line drawings of an $n$-vertex tree can be constructed consisting of a small number of linear morphing steps. We look both at the case in which the two given drawings are two-dimensional and at the one in which they are three-dimensional. In the former setting we prove that a crossing-free 3D morph always exists with $O(\log n)$ steps, while for the latter $\Theta(n)$ steps are always sufficient and sometimes necessary.Comment: Appears in the Proceedings of the 26th International Symposium on Graph Drawing and Network Visualization (GD 2018

Tackling inequalities in obesity: a protocol for a systematic review of the effectiveness of public health interventions at reducing socioeconomic inequalities in obesity among adults

Background: Socioeconomic inequalities in obesity and associated risk factors for obesity are widening throughout developed countries worldwide. Tackling obesity is high on the public health agenda both in the United Kingdom and internationally. However, what works in terms of interventions that are able to reduce inequalities in obesity is lacking. Methods/Design: The review will examine public health interventions at the individual, community and societal level that might reduce inequalities in obesity among adults aged 18 years and over, in any setting and in any country. The following electronic databases will be searched: MEDLINE, EMBASE, CINAHL, PsycINFO, Social Science Citation Index, ASSIA, IBSS, Sociological Abstracts, and the NHS Economic Evaluation Database. Database searches will be supplemented with website and gray literature searches. No studies will be excluded based on language, country or publication date. Randomized and non-randomized controlled trials, prospective and retrospective cohort studies (with/without control groups) and prospective repeat cross-sectional studies (with/without control groups) that have a primary outcome that is a proxy for body fatness and have examined differential effects with regard to socioeconomic status (education, income, occupation, social class, deprivation, poverty) or where the intervention has been targeted specifically at disadvantaged groups or deprived areas will be included. Study inclusion, data extraction and quality appraisal will be conducted by two reviewers. Meta-analysis and narrative synthesis will be conducted. The main analysis will examine the effects of 1) individual, 2) community and 3) societal level public health interventions on socioeconomic inequalities in adult obesity. Interventions will be characterized by their level of action and their approach to tackling inequalities. Contextual information on how such public health interventions are organized, implemented and delivered will also be examined. Discussion: The review will provide evidence, and reveal any gaps in the evidence base, of public health strategies which reduce and prevent inequalities in the prevalence of obesity in adults and provide information on the organization, implementation and delivery of such interventions. Systematic review registration: PROSPERO registration number: CRD4201300361

Results from the third Scottish National Prevalence Survey: is a population health approach now needed to prevent healthcare-associated infections?

Summary Background Healthcare associated infections (HAI) are a major public health concern and a significant cause of morbidity and mortality. A robust and current evidence base that is specific to local, national and Europe-wide settings is necessary to inform the development of strategies to reduce HAI and contain antimicrobial resistance (AMR). Aim To measure the prevalence of HAI and antimicrobial prescribing and identify key priority areas for interventions to reduce the burden of infection. Methods A national rolling PPS in National Health Service (NHS) acute, NHS non-acute, NHS paediatric and independent hospitals was carried out between September and November 2016 using the European Centre for Disease Prevention and Control protocol designed for the European PPS. Findings The prevalence of HAI was 4.6%, 2.7% and 3.2% in acute adults, paediatric and non-acute patient groups, respectively. The most common HAI types reported in adult patients were urinary tract infection and pneumonia. The prevalence of antimicrobial prescribing was 35.7%, 29.3% and 13.8% in acute adults, paediatric and non-acute patient groups, respectively. Respiratory, skin and soft tissue, gastrointestinal and urinary tract infections were the most common infections being treated at the time of survey. Conclusion HAI continues to be a public health concern in Scotland. UTI and pneumonia continue to place a significant burden on patients and on healthcare delivery, including those that develop in the community and require hospital admission. A broader population health approach which focuses on reducing the risk of infection upstream would reduce these infections in both community and hospital settings

Simultaneous multi-frequency single-pulse properties of AXP XTE J1810-197

We have used the 76-m Lovell, 94-m equivalent WSRT and 100-m Effelsberg radio telescopes to investigate the simultaneous single-pulse properties of the radio emitting magnetar AXP XTE J1810-197 at frequencies of 1.4, 4.8 and 8.35 GHz during May and July 2006. We study the magnetar's pulse-energy distributions which are found to be very peculiar as they are changing on time-scales of days and cannot be fit by a single statistical model. The magnetar exhibits strong spiky single giant-pulse-like subpulses, but they do not fit the definition of the giant pulse or giant micropulse phenomena. Measurements of the longitude-resolved modulation index reveal a high degree of intensity fluctuations on day-to-day time-scales and dramatic changes across pulse phase. We find the frequency evolution of the modulation index values differs significantly from what is observed in normal radio pulsars. We find that no regular drifting subpulse phenomenon is present at any of the observed frequencies at any observing epoch. However, we find a quasi-periodicity of the subpulses present in the majority of the observing sessions. A correlation analysis indicates a relationship between components from different frequencies. We discuss the results of our analysis in light of the emission properties of normal radio pulsars and a recently proposed model which takes radio emission from magnetars into consideration.Comment: 15 pages, 11 figures, accepted for publication by MNRA

The Commission and Its Report: Public Education, Advocacy and Lobbying

Mr. Harris: The question concerning the justification of commissions of inquiry has been raised in the preceding discussions. If their sole justification is having the bulk of their recommendations implemented, the institution probably would have died out long ago. Nevertheless, it must be of considerable concern to commissioners that the record has not been good in terms of implementation and one of the questions that perhaps will determine how successful commissions are in this respect has to do with what happens when the report is delivered and thereafter. These questions will be largely the subject of the panel that we are about to present. You will not be treated to profound, scholarly papers on policy analysis or anything like that in this panel. There will be practical comments and suggestions