The 'manufacture' of mental defectives in late nineteenth and early twentieth century Scotland

There has recently been a proliferation of historical studies of mental deficiency in late nineteenth and early twentieth century England, exploring the subject within its administrative, medical, educational and social contexts. This thesis contributes to the history of mental deficiency by describing developments that took place in Scotland. It focuses on the sharp increase in the proportion of the Scottish population labelled mentally defective during the period. This increase can be ascribed to the implementation of state policies geared towards the identification and segregation of mental defectives, but it also reflects a tendency amongst influential professional groups (notably, doctors and teachers) to broaden their definition of mental deficiency to include more people of higher ability. People were labelled mentally defective who would not have been regarded as such in earlier years; as one contemporary put it, 'the present policy tends to manufacture mental defectives'. This broadening of definitions occurred within the context of the Poor Law and lunacy administrations, but an analysis of quantitative and qualitative source material shows that it was within the state education system that most of Scotland's mental defectives were initially identified and segregated from their peers. The thesis also describes how various forms of segregated provision for mental defectives developed and expanded in Scotland over the period, taking into account special education, institutionalisation, boarding-out and other community-based forms of care and supervision. Finally, the roles of mental defectives and their families are considered, illustrating how they could influence mental deficiency provision through acts of co-operation and resistance, but also how their influence waned as the state assumed greater powers to intervene in the private lives of its citizens

How do systematic reviews incorporate risk of bias assessments into the synthesis of evidence? A methodological study

Background: Systematic reviews (SRs) are expected to critically appraise included studies and privilege those at lowest risk of bias (RoB) in the synthesis. This study examines if and how critical appraisals inform the synthesis and interpretation of evidence in SRs.<p></p> Methods: All SRs published in March–May 2012 in 14 high-ranked medical journals and a sample from the Cochrane library were systematically assessed by two reviewers to determine if and how: critical appraisal was conducted; RoB was summarised at study, domain and review levels; and RoB appraisals informed the synthesis process.<p></p> Results: Of the 59 SRs studied, all except six (90%) conducted a critical appraisal of the included studies, with most using or adapting existing tools. Almost half of the SRs reported critical appraisal in a manner that did not allow readers to determine which studies included in a review were most robust. RoB assessments were not incorporated into synthesis in one-third (20) of the SRs, with their consideration more likely when reviews focused on randomised controlled trials. Common methods for incorporating critical appraisals into the synthesis process were sensitivity analysis, narrative discussion and exclusion of studies at high RoB. Nearly half of the reviews which investigated multiple outcomes and carried out study-level RoB summaries did not consider the potential for RoB to vary across outcomes.<p></p> Conclusions: The conclusions of the SRs, published in major journals, are frequently uninformed by the critical appraisal process, even when conducted. This may be particularly problematic for SRs of public health topics that often draw on diverse study designs

Neighbourhood demolition, relocation and health: a qualitative longitudinal study of housing-led urban regeneration in Glasgow, UK

We conducted a qualitative longitudinal study to explore how adult residents of disadvantaged urban neighbourhoods (Glasgow, UK) experienced neighbourhood demolition and relocation. Data from 23 households was collected in 2011 and 2012. Some participants described moves to new or improved homes in different neighbourhoods as beneficial to their and their families’ wellbeing. Others suggested that longstanding illnesses and problems with the new home and/or neighbourhood led to more negative experiences. Individual-level contextual differences, home and neighbourhood-level factors and variations in intervention implementation influence the experiences of residents involved in relocation programmes

Examining local processes when applying a cumulative impact policy to address harms of alcohol outlet density.

One approach to addressing the negative health and social harms of excessive drinking has been to attempt to limit alcohol availability in areas of high outlet density. The Licensing Act (2003) enables English local authorities the power to implement a Cumulative Impact Policy (CIP) in order to tackle alcohol challenges. More than 100 English local authorities have implemented a CIP in one or more designated areas. We examined local licence decision-making in the context of implementing CIPs. Specifically, we explored the activities involved in alcohol licensing in one London local authority in order to explicate how local decision-making processes regarding alcohol outlet density occur. Institutional ethnographic research revealed that CIPs were contested on multiple grounds within the statutory licensing process of a local authority with this policy in place. CIPs are an example of multi-level governance in which national and local interests, legal powers and alcohol licensing priorities interface. Public health priorities can be advanced in the delivery of CIPs, but those priorities can at times be diluted by those of other stakeholders, both public sector and commercial

House of Lords: Revised transcript of evidence taken beforeThe Select Committee on National Policy for the Built Environment

The document is a transcript of evidence taken before The Select Committee on National Policy for the Built Environment Inquiry on BUILT ENVIRONMENT. The three Witnesses were: Dr Laurence Carmichael, Co-ordinator, WHO Collaborating Centre for Healthy Urban Environments, Dr Ann Marie Connolly, Director of Health Equity and Impact, Public Health England, and Dr Matt Egan, Senior Lecturer, London School of Hygiene and Tropical Medicine

Consequences of removing cheap, super-strength beer and cider: a qualitative study of a UK local alcohol availability intervention.

OBJECTIVES: Increasingly, English local authorities have encouraged the implementation of an intervention called 'Reducing the Strength' (RtS) whereby off-licences voluntarily stop selling inexpensive 'super-strength' (≥6.5% alcohol by volume (ABV)) beers and ciders. We conceptualised RtS as an event within a complex system in order to identify pathways by which the intervention may lead to intended and unintended consequences. DESIGN: A qualitative study including a focus group and semistructured interviews. SETTING: An inner-London local authority characterised by a high degree of residential mobility, high levels of social inequality and a large homeless population. Intervention piloted in three areas known for street drinking with a high alcohol outlet density. PARTICIPANTS: Alcohol service professionals, homeless hostel employees, street-based services managers and hostel dwelling homeless alcohol consumers (n=30). RESULTS: Participants describe a range of potential substitution behaviours to circumvent alcohol availability restrictions including consuming different drinks, finding alternative shops, using drugs or committing crimes to purchase more expensive drinks. Service providers suggested the intervention delivered in this local authority missed opportunities to encourage engagement between the council, alcohol services, homeless hostels and off-licence stores. Some participants believed small-scale interventions such as RtS may facilitate new forms of engagement between public and private sector interests and contribute to long-term cultural changes around drinking, although they may also entrench the view that 'problem drinking' only occurs in certain population groups. CONCLUSIONS: RtS may have limited individual-level health impacts if the target populations remain willing and able to consume alternative means of intoxication as a substitute for super-strength products. However, RtS may also lead to wider system changes not directly related to the consumption of super-strengths and their assumed harms

Comparing the effectiveness of using generic and specific search terms in electronic databases to identify health outcomes for a systematic review: a prospective comparative study of literature search methods

<p>Objective: To compare the effectiveness of systematic review literature searches that use either generic or specific terms for health outcomes.</p> <p>Design Prospective comparative study of two electronic literature search strategies. The 'generic' search included general terms for health such as 'adolescent health', 'health status', 'morbidity', etc. The 'specific' search focused on terms for a range of specific illnesses, such as 'headache', 'epilepsy’, 'diabetes mellitus', etc.</p> <p>Data: sources The authors searched Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO and the Education Resources Information Center for studies published in English between 1992 and April 2010.</p> <p>Main: outcome measures Number and proportion of studies included in the systematic review that were identified from each search.</p> <p>Results: The two searches tended to identify different studies. Of 41 studies included in the final review, only three (7%) were identified by both search strategies, 21 (51%) were identified by the generic search only and 17 (41%) were identified by the specific search only. 5 of the 41 studies were also identified through manual searching methods. Studies identified by the two ELS differed in terms of reported health outcomes, while each ELS uniquely identified some of the review's higher quality studies.</p> <p>Conclusions: Electronic literature searches (ELS) are a vital stage in conducting systematic reviews and therefore have an important role in attempts to inform and improve policy and practice with the best available evidence. While the use of both generic and specific health terms is conventional for many reviewers and information scientists, there are also reviews that rely solely on either generic or specific terms. Based on the findings, reliance on only the generic or specific approach could increase the risk of systematic reviews missing important evidence and, consequently, misinforming decision makers. However, future research should test the generalisability of these findings.</p&gt

Applying a Systems Perspective to Preventive Health: How Can It Be Useful? Comment on "What Can Policy-Makers Get Out of Systems Thinking? Policy Partners' Experiences of a Systems-Focused Research Collaboration in Preventive Health".

Advocates suggest that a paradigm shift in preventive health towards systems thinking is desirable and may be underway. In a recent study of policy-makers' opinions, Haynes and colleagues found a mixed response to an Australian initiative that sought to apply systems theories and associated methods to preventive health. Some were enthusiastic about systems, but others were concerned or unconvinced about its usefulness. This commentary responds to such concerns. We argue that a systems perspective can help provide policy-makers with timely evidence to inform decisions about intervention planning and delivery. We also suggest that research applying a systems perspective could provide policy-makers with evidence to support planning and incremental decision-making; make recommendations to support intervention adaptability; consider potential barriers due to incoherent systems, and consider the political consequences of interventions

Healthy Migrants in an Unhealthy City? The Effects of Time on the Health of Migrants Living in Deprived Areas of Glasgow.

This paper examines the healthy immigrant effect in Glasgow, a post-industrial city where the migrant population has more than doubled in the last decade. Using data from a community survey in 15 communities across the city, the paper compares four health outcomes for the following three groups: British-born, social and economic migrants and asylum seekers and refugees. Migrants were found to be healthier than the indigenous population on all four measures, particularly in the case of adult households in both migrant groups and for older asylum seeker and refugee households. Health declines for social and economic migrants with time spent in the UK, but there is no clear pattern for asylum seekers and refugees. Health declined for refugees according to time spent awaiting a decision, whilst their health improved after a leave-to-remain decision. Indigenous and social and economic migrant health declines with time spent living in a deprived area; this was true for three health indicators for the former and two indicators for the latter. Asylum seekers and refugees who had lived in a deprived area for more than a year had slightly better self-rated health and well-being than recent arrivals. The study's findings highlight the role of destination city and neighbourhood in the health immigrant effect, raise concerns about the restrictions placed upon asylum seekers and the uncertainty afforded to refugees and suggest that spatial concentration may have advantages for asylum seekers and refugees

Neighbourhood demolition, relocation and health. A qualitative longitudinal study of housing-led urban regeneration in Glasgow, UK.

We conducted a qualitative longitudinal study to explore how adult residents of disadvantaged urban neighbourhoods (Glasgow, UK) experienced neighbourhood demolition and relocation. Data from 23 households was collected in 2011 and 2012. Some participants described moves to new or improved homes in different neighbourhoods as beneficial to their and their families' wellbeing. Others suggested that longstanding illnesses and problems with the new home and/or neighbourhood led to more negative experiences. Individual-level contextual differences, home and neighbourhood-level factors and variations in intervention implementation influence the experiences of residents involved in relocation programmes