Social class inequalities in perinatal outcomes: Scotland 1980–2000

Objective: To examine social class inequalities in adverse perinatal events in Scotland between 1980 and 2000 and how these were influenced by other maternal risk factors. Design: Population based study using routine maternity discharge data. Setting: Scotland. Participants: All women who gave birth to a live singleton baby in Scottish hospitals between 1980 and 2000 (n = 1 282 172). Main outcome measures: Low birth weight (LBW), preterm birth, and small for gestational age (SGA). Results: The distribution of social class changed over time, with the proportion of mothers with undetermined social class increasing from 3.9% in 1980–84 to 14.8% in 1995–2000. The relative index of inequality (RII) decreased during the 1980s for all outcomes. The RII then increased between the early and late 1990s (LBW from 2.09 (95%CI 1.97, 2.22) to 2.43 (2.29, 2.58), preterm from 1.52 (1.44, 1.61) to 1.75 (1.65, 1.86), and SGA from 2.28 (2.14, 2.42) to 2.49 (2.34, 2.66) respectively). Inequalities were greatest in married mothers, mothers aged over 35, mothers taller than 164 cm, and mothers with a parity of one or more. Inequalities were also greater by the end of the 1990s than at the start of the 1980s for women of parity one or more and for mothers who were not married. Conclusion: Despite decreasing during the 1980s, inequalities in adverse perinatal outcomes increased during the 1990s in all strata defined by maternal characteristics

Analysis of open loop higher harmonic control at high airspeeds on a modern four-bladed articulated rotor

The effects of open loop higher harmonic control (HHC) on rotor hub loads, performance, and push rod loads of a Sikorsky S-76 helicopter rotor at high airspeeds (up to 200 knots) and moderate lift (10,000 lbs) were studied analytically. The analysis was performed as part of a wind tunnel pre-test prediction and preparation procedure, as well as to provide analytical results for post-test correlation efforts. The test associated with this study is to be concluded in the 40- by 80-Foot Wind Tunnel of the National Full-Scale Aerodynamics Complex (NFAC) at the NASA Ames Research Center. The results from this analytical study show that benefits from HHC can be achieved at high airspeeds. These results clear the way for conducting (with the requirement of safe pushrod loads) an open loop HHC test a high airspeeds in the 40- by 80-Foot Wind Tunnel using an S-76 rotor as the test article

Do differences in the administrative structure of populations confound comparisons of geographic health inequalities?

<p>Background: Geographical health inequalities are naturally described by the variation in health outcomes between areas (e.g. mortality rates). However, comparisons made between countries are hampered by our lack of understanding of the effect of the size of administrative units, and in particular the modifiable areal unit problem. Our objective was to assess how differences in geographic and administrative units used for disseminating data affect the description of health inequalities.</p> <p>Methods: Retrospective study of standard populations and deaths aggregated by administrative regions within 20 European countries, 1990-1991. Estimated populations and deaths in males aged 0-64 were in 5 year age bands. Poisson multilevel modelling was conducted of deaths as standardised mortality ratios. The variation between regions within countries was tested for relationships with the mean region population size and the unequal distribution of populations within each country measured using Gini coefficients.</p> <p>Results: There is evidence that countries whose regions vary more in population size show greater variation and hence greater apparent inequalities in mortality counts. The Gini coefficient, measuring inequalities in population size, ranged from 0.1 to 0.5 between countries; an increase of 0.1 was accompanied by a 12-14% increase in the standard deviation of the mortality rates between regions within a country.</p> <p>Conclusions: Apparently differing health inequalities between two countries may be due to differences in geographical structure per se, rather than having any underlying epidemiological cause. Inequalities may be inherently greater in countries whose regions are more unequally populated.</p&gt

A comparison of the Scottish index of multiple deprivation (SIMD) 2004 with the 2009 + 1 SIMD: does choice of measure affect the interpretation of inequality in mortality?

Background There is a growing international literature assessing inequalities in health and mortality by area based measures. However, there are few works comparing measures available to inform research design. The analysis here seeks to begin to address this issue by assessing whether there are important differences in the relationship between deprivation and inequalities in mortality when measures that have been constructed at different time points are compared. Methods We contrast whether the interpretation of inequalities in all-cause mortality between the years 2008-10 changes in Scotland if we apply the earliest (2004) and the 2009 + 1 releases of the Scottish Index of Multiple Deprivation (SIMD) to make this comparison. The 2004 release is based on data from 2001/2 and the 2009 + 1 release is based on data from 2008/9. The slope index of inequality (SII) and 1:10 ratio are used to summarise inequalities standardised by age/sex using population and mortality records. Results The 1:10 ratio suggests some differences in the magnitude of inequalities measured using SIMD at different time points. However, the SII shows much closer correspondence. Conclusions Overall the findings show that substantive conclusions in relation to inequalities in all-cause mortality are little changed by the updated measure. This information is beneficial to researchers as the most recent measures are not always available. This adds to the body of literature showing stability in inequalities in health and mortality by geographical deprivation over time.</p

The impact on health of employment and welfare transitions for those receiving out-of-work disability benefits in the UK

Employment status has a dynamic relationship with health and disability. There has been a striking increase in the working age population receiving out-of-work disability benefits in many countries, including the UK. In response, recent UK welfare reforms have tightened eligibility criteria and introduced new conditions for benefit receipt linked to participation in return-to-work activities. Positive and negative impacts have been suggested but there is a lack of high quality evidence of the health impact when those receiving disability benefits move towards labour market participation. Using four waves of the UK’s Understanding Society panel survey (2009–2013) three different types of employment and welfare transition were analysed in order to identify their impact on health. A difference-in-difference approach was used to compare change between treatment and control groups in mental and physical health using the SF-12. To strengthen causal inference, sensitivity checks for common trends used pre-baseline data and propensity score matching. Transitions from disability benefits to employment (n = 124) were associated on average with an improvement in the SF12 mental health score of 5.94 points (95% CI = 3.52–8.36), and an improvement in the physical health score of 2.83 points (95% CI = 0.85–4.81) compared with those remaining on disability benefits (n = 1545). Transitions to unemployed status (n = 153) were associated with a significant improvement in mental health (3.14, 95% CI = 1.17–5.11) but not physical health. No health differences were detected for those who moved on to the new out-of-work disability benefit. It remains rare for disability benefit recipients to return to the labour market, but our results indicate that for those that do, such transitions may improve health, particularly mental health. Understanding the mechanisms behind this relationship will be important for informing policies to ensure both work and welfare are ‘good for health’ for this group

The impact of Sure Start Local Programmes on five year olds and their families

The ultimate goal of Sure Start Local Programmes (SSLPs) was to enhance the life chances for young children growing up in disadvantaged neighbourhoods. Children in these communities are at risk of doing poorly at school, having trouble with peers and agents of authority (i.e., parents, teachers), and ultimately experiencing compromised life chances. In this report children and families who were seen at 9 months and 3 years of age in the NESS or MCS longitudinal studies are compared to determine whether differences in child and family functioning found at 3 years of age persist until 5 years of age, and whether any other differences emerge

The impact of Sure Start local programmes on seven year olds and their families

This research report presents the findings of a longitudinal study into the impact of Sure Start local programmes (SSLPs) on 7-year-olds and their families. In assessing the impact of SSLPs on child and family functioning over time, the evaluation followed up over 5,000 7-year-olds and their families in 150 SSLP areas who were initially studied when the children were 9 months and 3- and 5-years-old

National evaluation of Sure Start local programmes: an economic perspective

The first 524 Sure Start local programmes (SSLPs) were established between 1999 and 2003. They were aimed at families with children up to the age of 4 living in disadvantaged areas. The aim was to bring together early education, childcare, health services and family support to promote the physical, intellectual and social development of babies and children. This report discusses the economic issues arising out of the evaluation of the impact of Sure Start local programmes in England. It takes the outcomes for children and families at the age of five years reported in the National Evaluation of Sure Start and where possible estimates economic values for those outcomes. Where a direct estimation of economic value is not possible at this stage, probable sources of future economic values are discussed. It should be read in conjunction with the impact report, which describes the details of the methodology of the study and the full range of outcomes for children and their families when the children were 5-years-old