D Brown

Childhood residential mobility and health in late adolescence and adulthood: findings from the West of Scotland Twenty-07 Study

Background The relationship between childhood residential mobility and health in the UK is not well established; however, research elsewhere suggests that frequent childhood moves may be associated with poorer health outcomes and behaviours. The aim of this paper was to compare people in the West of Scotland who were residentially stable in childhood with those who had moved in terms of a range of health measures. Methods A total of 850 respondents, followed-up for a period of 20 years, were included in this analysis. Childhood residential mobility was derived from the number of addresses lived at between birth and age 18. Multilevel regression was used to investigate the relationship between childhood residential mobility and health in late adolescence (age 18) and adulthood (age 36), accounting for socio-demographic characteristics and frequency of school moves. The authors examined physical health measures, overall health, psychological distress and health behaviours. Results Twenty per cent of respondents remained stable during childhood, 59% moved one to two times and 21% moved at least three times. For most health measures (except physical health), there was an increased risk of poor health that remained elevated for frequent movers after adjustment for socio-demographic characteristics and school moves (but was only significant for illegal drug use). Conclusions Risk of poor health was elevated in adolescence and adulthood with increased residential mobility in childhood, after adjusting for socio-demographic characteristics and school moves. This was true for overall health, psychological distress and health behaviours, but physical health measures were not associated with childhood mobility.

Three-dimensional assessment of facial appearance following surgical repair of unilateral cleft lip and palate.

Background and Objective Objective assessment of postsurgical facial asymmetry can be difficult, but three-dimensional (3D) imaging techniques have made this possible. The objective of this study was to assess residual asymmetry in surgically repaired unilateral cleft lip (UCL) and unilateral cleft lip and palate (UCLP) patients and to compare this with noncleft controls. Design Retrospective multicohort comparative study. Patients and Methods Fifty-one 10-year-old children with surgically managed UCLP and 44 children with UCL were compared with a control group of 68 ten-year-olds. The 3D facial models at rest and with maximum smile were created using a 3D imaging system. Asymmetry scores were produced using both anatomical landmarks and a novel method of facial curve analysis. Results Asymmetry for the whole face was significantly higher in both cleft groups compared with controls (P < .001). UCLP asymmetry was higher than UCL (P < .001). In cleft patients, the upper lip and nasal rim were the most asymmetric (P < .001 to .05). Control subjects also displayed a degree of facial asymmetry. Maximum smile did not significantly affect the symmetry of the whole face, but it increased asymmetry of the vermillion border and nasal rim in all three groups (P < .001). Conclusions Despite surgical intervention at an early age, asymmetry remains significant in cleft patients at 10 years of age. Three-dimensional imaging is a noninvasive objective assessment tool that identifies specific areas of the face responsible for asymmetry. Facial curve analysis describes the face more comprehensively and characterizes soft tissue contours.

3D assessment of lip scarring and residual dysmorphology following surgical repair of cleft lip and palate: a preliminary study.

Objective To evaluate lip scarring and the three-dimensional (3D) lip morphology following primary reconstruction in children with unilateral cleft lip and palate (UCLP) relative to contemporaneous noncleft data. Design Retrospective, cross-sectional, controlled study. Setting Glasgow Dental Hospital and School, University of Glasgow, U.K. Patients and participants Three groups of 10-year-old children: 51 with UCLP, 43 UCL (unilateral cleft lip), and 68 controls. Methods Three-dimensional images of the face were recorded using stereo cameras on a two-pod capture station, and 3D coordinates of anthropometric landmarks were extracted from the facial images. A novel method was applied to quantify residual scarring and the associated lip dysmorphologies. The relationships among outcome measures were investigated. Results Residual lip dysmorphologies were more pronounced in UCLP cases. The width of the Cupids bow was increased due to lateral displacement of the Christa philteri left (cphL) in both UCL and UCLP patients. In the upper part of the lip, the nostril base was significantly wider in UCLP cases when compared with UCL cases and controls. Scar redness was more pronounced in UCL than in UCLP cases. No relationship could be identified between lip scarring and other measurements of lip dysmorphology. Conclusions Stereophotogrammetry, together with associated image analysis, allow early detection of residual dysmorphology following cleft repair.

Psychological status as a function of residual scarring and facial asymmetry after surgical repair of cleft lip and palate.

Objective Objective measure of scarring and three-dimensional (3D) facial asymmetry after surgical correction of unilateral cleft lip (UCL) and unilateral cleft lip (UCLP). It was hypothesized that the degree of scarring or asymmetry would be correlated with poorer psychological function. Design In a cross-sectional design, children underwent 3D imaging of the face and completed standardized assessments of self-esteem, depression, and state and trait anxiety. Parents rated childrens adjustment with a standard scale. Setting Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences. Patients Fifty-one children aged 10 years with UCLP and 43 with UCL were recruited from the cohort treated with the surgical protocol of the CLEFTSIS managed clinical network in Scotland. Methods Objective assessment to determine the luminance and redness of the scar and facial asymmetry. Depression, anxiety, and a self-esteem assessment battery were used for the psychological analysis. Results Cleft cases showed superior psychological adjustment when compared with normative data. Prevalence of depression matched the population norm. The visibility of the scar (luminance ratio) was significantly correlated with lower self-esteem and higher trait anxiety in UCLP children (P = .004). Similar but nonsignificant trends were seen in the UCL group. Parental ratings of poorer adjustment also correlated with greater luminance of the scar. Conclusions The objectively defined degree of postoperative cleft scarring was associated with subclinical symptoms of anxiety, depression, and low self-esteem.

Population mobility, deprivation and self-reported limiting long-term illness in small areas across Scotland.

This study investigates population mobility and its relationship with area level deprivation and health. Based on UK movement in the year preceding the 2001 census, small areas in Scotland were classified as being one of the following population types; decreasing, increasing or stable (with high or low turnover). In the most deprived areas, illness rates for those under 65 were significantly lower in stable populations with low turnover than in other areas of comparable deprivation. Decreasing populations in deprived areas had significantly highest illness rates overall. Leaving those in poor health behind may lead to artifactual increases in area based health inequalities.

Scottish mortality rates 2000-2002 by deprivation and small area population mobility

Despite recent increases in life expectancy, inequalities in mortality in Scotland have been widening. Previous research has suggested that one of the potential drivers of geographical inequalities in health is the process of selective migration. Although support for the effect of selective migration on widening geographic inequalities in health has been mixed, several studies have shown that people in good health move away from deprived areas while people in poor health move towards more deprived areas. In this paper, we examine mortality rates in Scotland by area deprivation and population mobility. Previous research in Scotland has shown that the relationship between population mobility and migration disappears once deprivation is accounted for. However, the authors measure population mobility over a longer time period than we do here and at a different geographical level. We consider small area population mobility on the basis of moves made in the year prior to the 2001 Scottish census. Areas were classified as one of four types: decreasing, increasing or stable (with high or low turnover). Mortality rates, calculated for the period 2000–2002, were found to be highest in deprived areas that had declined in population over the previous year. In the most deprived quintile, the causes of death contributing disproportionately to the excess mortality in decreasing areas were causes linked to alcohol and drug use, suicides and assault. Focussing on those individuals in the most deprived areas who live in areas that are declining in population could help to reduce widening inequalities for these causes of death. This work shows the extent to which population migration can influence small areas over a relatively short time period and gives some insight into potential factors, not measured by traditional indices of area level deprivation, which may lead to differences in the health status of areas.

Developing a new small-area measure of deprivation using 2001 and 2011 census data from Scotland

Material deprivation contributes to inequalities in health; areas of high deprivation have higher rates of ill-health. How deprivation is measured has a great impact on its explanatory power with respect to health. We compare previous deprivation measures used in Scotland and proposes a new deprivation measure using the 2001 and 2011 Scottish census data. We calculate the relative index of inequality (RII) for self-reported health and mortality. While across all age groups different deprivation measures provide similar results, the assessment of health inequalities among those aged 20–29 differs markedly according to the deprivation measure. In 2011 the RII for long-term health problem for men aged 20–24 was only 0.71 (95% CI 0.60–0.83) using the Carstairs score, but 1.10 (0.99–1.21) for the new score and 1.13 (1.03–1.24) for the income domain of Scottish Index of Multiple Deprivation (SIMD). The RII for mortality in that age group was 1.25 (0.89–1.58) for the Carstairs score, 1.69 (1.35–2.02) for the new measure and 1.76 (1.43–2.08) for SIMD. The results suggest that researchers and policy makers should consider the suitability of deprivation measures for different social groups.

Socio-demographic and health characteristics of individuals left behind in deprived and declining areas in Scotland

Deprived and declining areas in Scotland have poorer health than other areas in the rest of Scotland. Using data from the Scottish Longitudinal Study, this paper examines whether differential migration over a one year period can explain these differences. Compared with migrants to and from deprived and declining areas, stable residents in those areas were generally older, less well educated and less affluent. Continued disproportionate loss of more affluent and better educated individuals could result in deprived and declining areas becoming even more deprived over time. Migrants appeared to be in better health; however, this finding was reversed on adjustment for age. It may be that while the relationship between migration and socio-economic status is immediately apparent, the relationship between migration and health could take longer to develop.

Small-area deprivation measure datasets for Scotland, 2001 and 2011

These data present a new small-area deprivation measure, but also include a variety of other indicators, such as the Scottish Index of Multiple Deprivation (SIMD) and the Carstairs score. The data are for Scottish 2001 Datazones and for the years 2001 and 2011. In addition the data provide standardised self-reported measures of general health and limiting long-term illness. The theoretical background for developing the new deprivation measure, and the implications of using different measures to study health inequalities are discussed in “Developing a new small-area measure of deprivation using 2001 and 2011 census data from Scotland” (Allik et al., 2016) [1].

Male suicide trends and inequalities in Scotland 1980–2015: a population-based study

Abstract Background In Scotland, male suicide rates increased substantially in the 1980s and 1990s with higher rates in more deprived areas. We aimed to examine trends in male suicide in Scotland on an extended time scale (1980–2015) by method of suicide and individual socioeconomic position. Methods Records of suicide deaths for 1980–2015 were obtained from National Records Scotland. National Statistics socioeconomic classification (NS-SEC, 2001) was used to assess inequalities in 2000–02 for ages 20–59 years. Standardised death rates were calculated by age with the European population 2013 as reference, and Poisson regression used to determine the significance of trends. Inequalities were assessed with the slope of index of inequality (SII). Findings 12 281 suicide deaths were recorded between 1980 and 2015. At all ages, no significant linear trend was observed over time, but suicide rates (per 100 000 person-years) increased from 21 to 27 between 1980 and 2002 (p Interpretation Decline in male suicide rates may be attributed to suicide prevention strategies introduced by the Scottish Government from 2002 (such as Choose Life). Despite decreasing trends of male suicide, suicide by hanging, suffocation, and strangulation increased over time. Limitations are that trends in inequalities were not available, and the 13% of deaths in the NS-SEC categories, never worked and long term unemployed and not classified, were excluded from the analysis assessing inequalities since the interpretation of results for this group was ambiguous. What effect this omission would have on the estimation of inequalities is unclear. Policy should be directed at reducing deaths from hanging, suffocation, and strangulation. Funding UK Medical Research Council (MC_ UU_12017/13) and Chief Scientist Office (SPHSU13).