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McCartney G, Bouttell J, Craig N, Craig P, Graham L, Lakha F, Lewsey J, McAdams R, MacPherson M, Minton J, Parkinson J, Robinson M, Shipton D, Taulbut M, Walsh D, Beeston C. Explaining trends in alcohol-related harms in Scotland 1991-2011 (II): policy, social norms, the alcohol market, clinical changes and a synthesis. Public Health 2016; 132:24-32. [PMID: 26921977 DOI: 10.1016/j.puhe.2015.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/21/2015] [Accepted: 12/25/2015] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To provide a basis for evaluating post-2007 alcohol policy in Scotland, this paper tests the extent to which pre-2007 policy, the alcohol market, culture or clinical changes might explain differences in the magnitude and trends in alcohol-related mortality outcomes in Scotland compared to England & Wales (E&W). STUDY DESIGN Rapid literature reviews, descriptive analysis of routine data and narrative synthesis. METHODS We assessed the impact of pre-2007 Scottish policy and policy in the comparison areas in relation to the literature on effective alcohol policy. Rapid literature reviews were conducted to assess cultural changes and the potential role of substitution effects between alcohol and illicit drugs. The availability of alcohol was assessed by examining the trends in the number of alcohol outlets over time. The impact of clinical changes was assessed in consultation with key informants. The impact of all the identified factors were then summarised and synthesised narratively. RESULTS The companion paper showed that part of the rise and fall in alcohol-related mortality in Scotland, and part of the differing trend to E&W, were predicted by a model linking income trends and alcohol-related mortality. Lagged effects from historical deindustrialisation and socio-economic changes exposures also remain plausible from the available data. This paper shows that policy differences or changes prior to 2007 are unlikely to have been important in explaining the trends. There is some evidence that aspects of alcohol culture in Scotland may be different (more concentrated and home drinking) but it seems unlikely that this has been an important driver of the trends or the differences with E&W other than through interaction with changing incomes and lagged socio-economic effects. Substitution effects with illicit drugs and clinical changes are unlikely to have substantially changed alcohol-related harms: however, the increase in alcohol availability across the UK is likely to partly explain the rise in alcohol-related mortality during the 1990s. CONCLUSIONS Future policy should ensure that alcohol affordability and availability, as well as socio-economic inequality, are reduced, in order to maintain downward trends in alcohol-related mortality in Scotland.
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Affiliation(s)
- G McCartney
- NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, United Kingdom.
| | - J Bouttell
- Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, United Kingdom.
| | - N Craig
- NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, United Kingdom.
| | - P Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top Floor, 200 Renfield Street, Glasgow, G2 3QB, United Kingdom.
| | - L Graham
- Public Health and Intelligence, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, United Kingdom.
| | - F Lakha
- NHS Lothian, Waverley Gate, 2-4 Waterloo Place, Edinburgh EH1 3EG, United Kingdom.
| | - J Lewsey
- Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, United Kingdom.
| | - R McAdams
- NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, United Kingdom.
| | - M MacPherson
- NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, United Kingdom.
| | - J Minton
- Urban Studies, School of Social and Political Sciences, University of Glasgow, 25 Bute Gardens, Glasgow, United Kingdom.
| | - J Parkinson
- NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, United Kingdom.
| | - M Robinson
- NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, United Kingdom.
| | - D Shipton
- NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, United Kingdom.
| | - M Taulbut
- NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, United Kingdom.
| | - D Walsh
- Glasgow Centre for Population Health, Olympia Building, Bridgeton Cross, Glasgow, G40 2QH, United Kingdom.
| | - C Beeston
- NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, United Kingdom.
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McCartney G, Bouttell J, Craig N, Craig P, Graham L, Lakha F, Lewsey J, McAdams R, MacPherson M, Minton J, Parkinson J, Robinson M, Shipton D, Taulbut M, Walsh D, Beeston C. Explaining trends in alcohol-related harms in Scotland, 1991-2011 (I): the role of incomes, effects of socio-economic and political adversity and demographic change. Public Health 2016; 132:13-23. [PMID: 26917268 DOI: 10.1016/j.puhe.2015.12.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/21/2015] [Accepted: 12/25/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This paper tests the extent to which differing trends in income, demographic change and the consequences of an earlier period of social, economic and political change might explain differences in the magnitude and trends in alcohol-related mortality between 1991 and 2011 in Scotland compared to England & Wales (E&W). STUDY DESIGN Comparative time trend analyses and arithmetic modelling. METHODS Three approaches were utilised to compare Scotland with E&W: 1. We modelled the impact of changes in income on alcohol-related deaths between 1991-2001 and 2001-2011 by applying plausible assumptions of the effect size through an arithmetic model. 2. We used contour plots, graphical exploration of age-period-cohort interactions and calculation of Intrinsic Estimator coefficients to investigate the effect of earlier exposure to social, economic and political adversity on alcohol-related mortality. 3. We recalculated the trends in alcohol-related deaths using the white population only to make a crude approximation of the maximal impact of changes in ethnic diversity. RESULTS Real incomes increased during the 1990s but declined from around 2004 in the poorest 30% of the population of Great Britain. The decline in incomes for the poorest decile, the proportion of the population in the most deprived decile, and the inequality in alcohol-related deaths, were all greater in Scotland than in E&W. The model predicted less of the observed rise in Scotland (18% of the rise in men and 29% of the rise in women) than that in E&W (where 60% and 68% of the rise in men and women respectively was explained). One-third of the decline observed in alcohol-related mortality in Scottish men between 2001 and 2011 was predicted by the model, and the model was broadly consistent with the observed trends in E&W and amongst women in Scotland. An age-period interaction in alcohol-related mortality was evident for men and women during the 1990s and 2000s who were aged 40-70 years and who experienced rapidly increasing alcohol-related mortality rates. Ethnicity is unlikely to be important in explaining the trends or differences between Scotland and E&W. CONCLUSIONS The decline in alcohol-related mortality in Scotland since the early 2000s and the differing trend to E&W were partly described by a model predicting the impact of declining incomes. Lagged effects from historical social, economic and political change remain plausible from the available data.
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Affiliation(s)
- G McCartney
- NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, UK.
| | - J Bouttell
- Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.
| | - N Craig
- NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, UK.
| | - P Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top Floor, 200 Renfield Street, Glasgow, G2 3QB, UK.
| | - L Graham
- Public Health and Intelligence, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, UK.
| | - F Lakha
- NHS Lothian, Waverley Gate, 2-4 Waterloo Place, Edinburgh EH1 3EG, UK.
| | - J Lewsey
- Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.
| | - R McAdams
- NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, UK.
| | - M MacPherson
- NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, UK.
| | - J Minton
- Urban Studies, School of Social and Political Sciences, University of Glasgow, 25 Bute Gardens, University of Glasgow, Glasgow, UK.
| | - J Parkinson
- NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, UK.
| | - M Robinson
- NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, UK.
| | - D Shipton
- NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, UK.
| | - M Taulbut
- NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, UK.
| | - D Walsh
- Glasgow Centre for Population Health, Olympia Building, Bridgeton Cross, Glasgow, G40 2QH, UK.
| | - C Beeston
- NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, UK.
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Malmström V, Shipton D, Singh B, Al-Shamkhani A, Puklavec MJ, Barclay AN, Powrie F. CD134L expression on dendritic cells in the mesenteric lymph nodes drives colitis in T cell-restored SCID mice. J Immunol 2001; 166:6972-81. [PMID: 11359859 DOI: 10.4049/jimmunol.166.11.6972] [Citation(s) in RCA: 162] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Transfer of CD45RB(high) CD4+ T cells to immune-deficient mice in the absence of regulatory T cells leads to a Th1-mediated colitis. In this study, we show that intestinal inflammation is characterized by a 15-fold increase in the number of CD134L+ (OX40L+)-activated DC in the mesenteric lymph nodes (MLNs) compared with BALB/c mice. This was important functionally, as administration of an anti-CD134L mAb inhibited the proliferation of T cells in the MLNs as well as their expression of the gut-homing integrin alpha(4)beta(7). Most importantly, the anti-CD134L mAb completely blocked development of colitis. Surprisingly, CD134L was found to be expressed by a proportion of dendritic cells (DC) in the MLNs of unreconstituted SCID mice, suggesting that CD134L can be induced on DC in the absence of T cell-derived signals. These results indicate that some DC in the MLNs of SCID mice express an activated phenotype and that CD134L expression by these cells is involved in the development of colitis induced by T cell transfer. Accumulation of CD134L+ DC was inhibited by cotransfer of regulatory T cells, suggesting that inhibition of the accumulation of activated DC is one mechanism by which these cells prevent immune pathology.
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MESH Headings
- Animals
- Antibodies, Blocking/administration & dosage
- Antibodies, Blocking/biosynthesis
- Antibodies, Blocking/genetics
- Antibodies, Blocking/pharmacology
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/biosynthesis
- Antibodies, Monoclonal/genetics
- Antibodies, Monoclonal/pharmacology
- Cell Count
- Colitis/genetics
- Colitis/immunology
- Colitis/pathology
- Colitis/prevention & control
- Dendritic Cells/immunology
- Dendritic Cells/metabolism
- Dendritic Cells/pathology
- Growth Inhibitors/administration & dosage
- Growth Inhibitors/pharmacology
- Immunosuppressive Agents/administration & dosage
- Immunosuppressive Agents/pharmacology
- Injections, Intraperitoneal
- Ligands
- Lymph Nodes/immunology
- Lymph Nodes/metabolism
- Lymph Nodes/pathology
- Lymphocyte Activation/genetics
- Lymphocyte Activation/immunology
- Lymphocyte Transfusion
- Membrane Glycoproteins
- Mesentery
- Mice
- Mice, Inbred BALB C
- Mice, Knockout
- Mice, SCID
- OX40 Ligand
- Rats
- Receptors, OX40
- Receptors, Tumor Necrosis Factor/biosynthesis
- Receptors, Tumor Necrosis Factor/metabolism
- T-Lymphocytes/immunology
- T-Lymphocytes/transplantation
- Tumor Necrosis Factor Receptor Superfamily, Member 7/biosynthesis
- Tumor Necrosis Factor Receptor Superfamily, Member 7/immunology
- Tumor Necrosis Factor Receptor Superfamily, Member 7/metabolism
- Tumor Necrosis Factors
- Wasting Syndrome/genetics
- Wasting Syndrome/immunology
- Wasting Syndrome/prevention & control
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Affiliation(s)
- V Malmström
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
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