Local government spending and mental health: Untangling the impacts using a dynamic modelling approach

This study investigated the impact of local government spending on mental health in England between 2013 and 2019. Guided by the "Health in All Policies" vision, which encourages the integration of health in all decision-making areas, we explored how healthcare and multiple nonmedical budgeting decisions related to population mental health. We used random curve general cross-lagged modelling to dynamically partition effects into the short-run (from t to t + 1) and long-run (from t to t + 2) impacts, account for unobserved area-level heterogeneity and reverse causality from health outcomes to financial investments, and comprehensive modelling of budget items as an interconnected system. Our findings revealed that spending in adult social care, healthcare, and law & order predicted long-term mental health gains (0.004-0.081 SDs increase for each additional 10% in expenditure). However, these sectors exhibited negative short-term impulses (0.012-0.077 SDs decrease for each additional 10% in expenditure), markedly offsetting the long-term gains. In turn, infrastructural and environmental spending related to short-run mental health gains (0.005-0.031 SDs increase for each additional 10% in expenditure), while the long-run effects were predominantly negative (0.005-0.028 SDs decrease for each additional 10% in expenditure). The frequent occurrence of short-run and long-run negative links suggested that government resources may not be effectively reaching the areas that are most in need. In the short-term, negative effects could also imply temporary disruptions to service delivery largely uncompensated by later mental health improvements. Nonetheless, some non-health spending policies, such as law & order and infrastructure, can be related to long-lasting positive mental health impacts.

Pelizaeus-Merzbacher Disease: A Caregiver Assessment of Disease Impact

Pelizaeus-Merzbacher disease is a rare X-linked leukodystrophy accompanied by central nervous system hypomyelination with a spectrum of clinical phenotypes. This is the first survey of caregivers of individuals with Pelizaeus-Merzbacher disease to investigate the presenting symptoms, path to diagnosis, identity and impact of most bothersome symptoms, and needs that future treatment should address. One hundred participants completed the survey. Results from this survey demonstrate that the majority of Pelizaeus-Merzbacher disease symptoms manifest before 2 years of age and commonly include deficits in gross and fine motor skills, speech, and communication. Caregivers rated difficulty crawling, standing, or walking as the most bothersome symptoms due to Pelizaeus-Merzbacher disease, with constipation and difficulty with sleep, manual dexterity, and speech and communication rated nearly as high. The most important treatment goals for caregivers were improved mobility and communication. The survey findings present a caregiver perspective of the impact of symptoms in Pelizaeus-Merzbacher disease and provide helpful guidance to affected families, physicians, and drug developers on the often-long path to diagnosis and the unmet medical needs of this patient population.

Continuing inequalities in COVID-19 mortality in England and Wales, and the changing importance of regional, over local, deprivation

BACKGROUND

Observational studies have highlighted that where individuals live is far more important for risk of dying with COVID-19, than for dying of other causes. Deprivation is commonly proposed as explaining such differences. During the period of localised restrictions in late 2020, areas with higher restrictions tended to be more deprived. We explore how this impacted the relationship between deprivation and mortality and see whether local or regional deprivation matters more for inequalities in COVID-19 mortality.

METHODS

We use publicly available population data on deaths due to COVID-19 and all-cause mortality between March 2020 and April 2021 to investigate the scale of spatial inequalities. We use a multiscale approach to simultaneously consider three spatial scales through which processes driving inequalities may act. We go on to explore whether deprivation explains such inequalities.

RESULTS

Adjusting for population age structure and number of care homes, we find highest regional inequality in October 2020, with a COVID-19 mortality rate ratio of 5.86 (95% CI 3.31 to 19.00) for the median between-region comparison. We find spatial context is most important, and spatial inequalities higher, during periods of low mortality. Almost all unexplained spatial inequality in October 2020 is removed by adjusting for deprivation. During October 2020, one standard deviation increase in regional deprivation was associated with 20% higher local mortality (95% CI, 1.10 to 1.30).

CONCLUSIONS

Spatial inequalities are greatest in periods of lowest overall mortality, implying that as mortality declines it does not do so equally. During the prolonged period of low restrictions and low mortality in summer 2020, spatial inequalities strongly increased. Contrary to previous months, we show that the strong spatial patterning during autumn 2020 is almost entirely explained by deprivation. As overall mortality declines, policymakers must be proactive in detecting areas where this is not happening, or risk worsening already strong health inequalities.

Interrogating structural inequalities in COVID-19 mortality in England and Wales

BACKGROUND

Numerous observational studies have highlighted structural inequalities in COVID-19 mortality in the UK. Such studies often fail to consider the hierarchical, spatial nature of such inequalities in their analysis, leading to the potential for bias and an inability to reach conclusions about the most appropriate structural levels for policy intervention.

METHODS

We use publicly available population data on COVID-19-related mortality and all-cause mortality between March and July 2020 in England and Wales to investigate the spatial scale of such inequalities. We propose a multiscale approach to simultaneously consider three spatial scales at which processes driving inequality may act and apportion inequality between these.

RESULTS

Adjusting for population age structure and number of local care homes we find highest regional inequality in March and June/July. We find finer grained within region inequality increased steadily from March until July. The importance of spatial context increases over the study period. No analogous pattern is visible for non-COVID-19 mortality. Higher relative deprivation is associated with increased COVID-19 mortality at all stages of the pandemic but does not explain structural inequalities.

CONCLUSIONS

Results support initial stochastic viral introduction in the South, with initially high inequality decreasing before the establishment of regional trends by June and July, prior to reported regionality of the 'second-wave'. We outline how this framework can help identify structural factors driving such processes, and offer suggestions for a long-term, locally targeted model of pandemic relief in tandem with regional support to buffer the social context of the area.

Interrogating structural inequalities in COVID-19 mortality in England and Wales

BACKGROUND

Numerous observational studies have highlighted structural inequalities in COVID-19 mortality in the UK. Such studies often fail to consider the hierarchical, spatial nature of such inequalities in their analysis, leading to the potential for bias and an inability to reach conclusions about the most appropriate structural levels for policy intervention.

METHODS

We use publicly available population data on COVID-19-related mortality and all-cause mortality between March and July 2020 in England and Wales to investigate the spatial scale of such inequalities. We propose a multiscale approach to simultaneously consider three spatial scales at which processes driving inequality may act and apportion inequality between these.

RESULTS

Adjusting for population age structure and number of local care homes we find highest regional inequality in March and June/July. We find finer grained within region inequality increased steadily from March until July. The importance of spatial context increases over the study period. No analogous pattern is visible for non-COVID-19 mortality. Higher relative deprivation is associated with increased COVID-19 mortality at all stages of the pandemic but does not explain structural inequalities.

CONCLUSIONS

Results support initial stochastic viral introduction in the South, with initially high inequality decreasing before the establishment of regional trends by June and July, prior to reported regionality of the 'second-wave'. We outline how this framework can help identify structural factors driving such processes, and offer suggestions for a long-term, locally targeted model of pandemic relief in tandem with regional support to buffer the social context of the area.

Multiscale Contextual Poverty in the Netherlands: Within and Between-Municipality Inequality

Contextual poverty refers to high proportions of people with a low income in a certain (residential) space, and it can affect individual socioeconomic outcomes as well as decisions to move into or out of the neighbourhood. Contextual poverty is a multiscale phenomenon: Poverty levels at the regional scale reflect regional economic development, while meso-scale concentrations of poverty within cities are related to city-specific social, economic and housing characteristics. Within cities, poverty can also concentrate at micro spatial scales, which are often neglected, largely due to a lack of data. Exposure to poverty at lower spatial scales, such as housing blocks and streets, is important because it can influence individuals through social mechanisms such as role models or social networks. This paper is based on the premise that sociospatial context is necessarily multiscalar, and therefore contextual poverty is a multiscale problem which can be better understood through the inequality within and between places at different spatial scales. The question is how to compare different spatial contexts if we know that they include various spatial scales. Our measure of contextual poverty embraces 101 spatial scales and compares different locations within and between municipalities in the Netherlands. We found that the national inequality primarily came from the concentrations of poverty in areas of a few kilometres, located in cities, which have different spatial patterns of contextual poverty, such as multicentre, core-periphery and east-west. In addition to the inequality between municipalities, there are considerable within-municipality inequalities, particularly among micro-areas of a few hundred metres.

Opportunities, Enablers, and Barriers to the Use of Recorded Recovery Narratives in Clinical Settings

Background: Recorded Recovery Narratives (RRNs) describing first-person lived experience accounts of recovery from mental health problems are becoming more available. Little is known about how RRNs can be used in clinical practice and clinical education. Aims: The aim of this paper is to enable implementation planning for RRN interventions by identifying determinants of uptake. The objective was to identify opportunities, barriers, and enablers to the uptake of RRN interventions in clinical practice and education. Method: Three phases of focus groups were conducted with multi-professional mental health clinicians. Phase 1 (4 groups, n = 25) investigated current and possible uses of RRNs, Phase 2 (2 groups, n = 15) investigated a specific intervention delivering recovery narratives. Phase 3 (2 groups, n = 12) investigated clinical education uses. Thematic analysis was conducted. Results: RRNs can reinforce the effectiveness of existing clinical practices, by reducing communication barriers and normalizing mental health problems. They can also extend clinical practice (increase hope and connection, help when stuck). Clinical considerations are the relationship with care pathways, choice of staff and stage of recovery. In educational use there were opportunities to access lived experience perspectives, train non-clinical staff and facilitate attitudinal change. Barriers and enablers related to design (ability to use online resources, accessibility of language, ability to individualize choice of narrative), risk (triggering content, staff skills to respond to negative effects), trust in online resource (evidence base, maintenance), and technology (cost of use, technology requirements). Conclusions: RRNs can both improve and extend existing clinical practice and be an important educational resource. RRNs can improve engagement and hope, and address internalized stigma. Beneficially incorporating RRNs into clinical practice and education may require new staff skills and improved technological resources in healthcare settings. Future work could focus on the use of peer support workers views on RRN use and how to avoid unnecessary and unhelpful distress. Trial Registration Number: Work in this paper has informed three clinical trials: ISRCTN11152837; ISRCTN63197153; ISRCTN76355273.

VIDAS Enzyme-Linked Fluorescent Immunoassay for Detection of Salmonella in Foods: Collaborative Study

The VIDAS SLM method for detection of Salmonella was compared with the Bacteriological Analytical Manual (BAM)/AOAC culture method in a collaborative study. Twenty laboratories participated in the evaluation. Each laboratory tested one or more of 6 test products: milk chocolate, nonfat dry milk, dried whole egg, soy flour, ground black pepper, and ground raw turkey. No significant differences (P< 0.05) were observed between the 2 methods. The 2 methods were in agreement for 99% of 1544 samples analyzed. Of the 20 samples out of agreement, 8 were VIDAS SLM positive and BAM/AOAC negative, and 12 were VIDAS SLM negative and BAM/AOAC positive. The VIDAS SLM method for detection of Salmonella in foods has been adopted first action by AOAC INTERNATIONAL.

Conceptual framework for personal recovery in mental health among children and adolescents: a systematic review and narrative synthesis protocol

INTRODUCTION

Personal recovery has been defined as 'a profound personal and unique process for the individual to change their attitudes, values, feelings, goals, abilities and roles in order to achieve a satisfactory, hopeful and productive way of life, with the possible limitations of the illness'. However, research on personal recovery has focused almost exclusively on adults. This project aims to systematically review the available literature on definitions of personal recovery among children and adolescents with mental health conditions and to undertake a narrative synthesis to develop a conceptual framework of recovery.

METHODS AND ANALYSIS

Systematic review and narrative synthesis consisting (1) searching scientific literature databases, (2) handsearching, (3) citation tracking, (4) grey literature searching, (5) web-based searching and expert consultation. We will include qualitative and quantitative studies or systematic reviews providing a definition, theoretical or conceptual framework, domains or dimensions of personal recovery among eligible participants. The study will follow standard systematic review methodology for study selection and data extraction. We will assess quality of the evidence using tools appropriate for each study design. We will develop a new conceptual framework using a modified narrative synthesis approach, as follows: (1) describing eligible studies and conducting a preliminary synthesis, (2) determining relationships within and between studies and (3) determining the robustness of the synthesis.

ETHICS AND DISSEMINATION

We obtained a waiver of approval from our local Research Ethics Committee. Results will be disseminated via publications in international peer-reviewed journals and conference proceedings.This study will result in a theoretical framework that is based on an exhaustive review of the literature and the input of experts in the field of recovery. We expect that this framework will foster a better understanding of the stages and processes of recovery in children and adolescents with mental health conditions.

PROSPERO REGISTRATION NUMBER

CRD42018064087.

Genetic and Environmental Risk Factors Associated With Trajectories of Depression Symptoms From Adolescence to Young Adulthood

Importance

Less favorable trajectories of depressive mood from adolescence to early adulthood are associated with current and later psychopathology, impaired educational attainment, and social dysfunction, yet the genetic and environmental risk factors associated with these trajectories are not fully established. Examining what risk factors are associated with different trajectories of depressive mood could help identify the nature of depression symptoms and improve preventive interventions for those at most risk.

Objective

To examine the differential associations of genetic and environmental risk factors with trajectories of depression symptoms among individuals observed from ages 10 to 24 years.

Design, Setting, and Participants

In a longitudinal cohort study established in 1990 and currently ongoing (the Avon Longitudinal Study of Parents and Children [ALSPAC]), growth mixture modeling was used to identify trajectories of depression symptoms in 9394 individuals in the United Kingdom. Associations of different risk factors with these trajectories were then examined. Analysis was conducted between August 2018 and January 2019.

Main Outcomes and Measures

Trajectories were composed from depression symptoms measured using the Short Mood and Feelings Questionnaire at 9 occasions from ages 10 to 24 years. Risk factors included sex, a polygenic risk score taken from a recent genome-wide association study of depression symptoms, maternal postnatal depression, partner cruelty to the offspring's mother when the child was aged 2 to 4 years, childhood anxiety at age 8 years, and being bullied at age 10 years.

Results

Data on all risk factors, confounders, and the outcome were available for 3525 individuals, including 1771 (50.2%) who were female. Trajectories were assessed between the mean (SD) age of 10.7 (0.3) years and mean (SD) age of 23.8 (0.5) years. Overall, 5 distinct trajectories of depression symptoms were identified: (1) stable low (2506 individuals [71.1%]), (2) adolescent limited (325 individuals [9.2%]), (3) childhood limited (203 individuals [5.8%]), (4) early-adult onset (393 individuals [11.1%]), and (5) childhood persistent (98 individuals [2.8%]). Of all the associations of risk factors with trajectories, sex (odds ratio [OR], 6.45; 95% CI, 2.89-14.38), the polygenic risk score for depression symptoms (OR, 1.47; 95% CI, 1.10-1.96), and childhood anxiety (OR, 1.30; 95% CI, 1.16-1.45) showed the strongest association with the childhood-persistent trajectory of depression symptoms compared with the stable-low trajectory. Maternal postnatal depression (OR, 2.39; 95% CI, 1.41-4.07) had the strongest association with the early-adult-onset trajectory, while partner cruelty to mother (OR, 2.30; 95% CI, 1.36-3.90) had the strongest association with the adolescent-limited trajectory. Bullying (OR, 8.08; 95% CI, 4.92-13.26) showed the strongest association with the childhood-limited trajectory.

Conclusions and Relevance

The least favorable trajectories of depression symptoms (childhood persistent and early-adult onset) were associated with both genetic and environmental risk factors, but the 2 trajectories of limited duration that had resolved by early adulthood (childhood limited and adolescent limited) were not associated with the polygenic risk score or maternal postnatal depression. Bullying was strongly associated with both the childhood-persistent and childhood-limited trajectories, suggesting that this risk factor may have a time-specific effect. These findings suggest that examining genetic and multiple time-specific environmental antecedents could help identify trajectories of varying onset and chronicity.

Using sibling data to explore the impact of neighbourhood histories and childhood family context on income from work

Previous research has reported evidence of intergenerational transmissions of neighbourhood status and social and economic outcomes later in life. Research also shows neighbourhood effects on adult incomes of both childhood and adult neighbourhood experiences. However, these estimates of neighbourhood effects may be biased because confounding factors originating from the childhood family context. It is likely that part of the neighbourhood effects observed for adults, are actually lingering effects of the family in which someone grew up. This study uses a sibling design to disentangle family and neighbourhood effects on income, with contextual sibling pairs used as a control group. The sibling design helps us to separate the effects of childhood family and neighbourhood context from adult neighbourhood experiences. Using data from Swedish population registers, including the full Swedish population, we show that the neighbourhood effect on income from both childhood and adult neighbourhood experiences, is biased upwards by the influence of the childhood family context. Ultimately, we conclude that there is a neighbourhood effect on income from adult neighbourhood experiences, but that the childhood neighbourhood effect is actually a childhood family context effect. We find that there is a long lasting effect of the family context on income later in life, and that this effect is strong regardless the individual neighbourhood pathway later in life.

Identifying Critical Points of Trajectories of Depressive Symptoms from Childhood to Young Adulthood

Depression is a common mental illness and research has focused on late childhood and adolescence in an attempt to prevent or reduce later psychopathology and/or social impairments. It is important to establish and study population-averaged trajectories of depressive symptoms across adolescence as this could characterise specific changes in populations and help identify critical points to intervene with treatment. Multilevel growth-curve models were used to explore adolescent trajectories of depressive symptoms in 9301 individuals (57% female) from the Avon Longitudinal Study of Parents and Children, a UK based pregnancy cohort. Trajectories of depressive symptoms were constructed for males and females using the short mood and feelings questionnaire over 8 occasions, between 10 and 22 years old. Critical points of development such as age of peak velocity for depressive symptoms (the age at which depressive symptoms increase most rapidly) and the age of maximum depressive symptoms were also derived. The results suggested that from similar initial levels of depressive symptoms at age 11, females on average experienced steeper increases in depressive symptoms than males over their teenage and adolescent years until around the age of 20 when levels of depressive symptoms plateaued and started to decrease for both sexes. Females on average also had an earlier age of peak velocity of depressive symptoms that occurred at 13.5 years, compared to males who on average had an age of peak velocity at 16 years old. Evidence was less clear for a difference between the ages of maximum depressive symptoms which were on average 19.6 years for females and 20.4 for males. Identifying critical periods for different population subgroups may provide useful knowledge for treating and preventing depression and could be tailored to be time specific for certain groups. Possible explanations and recommendations are discussed.

Characteristics of mental health recovery narratives: Systematic review and narrative synthesis

BACKGROUND

Narratives of recovery from mental health distress have played a central role in the establishment of the recovery paradigm within mental health policy and practice. As use of recovery narratives increases within services, it is critical to understand how they have been characterised, and what may be missing from their characterisation thus far. The aim of this review was to synthesise published typologies in order to develop a conceptual framework characterising mental health recovery narratives.

METHOD

A systematic review was conducted of published literature on the characteristics of mental health recovery narratives. Narrative synthesis involved identifying characteristics and organising them into dimensions and types; and subgroup analysis based on study quality, narrator involvement in analysis, diagnosis of psychosis and experience of trauma. The synthesis was informed by consultation with a Lived Experience Advisory Panel and an academic panel. The review protocol was pre-registered (Prospero CRD42018090188).

RESULTS

8951 titles, 366 abstracts and 121 full-text articles published January 2000-July 2018 were screened, of which 45 studies analysing 629 recovery narratives were included. A conceptual framework of mental health recovery narratives was developed, comprising nine dimensions (Genre; Positioning; Emotional Tone; Relationship with Recovery; Trajectory; Use of Turning Points; Narrative Sequence; Protagonists; and Use of Metaphors), each containing between two and six types. Subgroup analysis indicated all dimensions were present across most subgroups, with Turning Points particularly evident in trauma-related studies.

CONCLUSIONS

Recovery narratives are diverse and multidimensional. They may be non-linear and reject coherence. To a greater extent than illness narratives, they incorporate social, political and rights aspects. Approaches to supporting development of recovery narratives should expand rather than reduce available choices. Research into the narratives of more diverse populations is needed. The review supports trauma-informed approaches, and highlights the need to understand and support post-traumatic growth for people experiencing mental health issues.

Better to stay or go? A longitudinal study of mobility over the educational life course

BackgroundThere has been substantial discussion in the literature about where you grow up and if whether or not you experience social and spatial mobility during childhood has substantial bearing upon later life achievement (Pribesh and Downey, 1999; Gasper et al, 2010; Sharkey and Elwert, 2011). ObjectivesThis paper utilises data from the National Pupil Database (NPD) and a quantitative framework to explore the impact of residential mobility on educational outcomes. Many previous studies of neighbourhood mobility have used point in time measures when studying inequality, which means that an individual’s neighbourhood trajectory is overlooked. Data/MethodsWe follow a single cohort of pupils’ over an eleven year time period to analyse their mobility along with their individual characteristics to provide a clear understanding of who is moving and the impact this has on them in terms of educational attainment. We also use the index of multiple deprivation as a measure of neighbourhood wealth to determine to what extent children are able to ’trade up’ in terms of neighbourhood. FindingsOur findings show that moving home has a negative impact on educational attainment compared to those that stay in the same location throughout the educational life cycle. Those that ‘trade up’ in terms of quality of neighbourhood still do not achieve the same educational outcomes as their peers who live in a lower deprived neighbourhood throughout their schooling. ConclusionResidential mobility between deprived areas, as shown in this paper, has more of an impact than just being ‘stuck in place’. It is not purely a case of where you live determining your outcomes, but also how often you move home in childhood and adolescence.

Context or composition: How does neighbourhood deprivation impact upon adolescent smoking behaviour?

Neighbourhood effects studies have demonstrated an association between area deprivation and smoking behaviour whereby people living in deprived neighbourhoods are more likely to smoke than those in non-deprived neighbourhoods. This evidence though is based largely upon data that ignores long term exposures to neighbourhood contexts and is confounded by neighbourhood selection bias. In this study, we investigate the temporal ordering of exposure to neighbourhood deprivation throughout childhood and whether associations between neighbourhood deprivation and cigarette smoking are due to compositional or contextual neighbourhood effects. Data come from a UK cohort study, the Avon Longitudinal Study of Parents and Children (ALSPAC). We use longitudinal measures of neighbourhood deprivation and self-reported smoking behaviour for 2744 children to examine the influence of neighbourhood deprivation on smoking status and smoking heaviness at age 17. Our results demonstrate that children who are born into and grow up in deprived neighbourhoods are up to twice as likely to be smokers at age 17 than those in non-deprived neighbourhoods. These associations are largely due to family socioeconomic position and the intergenerational transmission of smoking behaviour from parents to children; compositional rather than direct contextual ‘neighbourhood effects’. Our findings highlight the importance of considering longitudinal exposure to neighbourhood deprivation over cross sectional exposure. In conclusion, we find that it is the family rather than the neighbourhood into which a child is born that determines their smoking behaviour.

Residential mobility: Towards progress in mobility health research

Research into health disparities has long recognized the importance of residential mobility as a crucial factor in determining health outcomes. However, a lack of connectivity between the health and mobility literatures has led to a stagnation of theory and application on the health side, which lacks the detail and temporal perspectives now seen as critical to understanding residential mobility decisions. Through a critical re-think of mobility processes with respect to health outcomes and an exploitation of longitudinal analytical techniques, we argue that health geographers have the potential to better understand and identify the relationship that residential mobility has with health.

Uncovering interactions in multivariate contingency tables: a multi-level modelling exploratory approach

Much quantitative behavioural social science – a great deal of it exploratory in nature – involves the analysis of multivariate contingency tables, usually deploying logistic binomial and multinomial regression models with no exploration of interaction effects, despite arguments that this should be a crucial element of the analysis. This article builds on suggestions that the search for interaction effects should employ multi-level modelling strategies and outlines a procedure for modelling patterns in data sets with small numbers of observations in many, if not all, of their multivariate contingency table cells; all expected cells must be non-zero. The procedure produces precision-weighted estimates of the observed:expected rates for each and every cell, together with associated Bayesian credible intervals, and is illustrated using a large survey data set relating voting (and abstaining) at the 2015 UK general election to age, sex and educational qualifications. Crucially, while fine detail can be explored in the analysis, unreliable rates for particular subgroups are automatically down-weighted to what is happening generally. The identification of reliable differential rates then allows a simpler hybrid model that captures the main trends to be fitted and interpreted.

Ethnic Residential Segregation: A Multilevel, Multigroup, Multiscale Approach Exemplified by London in 2011

We develop and apply a multilevel modeling approach that is simultaneously capable of assessing multigroup and multiscale segregation in the presence of substantial stochastic variation that accompanies ethnicity rates based on small absolute counts. Bayesian MCMC estimation of a log-normal Poisson model allows the calculation of the variance estimates of the degree of segregation in a single overall model, and credible intervals are obtained to provide a measure of uncertainty around those estimates. The procedure partitions the variance at different levels and implicitly models the dependency (or autocorrelation) at each spatial scale below the topmost one. Substantively, we apply the model to 2011 census data for London, one of the world's most ethnically diverse cities. We find that the degree of segregation depends both on scale and group.

Intergenerational transmission of neighbourhood poverty: an analysis of neighbourhood histories of individuals

The extent to which socioeconomic (dis)advantage is transmitted between generations is receiving increasing attention from academics and policymakers. However, few studies have investigated whether there is a spatial dimension to this intergenerational transmission of (dis)advantage. Drawing on the concept of neighbourhood biographies, this study contends that there are links between the places individuals live with their parents and their subsequent neighbourhood experiences as independent adults. Using individual-level register data tracking the whole Stockholm population from 1990 to 2008, and bespoke neighbourhoods, this study is the first to use sequencing techniques to construct individual neighbourhood histories. Through visualisation methods and ordered logit models, we demonstrate that the socioeconomic composition of the neighbourhood children lived in before they left the parental home is strongly related to the status of the neighbourhood they live in 5, 12 and 18 years later. Children living with their parents in high poverty concentration neighbourhoods are very likely to end up in similar neighbourhoods much later in life. The parental neighbourhood is also important in predicting the cumulative exposure to poverty concentration neighbourhoods over a long period of early adulthood. Ethnic minorities were found to have the longest cumulative exposure to poverty concentration neighbourhoods. These findings imply that for some groups, disadvantage is both inherited and highly persistent.

A review of working with homeless adolescents with comorbid mental health and substance misuse problems

This article presents an overview of the issues of providing care for homeless adolescents who present with comorbid mental health and substance misuse problems within a specialist child and adolescent mental health service. The limited evidence base concerning dual diagnosis among the adolescent population is explored and the application of research based on the adult population to this client group is considered.The intervention strategies that have proved successful in clinical practice are discussed and the evidence to support this is highlighted. The importance of taking an assertive outreach approach to, and investing time in, the engagement process is first considered. Then the application and benefits of harm reduction and motivational interventions are explored before the importance of multi‐agency working is highlighted and a conclusion offered.

Dual diagnosis: co-existence of drug, alcohol and mental health problems

The Department of Health (DoH) published a set of good practice implementation guidelines on dual diagnosis in May 2002. This guidance suggests that in order to improve the prognosis for clients who have mental health problems and who drink or take drugs problematically, mental health and substance misuse services should adopt an integrated service model. There is a considerable amount of American-based research supporting this approach, but little evidence from the UK researchers demonstrating its application in the UK. This article offers an example of a service that has been developed in the city of Nottingham and argues that this client group will be served most effectively if mental health services support specialist dual-diagnosis resources. Integrated care pathways for this client group can be developed and led by specialist clinicians acting as consultants to mental health services (DoH, 2002a). This consultancy role within mental health services enhances the links needed between substance misuse and mental health services. As a result, specialist dual-diagnosis teams are best placed to increase positive prognoses for clients by ensuring evidence-based substance misuse skills are utilized and adapted by mental health teams to ensure fully integrated care coordination.

Dual diagnosis: approaches to the treatment of people with dual mental health and drug abuse problems

People with a dual diagnosis of mental health and drug or alcohol abuse problems may fall between existing specialist services, which tend to focus on treating one or other problem. DAVID MANLEY argues the case for a flexible, individualised approach to treatment which acknowledges the biological and psychosocial features of the co-existent problems and draws on clinical knowledge and skills from both the mental health and substance addiction professions.

The effect of respiratory mode and oxygen concentration on the risk of aerial predation in fishes

Six bimodal and six water-breathing species of fish were exposed to predation by a green heron (Butorides striatus) in a laboratory experiment to examine the hypothesis that aerial predation selects against the evolution and use of air breathing. Tests were performed at 1.6 and 0.5 mg O2∙L−1 ([Formula: see text] and 9 Torr, respectively; 1 Torr = 133.322 Pa). Most water breathers avoided the surface at 1.6 mg∙L−1 but not at 0.5 mg∙L−1, where they performed aquatic surface respiration. Most bimodal species breathed air at both oxygen concentrations. The risk of capture increased with proximity to the surface. The prey species responded to the predator by increasing mean depth, decreasing the rate of air breathing or aquatic surface respiration, and avoiding the vicinity of the predator when surfacing. Despite these and other antipredator characteristics, all species were vulnerable to capture in the test situation. Overall, the survivorship of water-breathing fishes was significantly higher than that of bimodal species at 1.6 mg∙L−1 and similar to that of bimodal species at 0.5 mg∙L−1. Aerial predation pressure should favor water breathing over air breathing except at oxygen concentrations lower than 0.5 mg∙L−1.

Survey of children and their families presenting at a child psychiatric service

This paper describes the source of referral, presenting problems and family characteristics of all children referred to the department of child psychiatry in Dunedin in 1980. This is the sole child psychiatric service for a child population of approximately 35 064, within a total population 120 426. Two hundred and six children were referred, mainly by general practitioners, but a number were referred by other agencies. The most common presenting problems were behaviour and anxiety disorders. The most striking finding was the excess of children of divorced or separated parents and the absence of any referrals of the children of single women who had not been previously married. Possible reasons for this are discussed.

High performance liquid chromatographic determination of aflatoxins in animal tissues and products

A method was developed for the determination of aflatoxins, M1, B1, G1, B2, and G2 in animal tissues, meat, eggs, and dairy products by high performance liquid chromatography (HPLC). Previous extraction procedures were modified to optimize the precision and recovery of the method. HPLC is performed isocratically with a 5 micrometer microparticulate octadecylsilica column and fluorometric detection. The analysis is based on treatment of the purified sample extract or standard with trifluoroacetic acid (TFA) to catalyze the hydration of aflatoxins M1, B1, and G1 to the highly fluorescent M2a, B2a, and G2a derivatives. Analysis by HPLC with and without TFA treatment of the extract provides quantitative and qualitative data. The recovery of added aflatoxins and the precision of the recovery depend on the type of sample; mean coefficient of variation for all recovery values was 19.7 +/- 11.0% for the analysis of liver, ground beef, dairy products, and eggs. The method was sensitive, with a detection limit of 0.05 + 0.10 ng/g for each aflatoxin. This procedure provides an alternative to existing thin layer chromatographic methods for determining aflatoxins in animal tissues and products

Unilateral medial rectus recession for small-angle esotropia

Ten patients with small-angle esotropia of 18 prism diopters or less were treated with a unilateral medial rectus recession of 5 mm. Nine of the ten cases considerably improved; one showed only minimal improvement. There were no overcorrections, but two cases did show lateral incomitance with a greater correction on gaze in the field of action of the recessed medial rectus muscle. Two patients became monofixators after the surgery. These had been patients with accommodative esotropia who had decompensated and had surgery for the nonaccommodative portion of the total esotropia. When indicated, the recession of one medial rectus muscle is a safe and predictable procedure for small-angle esotropia. An average correction of 11.6 prism diopters was obtained at distance and one of 11.3 prism diopters at near.