Deprived City Research Articles

Influencing factors on the functional level of haemophilic patients assessed byFISH

Joint destruction in early adulthood brings the patients to the orthopaedic clinics. If a haemophilic patient becomes disabled, it shows a number of factors such as timely diagnosis, availability of appropriate treatment depending on the country, access and affordability to treatments and equally importantly the responsibility of the patient in managing self care by remaining compliant by prescribed treatment regimen. We assessed the functional level by functional independence score in haemophilia (FISH). Overall, 104 patients with haemophilia A and 29 with haemophilia B were evaluated. We assessed the function of the patients by FISH. We divided the sum scores into weak (FISH score 8-16), moderate (17-24), and good (25-32). For evaluating the level of functional deficit in a 2 × 2 table, we categorized the weak and moderate levels into Disordered Group and the good level into Not-Disordered Group. The average age was 26.9 ± 14.24. Each 1 year increase in age can increase 1.07 fold the possibility of being placed in Disordered Function Group. Severe haemophilia can increase 7.34 fold, presence of inhibitor can increase 9.75 fold and home self-care increases 3.89 fold the possibility of being placed in Disordered Function Group. To decrease the burden of the cost on patient, family and the government, education plays the most important role. We suggest that we send a trained team of physician and nurses to the deprived villages and cities instead of waiting for the patient to refer to our Care Center.

Migration in the Face of Unemployment and Unemployment Risk: a Case Study of Temporal and Regional Effects

This article employs an elaborated model of migration decision-making and behaviour to analyse the influence of individually experienced unemployment and unemployment risk. Following a contrast group design, respondents from two cities inGermanywith different levels of economic prosperity are compared using event history data from a tailor-made panel study. According to a micro-economic approach to migration it is expected that respondents living in an economically deprived city are more likely to decide in favour of migration and actually move compared to those living in a prosperous city because they often perceive opportunities as better elsewhere than at their current place of residence. Moreover, perceiving a risk of becoming unemployed in the near future might trigger migration decision-making more in a deprived city because difficulties to find a new job at the place of residence are anticipated. On the other hand, the new household economics approach and the theory of social networks stress the importance of the meso level. Individuals seldom decide in favour or against migration solely; the family rather makes joint decisions. Former research revealed that for unemployed people social networks are a major source for social support and are therefore especially important. There is evidence that in deprived regions social networks deter individuals stronger from moving than in others. These theoretical considerations and findings lead to the expectation that once people are unemployed they seldom leave deprived regions, what is at odds with the expectations from micro-economic theory.The analyses reveal that the perceived risk of becoming unemployed indeed triggers migration decision-making, but exclusively in the deprived city, whereas people who are already unemployed do not consider or plan leaving the city more often than employed people. Nevertheless, having a partner, children and family at the place of residence might outweigh the impact of a perceived unemployment risk on migration decision-making. When it comes to putting migration plans into action, it is found that the unemployed living in the deprived city are significantly more often constrained from moving compared to the unemployed living in the prosperous city. The analyses suggest that a concentration of social networks at the place of residence primarily accounts for this effect.

A school-based epidemiological study of dental neglect among adolescents in a deprived area of the UK

To assess the prevalence of two types of dental neglect (DN) for adolescents attending secondary schools in a deprived inner city area: neglect of the prevention of oral disease (DPN) and neglect of dental treatment (DTN). This study used cross-sectional data from Phase III of the research with East London adolescents community health survey (RELACHS); a longitudinal school-based epidemiological study that followed up a representative random sample of pupils in 29 secondary schools across three boroughs of inner North East London. Participants were clinically examined and answered a supervised questionnaire. DN was assessed in relation to DPN (measured by reference to experience of dental conditions and/or dental pain) and DTN (measured by reference to experience of at least one untreated dental condition and/or dental pain). Dental conditions included dental caries and traumatic dental injuries. Four in ten adolescents in the study experienced DPN and five in ten experienced DTN. Adolescents with special educational needs without a statement, refugee and those 'looked after' by a local authority experienced a higher proportion of both types of DN. In an inner city deprived area, the proportion of adolescents with DN (either DPN or DTN) was of significance. Refugee adolescents and looked after children may be more at risk of DN.

Die häusliche Umgebung von Familien mit Kleinkindern als Adresse für ein Public Health Angebot zur Reduktion von Tabakrauch

There is limited research about the acceptance of population-based prevention activities, offered systematically and directly at home. Screening data about smoking behaviour in families with children younger than 3 years were used. We examined associations between family variables (education, employment, number of children in the household), the "proportion of persons on social welfare" (PPSW) in the population aged 15-65 years and the following dependent variables: participation rate in a systematic screening, proportion of smokers within the sample of screened families and participation rate in counselling. For postal and personal contacts reporting data of children aged < 3 years, resident in Stralsund (due date 01.06.2008, N=1 298) were used. A total number of 827 families participated in the screening. The counselling was offered if at least 1 adult had smoked at least 1 cigarette per day in the last 4 weeks. Associations between family variables, PPSW and dependent variables were analysed using multilevel statistics. The higher the PPSP the lower is the probability for participation in the screening (odds ratio=0.982; 95% confidence interval=0.970-0.996). There was at least one adult smoker in 425 (51.4%) of these 827 families participating in the screening. The counselling was offered in 425 families, whereby 65.9% (280) participated. There was no association between family variables, PPSW and participation in the counselling. Differences in participation in the screening procedure are low: a high proportion of families in districts with a high PPSW took part. Even in districts with a PPSW rate of more than 30%, 71.3% of the families were successfully contacted. There is the recommendation to offer prevention measures in social< deprived city areas in a more proactive way considering the association between the prevalence of smoking in families and the proportion of PPSW.

‘Hungry for hands-on’: talented, inner-city engineering students, applied learning and employer engagement in a vocational-learning trajectory

This paper analyses the findings of a case study into the attitudes and experiences of engineering students and teachers on a vocational education trajectory from the 14–19 Diploma in Engineering through post-16 vocational courses to a university Access course. The research took place in 2008–2009 in a deprived inner city area of London. A baseline survey of nearly 100 participants sought the views of secondary and further education (FE) students as to learning preferences, attitudes to the subject, motivation and aspirations. These issues were investigated in more depth through interviews with secondary, vocational and university access students nominated by their teachers as talented. Engineering teachers at secondary, FE and higher education levels were interviewed regarding their understandings of talent in engineering and their approaches to nurturing such talent. The paper overviews the findings on these questions, and focuses in more depth on issues surrounding applied learning and employer engagement. The study found strong preferences among learners and teachers in all phases for applied and work-relevant learning approaches in engineering education. Opportunities for these were unbalanced through the phases, however, with work experience, enrichment events and access to professional engineers more available to the younger, 14–19 Diploma students than to further or higher education students.

More green space is linked to less stress in deprived communities: Evidence from salivary cortisol patterns

Green space has been associated with a wide range of health benefits, including stress reduction, but much pertinent evidence has relied on self-reported health indicators or experiments in artificially controlled environmental conditions. Little research has been reported using ecologically valid objective measures with participants in their everyday, residential settings. This paper describes the results of an exploratory study (n=25) to establish whether salivary cortisol can act as a biomarker for variation in stress levels which may be associated with varying levels of exposure to green spaces, and whether recruitment and adherence to the required, unsupervised, salivary cortisol sampling protocol within the domestic setting could be achieved in a highly deprived urban population. Self-reported measures of stress and general wellbeing were also captured, allowing exploration of relationships between cortisol, wellbeing and exposure to green space close to home. Results indicate significant relationships between self-reported stress (P<0.01), diurnal patterns of cortisol secretion (P<0.05), and quantity of green space in the living environment. Regression analysis indicates percentage of green space in the living environment is a significant (P<0.05) and independent predictor of the circadian cortisol cycle, in addition to self-reported physical activity (P<0.02). Results also show that compliance with the study protocol was good. We conclude that salivary cortisol measurement offers considerable potential for exploring relationships between wellbeing and green space and discuss how this ecologically valid methodology can be developed to confirm and extend findings in deprived city areas to illuminate why provision of green space close to home might enhance health.

Socio-demographic diversity and unexplained variation in death rates between the most deprived areas in Britain

BackgroundThere is a strong relationship between area death rates and deprivation in Britain. However, there is also considerable unexplained variation in death rates between the most deprived cities and regions.ObjectivesTo...

An evaluation of the long-term effectiveness of two adult community-based group weight management interventions

Background: National guidance supports the provision of weight loss group programmes in a community setting using behavioural change methods as the first line intervention for adults (NICE, 2006) and post-natal women (NICE, 2010). The evidence base for the long-term effectiveness for such National Health Service-provided interventions is currently limited (Paul-Ebhohimhen & Avenell, 2009). The aim of this service evaluation of two types of community-based, group weight management, 6-week courses in a multicultural deprived inner city area was to determine whether the weight loss achieved over 6 weeks was sustained over the long term, thus demonstrating that these courses are effective. Methods: All 167 clients, who had attended four or more sessions of a 6-week long Size Down or Post-Natal Size Down weight loss course between 6 and 24 months ago, were telephoned with the purpose of completing a telephone questionnaire to determine a recent weight measure. At least two attempts were made to contact each client. In addition, those who had attended the Post-Natal Size Down course were offered a home visit with electronic scales to obtain a weight measure aiming to lend validity to the reported weights from the telephone questionnaire. The weights obtained were compared with the clients’ weights on completion of the course. Verbal consent was obtained. Results: Seventy-four clients (72 female and two male) completed the telephone questionnaire. Ninety-three (56%) clients were noncontactable. Recent weight measures were obtained for 65 clients, 17 of which were obtained by a home visit. Nine clients refused to report their weight. Since completing the course, 31 (42%) clients had continued to lose weight with a mean further weight loss of 5.5% (Size Down, 4.3%; Post-Natal Size Down, 9%) (range 0.1–21.9%), in addition to the mean weight loss of 1.9% (Size Down, 1.7%; Post-Natal Size Down, 2.2%) over the 6-week course. Twenty-one (28%) clients had maintained their weight and 13 (18%) had gained weight. Overall mean weight change for all clients from the beginning of the course to the telephone questionnaire was −3.8% (Size Down, −3.9%; Post-Natal Size Down, −3.6%). Further analysis of all the 38 clients that had completed both courses ≥12 months ago (mean 17.5 months; range 12–25 months) demonstrated a mean −4.1 kg (3.9%) weight change from baseline weight. Discussion: Given that further weight loss or weight maintenance is reportedly unachievable over the long term for the majority of those who attend weight management groups (Wing, 2005), these data suggest a more positive outcome for these two particular interventions, with two-thirds of clients either continuing to lose more weight or being able to maintain the weight initially lost. The further analysis of the group weight change from baseline values compares favourably with a recent Cochrane review on weight loss interventions (Norris et al., 2009) where, after 1 year, baseline weight was reduced by 2.8 kg (3.3%). The limitations of this evaluation are the accuracy of the telephone interview for obtaining weight data because these weights were self-reported; the majority of the clients were female; the sample size used was small with a large number of clients noncontactable. Conclusions: This service evaluation of Size Down and Post-Natal Size Down suggests that the weight loss achieved over 6 weeks was successfully sustained by two-thirds of the clients over the long term, and that these particular interventions are effective. Further evaluation using actual weight measures and including more male clients is needed.

Is ADHD a disease of affluence? A local authority experience in north-west of england

AimThe relationship between social class and ADHD is unclear. We sought to investigate possible effects of social deprivation on ADHD prevalence in Liverpool area.Method1069 children from all areas of Liverpool...

* Effect of deprivation and ethnicity on bowel cancer screening uptake

IntroductionThe BCSP commenced in Bradford and Airedale during 2007, throughout this period, the authors have seen slightly lower uptake than other areas in our region. Bradford and Airedale BCSP encompasses...

The impact of deprivation on youth violence: a comparison of cities and their feeder towns

Background and aims66 000 children and adolescents are treated at emergency departments (EDs) in England and Wales each year for assault injury. The aim of this study was to compare...

The introduction of an oral surgical service in an intensive care unit serving a deprived inner city population - Evaluation of the first 100 patients

Background and Goal of Study: The population of Greater Glasgow exhibits poor oral health1. Poor oral hygiene is associated with the development of ven‐tilator associated pneumonia (VAP) as acknowledged in NICE (National Institute for Health and Clinical Excellence) guidelines2. We serve an inner city population with widespread socioeconomic deprivation. Following a recent survey of Scottish ICUs, which demonstrated that no ICU incorporated a dental review into their care3, we introduced an oral surgical review into our routine practice. Materials and Methods: An oral surgeon experienced in oral care provision in the critically ill performed ward rounds over a 6 month period. Patients expected to be intubated for >48 hours were examined. Patients were excluded if they were expected to be intubated for <48 hours, survive for <48hours, and where oral cavity examination was not possible (e.g. facial burns). Oral health was assessed and interventions documented including: advice to nursing staff on oral hygiene, debridement of oral debris, dental extraction and referral to the Community Dental Service on discharge. Results and Discussion: One hundred patients were examined. Mean age was 53.5 years. 67 patients (67%) were current or ex‐smokers, and 37 patients (37%) consumed >30 units of alcohol per week. 47 patients (47%) underwent oral surgical intervention. 13 patients (13%) required dental extraction. 24/53 patients (45%) who did not require oral surgical intervention were edentulous. One patient, with marked periodontal disease, was diagnosed with VAP during their stay. The patients reviewed are typical of the population in this ICU. Risk factors associated with poor oral hygiene are prevalent and dental health is poor. Conclusion(s): Our findings suggest that oral care needs of this patient group may not be adequately met by routine oral hygiene protocols. Further work is required to determine the optimal way to provide such a service, its cost effectiveness and any impact on VAP prevention.

Effectiveness of earlier antenatal screening for sickle cell disease and thalassaemia in primary care: cluster randomised trial

Objective To evaluate the effectiveness of offering antenatal screening for sickle cell disease and thalassaemia in primary care as a way of facilitating earlier uptake of screening.Design Partial factorial cluster...

Evaluation of the Townscape Heritage Initiative: Evidence from the Heritage Lottery Fund

The Heritage Lottery Fund (HLF) was set up in 1994 to distribute a share of National Lottery funds to projects involving the local, regional and national heritage of the UK. The Fund's urban regeneration programme, the Townscape Heritage Initiative (THI) was launched four years later. The THI is a conservation-led, area-based programme which aims to contribute to the regeneration of urban areas with heritage and socio-economic need. The rationale for the programme is that investment in historic fabric will benefit the appearance of an area, improve confidence, quality of life and economic performance, so initiating a cycle of new investment. The THI has now channelled more than £170m of HLF funds into over 175 towns and cities and secured at least the same amount of investment through public partnerships and private sources. This paper draws on the latest results of a longitudinal evaluation of the programme carried out by Oxford Brookes University between 1999 and 2008 ('Townscape Heritage Initiative five year review evaluation — final report', available at http://www.hlf.org.uk/HLF/Docs/ ResearchAndConsultation/THI%20five%20year% 20final%20report%201%20Aug.pdf). Oxford Brookes' researchers followed the progress of 17 case studies, beginning with a detailed baseline data-recording exercise. The research is thought to be the most significant evaluation of heritage-led regeneration in print to date, and this paper summarises the key impact findings and presents what appear to be some of the most significant prerequisites for achieving successful outcomes from a THI scheme. A case is also made that, particularly in relation to the most deprived towns and cities, conservation funding needs to be integrated within a wider regeneration strategy to have a high likelihood of success.

The effectiveness of a social marketing model on case-finding for COPD in a deprived inner city population

To evaluate the effectiveness of a social marketing model on case-finding for COPD in a population with high smoking rates and COPD prevalence. A two-week marketing campaign was conducted using high visibility posters, leaflets distributed with the local newspaper, and the creation of a free automated COPD information line. The primary outcome measure was the number of newly-diagnosed cases of COPD as a result of the campaign. Secondary outcomes measures were: the number of phone calls to the information line up to four weeks after the end of the campaign; the number of individuals who presented to their general practitioner (GP) for spirometry as a result of the campaign; and responses to a questionnaire sent to members of the public to analyse and assess the visibility and impact of the campaign. Ten people came forward to have spirometry performed and all had non-obstructive results. Nine calls were made to the dedicated COPD phone line. 135 out of 400 members of the public (34%) responded to the questionnaire; of these, only 34 (25%) recalled seeing a campaign poster. Posters and leaflets from this campaign were visible but only led to 10 individuals coming forward for spirometry, none of whom had COPD. This form of healthcare marketing was costly and not effective for COPD case-finding in our area.

Home blood pressure monitoring

Shah and colleagues found patients with heart failure who lived in areas of socioeconomic deprivation were less likely than those in more affluent areas to be treated with recommended beta blockers.1 We recently investigated use of home blood pressure (BP) monitoring in stroke patients registered at a deprived inner city general practice in Lambeth. In March 2008 we sent confidential postal questionnaires, backed up by a telephone call if required, to 74 patients listed on the stroke register at an inner London general practice. We excluded 57 patients in nursing homes and four patients with severe illness because of the difficulty of completing and posting questionnaires. The questions included asking patients whether they measured their BP at home and whether they were aware of their target BP. The protocol, patient information leaflet, and questionnaire were reviewed by Wandsworth Research Ethics Committee. Data were entered and analysed using SPSS (version 13).

Born in Bradford, a cohort study of babies born in Bradford, and their parents: Protocol for the recruitment phase

BackgroundBradford, one of the most deprived cities in the United Kingdom, has a wide range of public health problems associated with socioeconomic deprivation, including an infant mortality rate almost double that for England and Wales. Infant mortality is highest for babies of Pakistani origin, who comprise almost half the babies born in Bradford. The Born in Bradford cohort study aims to examine environmental, psychological and genetic factors that impact on health and development perinatally, during childhood and subsequent adult life, and those that influence their parents' health and wellbeing. This protocol outlines methods for the recruitment phase of the study.MethodsMost Bradford women attend for antenatal care and give birth at the Bradford Royal Infirmary, which has approximately 5,800 births per year. Women are eligible for recruitment if they plan to give birth here. Babies born from March 2007 are eligible to participate, recruitment is planned to continue until 2010. Fathers of babies recruited are invited to participate.Women are usually recruited when they attend for a routine oral glucose tolerance test at 26–28 weeks gestation. Recruitment of babies is at birth. Fathers are recruited whenever possible during the antenatal period, or soon after the birth. The aim is to recruit 10,000 women, their babies, and the babies' fathers.At recruitment women have blood samples taken, are interviewed to complete a semi-structured questionnaire, weighed, and have height, arm circumference and triceps skinfold measured. Umbilical cord blood is collected at birth. Within two weeks of birth babies have their head, arm and abdominal circumference measured, along with subscapular and triceps skinfold thickness. Fathers self-complete a questionnaire at recruitment, have height and weight measured, and provide a saliva sample.Participants are allocated a unique study number. NHS numbers will be used to facilitate record linkage and access to routine data. A wide range of hospital and community sources is being accessed to provide data for the women and children. Data are checked for accuracy and consistency.ConclusionBorn in Bradford will increase understanding of the factors that contribute to health and wellbeing, and identify factors that influence differences in them between people of Pakistani and European origin.

Clinical wastes in the community: local authority management of discarded drug litter

Despite comprehensive multi-agency management of complex social, criminal and health issues surrounding illicit drug use, substance abuse continues to escalate. Previously limited to deprived inner city areas, most communities now record rising numbers of intravenous drug users (IDUs) with increases of drug litter carelessly discarded in the environment, particularly in parks, gardens and public toilets. Bloodborne virus transmission with Hepatitis B (HBV) and Hepatitis C virus (HCV), and Human Immunodeficiency Virus (HIV) is the primary hazard. Needlestick injuries continue to occur, often involving children. Seroconversion and life-threatening infection is uncommon, although post-exposure prophylaxis and extensive follow-up is necessary and this may precipitate prolonged and debilitating stress for the victim and family group. Local authorities must maintain strategies to ensure the prompt and safe retrieval of drug litter. To evaluate the effectiveness of these services, an audit was undertaken to review information on the websites of each county, borough and district council and unitary authority throughout England (n 1⁄4 439), Northern Ireland (n 1⁄4 29), Scotland (n 1⁄4 37) and Wales (n 1⁄4 21). These 526 sites were accessed using search strategies described pre-

Creative clusters and city growth

Inspired by US management guru Michael Porter (1995) the City Growth Strategy initiative is promoting business clusters as a means of encouraging the regeneration of deprived inner city areas in the UK. This paper draws on an ongoing evaluation of one of the initial pilots for this initiative — the City Fringe area of London where six creative clusters are being targeted as a means of stimulating local economic development and social inclusion. Drawing on baseline research with the jewellery cluster the paper explores the degree to which this cluster gains competitive advantage from its inner city location and the extent to which it is able to contribute to the regeneration of the local area. It thus provides a critique of Porter's theory and contributes to our understanding of the extent to which creative clusters can act as a tool for inner city regeneration.

Social capital in its place: Using social theory to understand social capital and inequalities in health

Social capital has been controversially linked to public health benefits, particularly as an explanation for the relationship between economic inequalities and health. This paper focuses on social capital in this context, particularly a recent emphasis on social capital in neighbourhoods and growing use of Bourdieu's social theory in empirical investigations. A review of some of this work is used to suggest the need for a more coherent theoretical approach to using Bourdieu and to introduce an ethnographic study of social connections in New Zealand. Forty-six residents of, a rural town, a deprived city suburb, or an affluent suburb, volunteered to be interviewed about their social connections. Their talk was transcribed and analysed in terms of everyday practice. The results of this study suggest that social connections are not necessarily located in neighbourhoods, and that social capital will be better understood in a broader social context which includes competition for resources between deprived and non-deprived groups, and the practices of all citizens across neighbourhoods. When considering social capital, an exclusive focus on deprived neighbourhoods as sites for research and intervention is not helpful.