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1.  Evaluation of Health in Pregnancy grants in Scotland: a protocol for a natural experiment 
BMJ Open  2014;4(10):e006547.
A substantial proportion of low birth weight is attributable to the mother's cultural and socioeconomic circumstances. Early childhood programmes have been widely developed to improve child outcomes. In the UK, the Health in Pregnancy (HiP) grant, a universal conditional cash transfer of £190, was introduced for women reaching the 25th week of pregnancy with a due date on/or after 6 April 2009 and subsequently withdrawn for women reaching the 25th week of pregnancy on/or after 1 January 2011. The current study focuses on the evaluation of the effectiveness and cost-effectiveness of the HiP grant.
Methods and analysis
The population under study will be all singleton births in Scotland over the periods of January 2004 to March 2009 (preintervention), April 2009 to April 2011 (intervention) and May 2011 to December 2013 (postintervention). Data will be extracted from the Scottish maternity and neonatal database. The analysis period 2004–2013 should yield over 585 000 births. The primary outcome will be birth weight among singleton births. Other secondary outcomes will include gestation at booking, booking before 25 weeks; measures of size and stage; gestational age at delivery; weight-for-dates, term at birth; birth outcomes and maternal smoking. The main statistical method we will use is interrupted time series. Outcomes will be measured on individual births nested within mothers, with mothers themselves clustered within data zones. Multilevel regression models will be used to determine whether the outcomes changed during the period in which the HiP grants was in effect. Subgroup analyses will be conducted for those groups most likely to benefit from the payments.
Ethics and dissemination
Approval for data collection, storage and release for research purpose has been given (6 May 2014, PAC38A/13) by the Privacy Advisory Committee. The results of this study will be disseminated through peer-reviewed publications in journals, national and international conferences.
PMCID: PMC4202003  PMID: 25324327
2.  Early death in those previously hospitalised for mental healthcare in Scotland: a nationwide cohort study, 1986–2010 
BMJ Open  2013;3(7):e002768.
To compare the mortality in those previously hospitalised for mental disorder in Scotland to that experienced by the general population.
Population-based historical cohort study using routinely available psychiatric hospital discharge and death records.
All Scotland.
Individuals with a first hospital admission for mental disorder between 1986 and 2009 who had died by 31 December 2010 (34 243 individuals).
The main outcome measure was death from any cause, 1986–2010. Excess mortality was presented as standardised mortality ratios (SMRs) and years of life lost (YLL). Excess mortality was assessed overall and by age, sex, main psychiatric diagnosis, whether the psychiatric diagnosis was ‘complicated’ (ie, additional mental or physical ill-health diagnoses present), cause of death and time period of first admission.
111 504 people were included in the study, and 34 243 had died by 31 December 2010. The average reduction in life expectancy for the whole cohort was 17 years, with eating disorders (39-year reduction) and ‘complicated’ personality disorders (27.5-year reduction) being worst affected. ‘Natural’ causes of death such as cardiovascular disease showed modestly elevated relative risk (SMR1.7), but accounted for 67% of all deaths and 54% of the total burden of YLL. Non-natural deaths such as suicide showed higher relative risk (SMR5.2) and tended to occur at a younger age, but were less common overall (11% of all deaths and 22% of all YLL). Having a ‘complicated’ diagnosis tended to elevate the risk of early death. No worsening of the overall excess mortality experienced by individuals with previous psychiatric admission over time was observed.
Early death for those hospitalised with mental disorder is common, and represents a significant inequality even in well-developed healthcare systems. Prevention of suicide and cardiovascular disease deserves particular attention in the mentally disordered.
PMCID: PMC3731727  PMID: 23901025
Mental Health; Public Health
3.  General practitioner provision of preventive child health care: analysis of routine consultation data 
BMC Family Practice  2012;13:73.
GPs contribute to preventive child health care in various ways, including provision of child health surveillance (CHS) reviews, opportunistic preventive care, and more intensive support to vulnerable children. The number of CHS reviews offered in Scotland was reduced from 2005. This study aimed to quantify GPs’ provision of different types of preventive care to pre-school children before and after the changes to the CHS system.
GP consultation rates with children aged 0–4 years were examined for the 2½ years before and after the changes to the CHS system using routinely available data from 30 practices in Scotland. Consultations for CHS reviews; other aspects of preventive care; and all reasons were considered.
Prior to the changes to the CHS system, GPs often contributed to CHS reviews at 6–8 weeks and 8–9 and 39–42 months. Following the changes, GP provision of the 6–8 week review continued but other reviews essentially ceased. Few additional consultations with pre-school children are recorded as involving other aspects of preventive care, and the changes to CHS have had no impact on this. In the 2½ years before and after the changes, consultations recorded as involving any form of preventive care accounted for 11% and 7.5% respectively of all consultations with children aged 0–4 years, with the decline due to reductions in CHS reviews.
Effective preventive care through the early years can help children secure good health and developmental outcomes. GPs are well placed to contribute to the provision of such care. Consultations focused on preventive care form a small minority of GPs’ contacts with pre-school children, however, particularly since the reduction in the number of CHS reviews.
PMCID: PMC3460766  PMID: 22862924
Child health; General practice; Preventive health services; Health promotion; General practitioners; Health visitors
4.  Trends in the coverage of ‘universal’ child health reviews: observational study using routinely available data 
BMJ Open  2012;2(2):e000759.
Universally offered child health reviews form the backbone of the UK child health programme. The reviews assess children's health, development and well-being and facilitate access to additional support as required. The number of reviews offered per child has been reduced over recent years to allow more flexible provision of support to families in need: equitable coverage of the remaining reviews is therefore particularly important. This study assessed the coverage of universal child health reviews, with an emphasis on trends over time and inequalities in coverage by deprivation.
Assessment of the coverage of child health reviews by area-based deprivation using routinely available data. Supplementary audit of the quality of the routine data source used.
Two cohorts of around 40 000 children each. The cohorts were born in 1998/1999 and 2007/2008 and eligible for the previous programme of five and the current programme of two preschool reviews, respectively.
Outcome measures
Coverage of the specified child health reviews for the whole cohorts and by deprivation.
Coverage of the 10 day review is high (99%), but it progressively declines for reviews at older ages (86% for the 39–42 month review). Coverage is lower in children living in the most deprived areas for all reviews, and the discrepancy progressively increases for reviews at older ages (78% and 92% coverage for the 39–42 month review in most and least deprived groups). Coverage has been stable over time: it has not increased for the remaining reviews after reduction in the number of reviews provided.
The inverse care law continues to operate in relation to ‘universal’ child health reviews. Equitable uptake of reviews is important to ensure maximum likely impact on inequalities in children's outcomes.
Article summary
Article focus
A series of universally offered child health reviews providing assessment of children's health, development and well-being forms the backbone of the UK child health programme.
The number of reviews offered per child has been reduced over recent years to increase capacity to provide effective individualised support to families in need: equitable coverage of the remaining reviews is therefore particularly important.
We used routinely available data to assess the coverage of the various child health reviews (overall and by deprivation) before and after the change in the number of reviews offered.
Key messages
Coverage of reviews offered in early infancy is high, but it progressively declines for reviews at older ages (around 99% coverage for the 10 day review and 86% for the 39–42 month review).
Coverage is lower in the most deprived groups for all reviews, and the discrepancy progressively increases for reviews at older ages (78% and 92% coverage for the 39–42 month review in most and least deprived groups).
Coverage has not changed for the remaining reviews after reduction in the number of reviews offered: the inverse care law continues to operate in relation to provision of ‘universal’ child health reviews.
Strengths and limitations of this study
To our knowledge, no quantitative assessment of the coverage of child health reviews offered in the UK has previously been published.
This analysis involved large numbers of children: over 80 000 children eligible to receive their child health reviews in Scotland were included.
Careful consideration must be given to data quality when analysing routinely available data: we conducted an audit of data quality to allow the uncertainty in the results to be quantified.
PMCID: PMC3317139  PMID: 22457481
5.  Conditioned lick behavior and evoked responses using whisker twitches in head restrained rats 
Behavioural brain research  2008;197(1):16-23.
To examine whisker barrel evoked response potentials in chronically implanted rats during behavioral learning with very fast response times, rats must be calm while immobilized with their head restrained. We quantified their behaviors during training with an ethogram and measured each individual animals’ progress over the training period. Once calm under restraint, rats were conditioned to differentiate between a reward and control whisker twitch, then provide a lick response when presented with the correct stimulus, rewarded by a drop of water. Rats produced the correct licking response (after reward whisker twitch), and learned not to lick after a control whisker was twitched. By implementing a high density 64 channel electrocorticogram (ECoG) electrode array, we mapped the barrel field of the somatosensory cortex with high spatial and temporal resolution during conditioned lick behaviors. In agreement with previous reports, we observe a larger evoked response after training, probably related to mechanisms of cortical plasticity.
PMCID: PMC2607480  PMID: 18718491
EEG; ECoG Electrode array; Restraint; Somatosensory cortex; Learning
6.  Measuring inequalities in health: the case for healthy life expectancy 
To evaluate healthy life expectancy (HLE) as a measure of health inequalities by comparing geographical and area‐based deprivation‐related inequalities in healthy and total life expectancy (TLE).
Life table analysis based on ecological cross‐sectional data.
Setting and population
Council area quarters and postcode sector‐based deprivation fifths in Scotland.
Main outcome measures
Expectation of life in good self‐assessed general health, or free from limiting long‐term illness, and TLE, for females and males at birth.
Women in Scotland have a life expectation of 70.3 years in good health, 61.6 years free from limiting long‐term illness, and a TLE of 78.9 years. Comparable figures for men are 66.3, 58.6 and 73.5 years. TLE and HLE decrease with increasing area deprivation. Differences are substantially wider for HLE. A 4.7‐year difference is seen in TLE between women living in the most and least deprived fifth of areas. The difference in HLE is 10.7 years in good health and 11.6 years free from limiting long‐term illness. The degree of deprivation‐related inequality in HLE is 2.5 times wider for women and 1.8 times wider for men than in TLE.
Differences in TLE underestimate health inequalities substantially. By including morbidity and mortality, HLE reflects the excess burden of ill health experienced by disadvantaged populations better. Inequalities in length of life and health status during life should be taken into account while monitoring inequalities in population health.
PMCID: PMC2465513  PMID: 17108308

Results 1-6 (6)