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Summary: Socio‐economic deprivation is associated with adverse maternal and childhood outcomes. Epidural analgesia, the gold standard for labour analgesia, may improve maternal well‐being. We assessed the association of socio‐economic status with utilisation of epidural analgesia and whether this differed when epidural analgesia was advisable for maternal safety. This was a population‐based study of NHS data for all women in labour in Scotland between 1 January 2007 and 23 October 2020, excluding elective caesarean sections. Socio‐economic status deciles were defined using the Scottish Index of Multiple Deprivation. Medical conditions for which epidural analgesia is advisable for maternal safety (medical indications) and contraindications were defined according to national guidelines. Of 593,230 patients in labour, 131,521 (22.2%) received epidural analgesia. Those from the most deprived areas were 16% less likely to receive epidural analgesia than the most affluent (relative risk 0.84 [95%CI 0.82–0.85]), with the inter‐decile mean change in receiving epidural analgesia estimated at ‐2% ([95%CI ‐2.2% to ‐1.7%]). Among the 21,219 deliveries with a documented medical indication for epidural analgesia, the socio‐economic gradient persisted (relative risk 0.79 [95%CI 0.75–0.84], inter‐decile mean change in receiving epidural analgesia ‐2.5% [95%CI ‐3.1% to ‐2.0%]). Women in the most deprived areas with a medical indication for epidural analgesia were still less likely (absolute risk 0.23 [95%CI 0.22–0.24]) to receive epidural analgesia than women from the most advantaged decile without a medical indication (absolute risk 0.25 [95%CI 0.24–0.25]). Socio‐economic deprivation is associated with lower utilisation of epidural analgesia, even when epidural analgesia is advisable for maternal safety. Ensuring equitable access to an intervention that alleviates pain and potentially reduces adverse outcomes is crucial. [ABSTRACT FROM AUTHOR]

Our study is the first to demonstrate at a national level that rates of new MND diagnoses and all-cause mortality in pwMND have thus far been unaffected by COVID-19. The adverse impact of COVID-19 on longer-term quality of life, carer burden, morbidity and mortality in this vulnerable group requires longitudinal evaluation. Laura Marshall: Department of Neurology, NHS Forth Valley, Larbert, UK; Department of Neurology, NHS Fife, Kirkaldy, UK. [Extracted from the article]

Background: Fifteen regional studies published over the last six decades surveying prevalence, mortality and hospital admissions have suggested that Scotland is amongst the highest risk nations for multiple sclerosis (MS) in the world. However, substantial intranational variation in rates (between regions) has been described in numerous countries, including in the only previous Scottish national survey, which used hospital admission data, to address this issue. Against this backdrop, the Scottish Multiple Sclerosis Register (SMSR) was established in 2010 to prospectively collect nationally comprehensive incidence data and to allow for regional comparisons. Methods: Here, we present the SMSR and analyse the variation in crude and age–sex standardized incidence rates, lifetime risk (cumulative incidence), and the sex distribution of cases and rates, between the 14 administrative Health Boards or regions of Scotland: 01 January 2010 to 31 December 2017. Results: The overall incidence rate for Scotland was 8.76/100,000 person-years (standardized: 8.54). Regional incidence rates varied significantly—up to threefold—between Health Boards (p < 1 × 10–13). The national female-to-male sex ratio was 2.3:1, but this too varied regionally (outlier regions result in a range from 1.0 to 4.2:1). Lifetime risk ranged from 19.9/1000 for females in Orkney (58.98°N) to 1.6/1000 for males in the Borders (55.60°N). Comparison with a previous national survey suggests that these differences are longstanding. In 6 of 14 regions the lifetime risk for women exceeds 1%. Conclusions: This study introduces a national incidence register: a valuable research tool and the result of substantial public investment. The wide variation in incidence rates and sex ratios between regions, in a relatively homogenous population, raises questions for future study. [ABSTRACT FROM AUTHOR]

The Scottish Government’s vision of improving outcomes for children prioritises attachment theory and research in promoting children’s well-being across children’s services. This theme is also noted as increasing international relevance. Our narrative research springs from the experience of designing and delivering the first course within initial teacher education in Scotland to focus on the application of attachment theory to the role and identity of the teacher – particularly, in supporting children vulnerable through experiences of trauma and adversity. We capture students’ ‘real time’ learning moments through reflective journaling during school experience within the analytic ‘Doing, knowing, being and becoming’. Emergent themes include: looking behind and responding to behaviours, making links with ‘lived lives’, understanding teachers’ potential as attachment figures and ‘secure base’, understanding the relevance of adult attachment theory and resilience/self-care to teachers’ emotions and their own attachment experiences. [ABSTRACT FROM PUBLISHER]

Urban regeneration (UR) programmes are recognised as a type of Population Health Intervention (PHI), addressing social and health inequalities. Policy recommends programmes involve communities through engagement and empowerment. Whilst the literature has started to link empowerment with health improvement, this has not been within an UR context. As part of broader research on the economic evaluation of community empowerment activities, this paper examines how health gains can be generated through promoting empowerment as well as identifying whether feelings of empowerment are associated with residents personal characteristics or perceptions of their neighbourhood. Using 2011 Community Health and Wellbeing Survey (GoWell) cross-sectional data, ordinal logistic regression and simple linear regression analysis of 15 Glasgow neighbourhoods undergoing regeneration with 4302 adult householders (≥16 years old) was completed. Analyses identified strong associations (P≥ 0.05) between empowerment and the mental health subscale of the SF12v2 and with several items of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) scale. Furthermore, residents’ who felt more empowered reported more positive attitudes towards their surroundings and housing providers. This concurs with recent evidence of the importance of residents’ psychological investments in their neighbourhood influencing their sense of place attachment. Such analyses present initial evidence of the value of investing resources within UR programmes to activities geared towards increasing residents’ empowerment as a means of producing those health gains often sought by more costly aspects of the programmes. [ABSTRACT FROM AUTHOR]

There is a growing policy concern about the extent of loneliness in advanced societies, and its prevalence among various social groups. This study looks at loneliness among people living in deprived communities, where there may be additional barriers to social engagement including low incomes, fear of crime, poor services and transient populations. The aim was to examine the prevalence of loneliness, and also its associations with different types of social contacts and forms of social support, and its links to self-reported health and well-being in the population group. The method involved a cross-sectional survey of 4302 adults across 15 communities, with the data analysed using multinomial logistic regression controlling for sociodemographics, then for all other predictors within each domain of interest. Frequent feelings of loneliness were more common among those who: had contact with family monthly or less; had contact with neighbours weekly or less; rarely talked to people in the neighbourhood; and who had no available sources of practical or emotional support. Feelings of loneliness were most strongly associated with poor mental health, but were also associated with long-term problems of stress, anxiety and depression, and with low mental well-being, though to a lesser degree. The findings are consistent with a view that situational loneliness may be the product of residential structures and resources in deprived areas. The findings also show that neighbourly behaviours of different kinds are important for protecting against loneliness in deprived communities. Familiarity within the neighbourhood, as active acquaintance rather than merely recognition, is also important. The findings are indicative of several mechanisms that may link loneliness to health and well-being in our study group: loneliness itself as a stressor; lonely people not responding well to the many other stressors in deprived areas; and loneliness as the product of weak social buffering to protect against stressors. [ABSTRACT FROM PUBLISHER]

This article draws on the author’s experience of a narrative inquiry project with young people who were designated within the policy context in Scotland as at risk of social exclusion and in need of ‘More Choices, More Chances’. The project explored how the young people’s narratives of transition integrated the concept of ‘critical moments’, namely how the complex interplay between self and social structures was seen to be embedded at key transitional stages. The relevance of professional support was also examined through engaging with themes of identity construction and inclusion at these ‘moments’, and through highlighting choices and constraints to choice as the overarching theme.This article focuses on the methodological dimensions of the research through the lens of ethical practice and social justice, interrogating notions of researcher reflexivity, empowerment, authenticity and transferability in accessing and representing the marginalized ‘voices’ of the participants, and exploring the ethical dilemmas which arose in this process. The use of visual tools to prompt and represent the young people’s narratives is examined in the light of the interweaving of substantive and participatory aims. In conclusion key questions are posed in relation to how far the research may contribute to a social justice agenda. [ABSTRACT FROM AUTHOR]

Background: There is a healthy public policy agenda investigating the health impacts of improving living conditions. However, there are few economic evaluations, to date, assessing value for money. We conducted the first cost-effectiveness analysis of a nationwide intervention transferring social and private tenants to new-build social housing, in Scotland. Methods: A quasi-experimental prospective study was undertaken involving 205 intervention households and 246 comparison households, over 2 years. A cost-utility analysis assessed the average cost per change in health utility (a single score summarising overall health-related quality of life), generated via the SF-6D algorithm. Construction costs for new builds were included. Analysis was conducted for all households, and by family, adult and elderly households; with estimates adjusted for baseline confounders. Outcomes were annuitised and discounted at 3.5%. Results: The average discounted cost was £18 708 per household, at a national programme cost of £28.4 million. The average change in health utility scores in the intervention group attributable to the intervention were +0.001 for all households, +0.001 for family households, −0.04 for adult households and −0.03 for elderly households. All estimates were statistically insignificant. Conclusions: At face value, the interventions were not value for money in health terms. However, because the policy rationale was the amenity provision of housing for disadvantaged groups, impacts extend beyond health and may be fully realised over the long term. Before making general value-for-money inferences, economic evaluation should attempt to estimate the full social value of interventions, model long-term impacts and explicitly incorporate equity considerations. [ABSTRACT FROM AUTHOR]

Abstract: Few studies have simultaneously examined the relationship of levels of recorded crime, perceptions of crime and disorder, and safety from crime with rates of physical activity. We developed a series of multilevel ordinal regression models to examine these aspects in relation to self-reported neighbourhood walking frequency in a cross-sectional sample of 3824 British adults from 29 deprived neighbourhoods in Glasgow, UK. Perceptions of several serious local antisocial behaviours (drunkenness and burglary) and feelings of personal safety (feeling safe in the home and if walking alone in the local area at night) were consistently associated, respectively, with less and more frequent walking. Conversely, perceiving drug dealing or drug use as a serious problem was associated with walking more frequently. There was a small but significant association between walking frequency in neighbourhoods with higher recorded person crime (but not property crime) rates when considered in conjunction with other aspects of disorder and crime safety, although not when additionally controlling for sociodemographic, neighbourhood and community aspects. The magnitude of these objective and perceived crime-related effects is modest and features of the psychosocial environment and social cohesion (having a sense of progress from living in the neighbourhood, group participation and positively rating social venues), as well as health and personal income deprivation, may more strongly determine levels of neighbourhood walking. Nevertheless, physical activity benefits may accrue at the population level through provision of environments that are safer from crime. Our study also shows the importance to local walking of neighbourhood management, which reduces problems of disorder, and of social regeneration, which helps strengthen sense of community. [Copyright &y& Elsevier]

Background: Recently there has been growing interest in how neighbourhood features, such as the provision of local facilities and amenities, influence residents' health and well-being. Prior research has measured amenity provision through subjective measures (surveying residents' perceptions) or objective (GIS mapping of distance) methods. The latter may provide a more accurate measure of physical access, but residents may not use local amenities if they do not perceive them as 'local'. We believe both subjective and objective measures should be explored, and use West Central Scotland data to investigate correspondence between residents' subjective assessments of how well-placed they are for everyday amenities (food stores, primary and secondary schools, libraries, pharmacies, public recreation), and objective GIS-modelled measures, and examine correspondence by various sub-groups. Methods: ArcMap was used to map the postal locations of 'Transport, Health and Well-being 2010 Study' respondents (n = 1760), and the six amenities, and the presence/absence of each of them within various straight-line and network buffers around respondents' homes was recorded. SPSS was used to investigate whether objective presence of an amenity within a specified buffer was perceived by a respondent as being well-placed for that amenity. Kappa statistics were used to test agreement between measures for all respondents, and by sex, age, social class, area deprivation, car ownership, dog ownership, walking in the local area, and years lived in current home. Results: In general, there was poor agreement (Kappa <0.20) between perceptions of being well-placed for each facility and objective presence, within 800 m and 1000 m straight-line and network buffers, with the exception of pharmacies (at 1000 m straight-line) (Kappa: 0.21). Results varied between respondent sub-groups, with some showing better agreement than others. Amongst sub-groups, at 800 m straight-line buffers, the highest correspondence between subjective and objective measures was for pharmacies and primary schools, and at 1000 m, for pharmacies, primary schools and libraries. For road network buffers under 1000 m, agreement was generally poor. Conclusion: Respondents did not necessarily regard themselves as well-placed for specific amenities when these amenities were present within specified boundaries around their homes, with some exceptions; the picture is not clear-cut with varying findings between different amenities, buffers, and sub-groups. [ABSTRACT FROM AUTHOR]

Objectives. We took advantage of a 2-intervention natural experiment to investigate the impacts of neighborhood demolition and housing improvement on adult residents' mental and physical health. Methods. We identified a longitudinal cohort (n = 1041, including intervention and control participants) by matching participants in 2 randomly sampled cross-sectional surveys conducted in 2006 and 2008 in 14 disadvantaged neighborhoods of Glasgow, United Kingdom. We measured residents' self-reported health with Medical Outcomes Study Short Form Health Survey version 2 mean scores. Results. After adjustment for potential confounders and baseline health, mean mental and physical health scores for residents living in partly demolished neighborhoods were similar to the control group (mental health, b = 2.49; 95% confidence interval [CI] = -1.25, 6.23; P = .185; physical health, b = -0.24; 95% CI = -2.96, 2.48; P = .859). Mean mental health scores for residents experiencing housing improvement were higher than in the control group (b = 2.41; 95% CI = 0.03, 4.80; P = .047); physical health scores were similar between groups (b = -0.66; 95% CI = -2.57, 1.25; P = .486). Conclusions. Our findings suggest that housing improvement may lead to small, short-term mental health benefits. Physical deterioration and demolition of neighborhoods do not appear to adversely affect residents' health. [ABSTRACT FROM AUTHOR]

Background People living in areas of multiple deprivation are more likely to smoke and less likely to quit smoking. This study examines the effect on smoking and intention to quit smoking for those who have experienced housing improvements (HI) in deprived areas of Glasgow, UK, and investigates whether such effects can be explained by improved mental health. Methods Quasi-experimental, 2-year longitudinal study, comparing residents’ smoking and intention to quit smoking for HI group (n=545) with non-HI group (n=517), adjusting for baseline (2006) sociodemographic factors and smoking status. SF-12 mental health scores were used to assess mental health, along with self-reported experience of, and General Practitioner (GP) consultations for, anxiety and depression in the last 12 months. Results There was no relationship between smoking and HI, adjusting for baseline rates (OR=0.97, 95% CI 0.57 to 1.67, p=0.918). We found an association between intention to quit and HI, which remained significant after adjusting for sociodemographics and previous intention to quit (OR 2.16, 95% CI 1.12 to 4.16, p=0.022). We found no consistent evidence that this association was attenuated by improvement in our three mental health measures. Conclusions Providing residents in disadvantaged areas with better housing may prompt them to consider quitting smoking. However, few people actually quit, indicating that residential improvements or changes to the physical environment may not be sufficient drivers of personal behavioural change. It would make sense to link health services to housing regeneration projects to support changes in health behaviours at a time when environmental change appears to make behavioural change more likely. [ABSTRACT FROM AUTHOR]

Background The study investigated whether perceived relative position was associated with mental well-being for people living in deprived areas, as a contribution to debates about income inequality, relative deprivation and health. Methods A survey of 4615 residents of deprived areas of Glasgow measured mental well-being using the WEMWBS scale. Perceived relative position was assessed locally and across wider society in relation to housing, neighbourhood and standard of living. Personal and dwelling characteristics were controlled for. Results Mental well-being was found to be positively associated with: perceived relative quality (RR 4.1, 95% CI 2.4 to 6.8) and status (RR 7.1, 95% CI 4.5 to 11.1) of the home; perceived internal reputation of the neighbourhood (RR 4.9, 95% CI 2.9 to 8.2), though not external reputation; and perceived relative standard of living (RR 5.2, 95% CI 3.2 to 8.4). Furthermore, respondents who thought they lived in an area where some people had higher incomes than others also reported higher mental well-being (RR 4.5, 95% CI 2.2 to 9.1), controlling for the effects of their own income. Conclusion Studies of inequality and health could give more consideration to the importance of the residential domain of housing and neighbourhood to mental wellbeing outcomes, via the psychosocial pathway. The local spatial scale may be more important to issues of relative deprivation than previously thought, as people make local as well as broader comparisons. The ability to make upward comparisons of income within deprived areas may be beneficial to residents rather than detrimental, possibly as an indicator of area progress and 'normality'. [ABSTRACT FROM AUTHOR]

In advanced countries, where many of the most deleterious physical health effects of poor housing have been eradicated or substantially reduced, there has been increasing interest in mental health and psychosocial benefits as housing outcomes. Recently available data, based on a large-scale survey of social renters in Glasgow, have offered the opportunity to explore the psychosocial benefits of home in previously unavailable detail, over a range of property types and housing improvement interventions. Findings indicate that home improvements have mediating effects upon the psychosocial benefits, which occupants derive from their homes via their impacts upon perceived home quality. However, landlord relations and the quality of the wider neighbourhood within which improvements take place are shown to be important moderators of this relationship. In particular, landlords' overall service performance, how they keep tenants informed and how they take tenants' views on board, all make a difference to perceptions of home quality and to psychosocial status and control. [ABSTRACT FROM AUTHOR]

This paper tells the story of how a model of action research was used to examine my own development and emerging identity as a researcher through the Master of Research programme at my employing university in Scotland. It is located within a context of increasing expectations on academics within vocational training departments of UK universities to give priority to research activity. My story aims to engage with how the challenges in developing ‘self-as-researcher’ were interwoven with my learning through undertaking a narrative inquiry project with ‘More Choices, More Chances’ young people, as part of the Master of Research. The key stages of the research process, notably the search for authentic ways of gathering and representing the stories of the young people around the key themes of identity and inclusion, evoked the resonance of these themes with my own narrative of shifting and overlapping identities. In setting this paper within the context of current international literature I aim to add to current interest in reflexivity in research through illuminating the connections between the action research and narrative inquiry processes. Values around empowerment and social justice, illustrated in the paper through reflecting on the researcher/participant relationship, are interwoven in both. The visual research methods used in the narrative inquiry project are examined in terms of their contribution to an empowering ‘space’ for storytelling, and to my representation of these stories in trustworthy ways. [ABSTRACT FROM AUTHOR]

The current period is one of ambiguity and contestation over the future of high-rise. A range of analyses is performed on survey data from deprived areas in Glasgow to examine the impacts of living in high-rise in comparison to other dwelling types. The findings show that many residential outcomes are worse for people in high-rise, especially related to noise and security issues in dwellings and buildings. Social and psychosocial outcomes are often worse in high-rise, particularly frequency of contact with neighbours and a number of aspects of control and recuperation at home. Further analysis shows that neighbourhood satisfaction and some social outcomes are better (or ameliorated) for people living higher up in tall buildings. There were different patterns of impacts for different household types. Contrary to much of the literature, the study found that negative impacts of high-rise were most wide ranging among adult-only households rather than families, with older persons least affected by negative social outcomes in high-rise. [ABSTRACT FROM AUTHOR]

The association between poor housing and poor health is widely accepted, but there is a lack of evidence on the health impact of housing interventions. In particular, evidence on mechanisms linking housing interventions to health is lacking. Scotland's Housing and Regeneration Project (SHARP) evaluated the health impacts of new-build social housing using a quasi-experimental survey design. Qualitative interviews were also conducted with a sub-sample of survey respondents. The qualitative data indicated that changes in dwelling type influenced key psychosocial processes such as control, with consequent impacts on well-being. This study provided insights into the psychosocial impacts of housing design, whilst also demonstrating the utility of qualitative methods for enhancing understanding of the mechanisms linking housing change with improved well-being. [ABSTRACT FROM AUTHOR]

Abstract: More frequent neighbourhood walking is a realistic goal for improving physical activity in deprived areas. We address regeneration activity by examining associations of residents'' circumstances and perceptions of their local environment with frequent (5+ days/week) local walking (NW5) in 32 deprived neighbourhoods (Glasgow, UK), based on interview responses from a random stratified cross-sectional sample of 5657 residents. Associations were investigated by bivariate and multilevel, multivariate logistic regression. People living in low-rise flats or houses reported greater NW5 than those in multi-storey flats. Physical and social aspects of the neighbourhood were more strongly related to walking than perceptions of housing and neighbourhood, especially the neighbourhood''s external reputation, and feelings of safety and belonging. Amenity use, especially of parks, play areas and general shops (mainly in the neighbourhood), was associated with more walking. Multidimensional regeneration of the physical, service, social and psychosocial environments of deprived communities therefore seems an appropriate strategy to boost walking. [Copyright &y& Elsevier]

An overview of various conference papers about the contemporary challenges to family support is presented, including a discussion on family support based on a conceptual framework comprising a rights-based, outcomes approach, an exploration of the theme of providing culturally relevant and responsive services to parents, and a description of the development of a new form of family support work and welfare services in a Scottish local authority between 2006-2009.

A key objective of the Glasgow housing stock transfer in 2003 was promoting community empowerment, community control and community ownership. The first-stage transfer was from Glasgow City Council to Glasgow Housing Association and it was assumed by many that transfer to local housing organisations (LHOs)--thus promoting community ownership--would follow. This paper assesses the nature of community empowerment in LHO management committees and is part of a wider programme of research on governance, participation and empowerment. The study found that, despite its construction and aims, stock transfer policy is not able to deliver a uniform policy outcome in terms of community empowerment. No unitary relationship between community empowerment and community ownership was observed: it is suggested that the opportunity and capability to make choices about preferred management/ ownership arrangements is more empowering than ownership per se. [ABSTRACT FROM AUTHOR]

This paper starts by identifying the intended benefits of community engagement in regeneration according to policy theory. It then adds to the evidence base by assessing to what extent these aims are being achieved through community engagement in the latest cycle of area regeneration in the city of Glasgow. It is based on a qualitative study of residents’ experiences and perceptions of the regeneration planning process in three neighbourhoods undergoing major regeneration. Up to the period beyond regeneration planning, and into the early stages of implementation, community engagement had made contributions to some of the identified aims. However, there were weaknesses in relation to community empowerment beyond regeneration, community cohesion and effective implementation in particular. A series of recommendations are made; of particular importance is the necessity to maintain community engagement throughout the regeneration process, between planning and implementation, in order to ensure that any benefits are sustained. [ABSTRACT FROM AUTHOR]

Background: There is little robust evidence to test the policy assumption that housing-led area regeneration strategies will contribute to health improvement and reduce social inequalities in health. The GoWell Programme has been designed to measure effects on health and wellbeing of multi-faceted regeneration interventions on residents of disadvantaged neighbourhoods in the city of Glasgow, Scotland. Methods/Design: This mixed methods study focused (initially) on 14 disadvantaged neighbourhoods experiencing regeneration. These were grouped by intervention into 5 categories for comparison. GoWell includes a preintervention householder survey (n = 6008) and three follow-up repeat-cross sectional surveys held at two or three year intervals (the main focus of this protocol) conducted alongside a nested longitudinal study of residents from 6 of those areas. Self-reported responses from face-to-face questionnaires are analysed along with various routinely produced ecological data and documentary sources to build a picture of the changes taking place, their cost and impacts on residents and communities. Qualitative methods include interviews and focus groups of residents, housing managers and other stakeholders exploring issues such as the neighbourhood context, potential pathways from regeneration to health, community engagement and empowerment. Discussion: Urban regeneration programmes are 'natural experiments.' They are complex interventions that may impact upon social determinants of population health and wellbeing. Measuring the effects of such interventions is notoriously challenging. GoWell compares the health and wellbeing effects of different approaches to regeneration, generates theory on pathways from regeneration to health and explores the attitudes and responses of residents and other stakeholders to neighbourhood change. [ABSTRACT FROM AUTHOR]

The most significant housing stock transfer in the UK took place in Glasgow in 2003. It has been widely and repeatedly depicted as a policy 'failure', by both journalists and informed critics. This article evaluates the specific claims of failure by looking at developments to date and the available evidence. It uses an available theoretical framework to consider how such judgements have been arrived at, revealing the biases contained therein. The label of 'failure' is rejected, but policy deficiencies are identified; again, a theoretical framework is used to relate these weaknesses to the nature of the politics involved in the formation and oversight of the policy. [ABSTRACT FROM AUTHOR]

This paper looks at changing patterns of residence for South Asians (Pakistani, Indian, Bangladeshi and other South Asians as represented in the census) in Greater Glasgow, as well as considering what South Asians' motivations for choice of residential location are, and how these relate to issues of personal identity. Providing a single account for the city of Glasgow proves difficult, since there are big differences in experience between traditional areas of settlement and suburbs north of the city centre, compared with those in the south of the city. Whilst the study finds evidence of greater residential mixing by South Asians within the city (contrary to the self-segregation claim), there are also indications that these are somewhat 'bounded choices' made by people trying to balance competing identities and cultural claims and aspirations, and not simply a desire to 'mix'. Equally, one must be careful to interpret suburbanisation as a particular form of 'integration' founded on a normality that involves greater privatism and socio-economic aspirations and little expectation of social interaction with white neighbours. [ABSTRACT FROM AUTHOR]

In 2003 the City of Glasgow saw the largest housing stock transfer in the UK, involving around 80 000 dwellings. Since then, the implementation of the stock transfer policy has been heavily criticised. This paper uses a framework developed from implementation studies to analyse why this policy has been susceptible to difficulties and to reflect upon the important elements of a revised analytical framework. The paper finds that the study of policy implementation must contain an appreciation of the effects of having multiple policy objectives, multiple layers of governance and multiple actors involved in policy delivery. Additional elements of a policy implementation framework are: the specification of the stages of implementation; consideration of interactions between policy objectives; the need for government to oversee and ensure the effective management of policy networks; and finally, consideration of the effects of competing political interests and perspectives. [ABSTRACT FROM AUTHOR]

Abstract Problem A Scottish national health service ophthalmic facility was unable to cope with increasing demand for cataract surgery. Design Multifaceted approach to redesign hospital space to accommodate a cataract unit; to invest in cataract nursing staff to allow more operations under local anaesthesia and as day cases; and to enhance input by general practitioners and optometrists to streamline and reduce false positive cataract referrals. A prospective audit for productivity was undertaken in 2004 (two years after the redesign) and compared against the national cataract surgery audit data for Fife from 1997. Setting District general hospital serving a population of 400 000 in south east Scotland. Key measures for improvement Increasing throughput of cataract surgery while assessing quality of care provided against predefined evidence and Royal College of Ophthalmologists' guidelines, and evaluating training standards for ophthalmic surgical trainees against higher surgical training requirements. Strategies for change Cataract services were redesigned to increase throughput and to reduce waiting times while preserving the quality of patient care. A secondary end point was to maintain surgical case load mix thus allowing trainees to continue to fulfil the number of operations required to acquire higher surgical training standards. Effects of change In the same three month period 237 cataract operations were carried out in 1997 and 374 in 2004, representing an increase of productivity by 60%. The waiting time for surgery decreased from more than one year to three months. The redesign resulted in almost complete preoperative and postoperative assessment by nursing staff, thus freeing medical time and allowing for more operations. Optometrists' referrals with reports increased significantly (P<0.0001). The number of operations carried out as day cases under local anaesthesia increased, with fewer intraoperative complications and postoperative visits (P<0.0001). Th [ABSTRACT FROM AUTHOR]

This paper seeks to develop the evidence base for urban, neighbourhood and housing policies, that aim to increase neighbourhood satisfaction and reduce residential instability. Using the longitudinal Scottish House Condition Survey 1991-96, the paper examines whether residential perceptions are generally significant predictors of individual house moving intentions and behaviours, taking into account factors related to life cycle stage, employment, tenure and type of neighbourhood. The effect of specific residential perceptions on overall satisfaction with the home and neighbourhood is traced through moving intentions to actual moves over the 1991-96 period. Using a sample of matching respondents surveyed twice in 1991 and 1996, the paper also examines whether changed residential perceptions affect moving intentions. There is evidence that deteriorating neighbourhood perceptions increase the likelihood that an individual would consider a house move, while greater satisfaction with the home is associated with reduced moving intentions. [ABSTRACT FROM AUTHOR]

This paper describes an analysis of perceptions of the local residential environment and self-reported health in four socially contrasting neighbourhoods in Glasgow in the late 1990s. After adjusting for individual characteristics such as age, sex and social class, neighbourhood of residence predicted perceptions of problems and neighbourhood cohesion in the area: and self-assessed health, mental health and recent symptoms were associated with perceived local problems and neighbourhood cohesion. Housing tenure and employment status also predicted perceptions of the neighbourhood. These results support the importance of tackling anti-social problems in worst-off areas and of neighbourhood management across a range of areas. [ABSTRACT FROM AUTHOR]

It has been said that people need the confidence, continuity and trust in the world which comprise ontological security in order to lead happy and fulfilled lives, and furthermore that ontological security can be attained more through owner occupied than rented housing. Ontological security, however, can be elusive both in a real sense and in empirical research terms. As part of a study of the relationships between housing tenure and health, we explored through in-depth interviews with 43 adults the extent to which home owners and social renters in the West of Scotland obtained psycho-social benefits from their homes. It is important to acknowledge the regional context of the study, in particular the residualised state of social rented housing in the UK and the problematic, post-industrial nature of the Scottish regional economy. Interviewees felt protected by their homes when they were in a low crime area which was more likely to be in an area of owner occupied housing. For some interviewees owner occupation provided less protection than social renting from the threat of losing the home because of the risk of repossession. Inhabiting a house rather than a flat could promote autonomy over the home, as could having skills or income to carry out repairs and maintenance. Owner occupation was thought to be more prestigious than social renting, but whether being prestigious was desirable was sometimes contested. Interviewees also talked about ontological security in terms of the home being a site of constancy but this runs counter to the restless tendency to move house in order to progress in society and move up the housing ladder. [ABSTRACT FROM AUTHOR]

The article The immediate impact of the COVID‑19 pandemic on motor neuron disease services and mortality in Scotland, written by Stella A. Glasmacher, Juan Larraz, Arpan R. Mehta, Patrick K. A. Kearns, Michael Wong, Judith Newton, Richard Davenport, George Gorrie, Ian Morrison, Javier Carod Artal, Siddharthan Chandran, Suvankar Pal and CARE-MND Consortium, was originally published online on 5 September 2020 with Open Access under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made [ABSTRACT FROM AUTHOR]

Summary: Socio‐economic deprivation is associated with adverse maternal and childhood outcomes. Epidural analgesia, the gold standard for labour analgesia, may improve maternal well‐being. We assessed the association of socio‐economic status with utilisation of epidural analgesia and whether this differed when epidural analgesia was advisable for maternal safety. This was a population‐based study of NHS data for all women in labour in Scotland between 1 January 2007 and 23 October 2020, excluding elective caesarean sections. Socio‐economic status deciles were defined using the Scottish Index of Multiple Deprivation. Medical conditions for which epidural analgesia is advisable for maternal safety (medical indications) and contraindications were defined according to national guidelines. Of 593,230 patients in labour, 131,521 (22.2%) received epidural analgesia. Those from the most deprived areas were 16% less likely to receive epidural analgesia than the most affluent (relative risk 0.84 [95%CI 0.82–0.85]), with the inter‐decile mean change in receiving epidural analgesia estimated at ‐2% ([95%CI ‐2.2% to ‐1.7%]). Among the 21,219 deliveries with a documented medical indication for epidural analgesia, the socio‐economic gradient persisted (relative risk 0.79 [95%CI 0.75–0.84], inter‐decile mean change in receiving epidural analgesia ‐2.5% [95%CI ‐3.1% to ‐2.0%]). Women in the most deprived areas with a medical indication for epidural analgesia were still less likely (absolute risk 0.23 [95%CI 0.22–0.24]) to receive epidural analgesia than women from the most advantaged decile without a medical indication (absolute risk 0.25 [95%CI 0.24–0.25]). Socio‐economic deprivation is associated with lower utilisation of epidural analgesia, even when epidural analgesia is advisable for maternal safety. Ensuring equitable access to an intervention that alleviates pain and potentially reduces adverse outcomes is crucial. [ABSTRACT FROM AUTHOR]

Objectives: To establish the theoretical and perceived links between area regeneration and health in a Scottish context in order to inform a comprehensive evaluation of regeneration activity. The evaluation will include health outcomes. Study design: Mixed method combining and comparing key informant interviews with policy analysis. Methods: Analysis of identified links between elements of regeneration activity and health was undertaken of published policies and strategies which described regeneration for Scotland and the city of Glasgow. Interviews with key informants explored their understanding of the inputs to regeneration, and the pathways between regeneration and better health outcomes. Results: The policy analysis and interviews revealed a holistic approach to a complex problem. Both identified a need for action to improve housing, neighbourhoods and services, education, employment, community participation and social issues. Improved health was identified as an emergent property. Interviewees identified a need to augment the established structural components with a more person-centred approach, fostering confidence and higher aspirations, but were uncertain how to achieve this. The interviews revealed a lack of confidence that current practice would deliver all the components of the holistic model. Conclusions: A holistic model of regeneration appears to inform policy, but is proving difficult to deliver. Improved health and reduced health inequalities were not primary objectives but emergent properties. In light of this, the ability of regeneration to actively maximize positive health impacts, particularly if this requires focused planning or opportunity costs to other activities, is questioned. [ABSTRACT FROM AUTHOR]

This study aimed to explore the role of dwelling conditions and neighbourhood characteristics in explaining the frequently observed association between housing tenure and health. A postal questionnaire, focusing on a number of specific aspects of the home and the area, was sent to a random sample of adults in the west of Scotland (achieved sample size 2867, response rate 50%). The health measures were limiting long-standing illness, self-assessed health, recent symptoms, and anxiety and depression. Having controlled for age, sex, and marital status, housing tenure explained, respectively, 2.7%, 5.4%, 3.9%, 2.4% and 5.4% of the variance in these variables. These percentages were reduced by between 93% (for anxiety) and 73% (for self-assessed health) when housing problems, housing fixtures, overcrowding, dwelling type, access to garden, area type and area amenities were introduced into the model. This suggests that features of the dwelling and its surroundings help to explain observed associations between tenure and health in the UK, and that housing and area problems may be particularly important. Housing improvements and urban regeneration may help to reduce the health gap between housing tenures, and more generally to reduce inequalities in health. [Copyright &y& Elsevier]

Narratives of deindustrialization, urban decline and failing public housing and the negative outcomes associated with these processes dominate accounts of post-war Scotland, bolstering the interpretation of Scottish exceptionalism in a British context. Within these accounts working people appear as victims of powerful and long-term external forces suffering sustained and ongoing deleterious vulnerabilities in terms of employment, health, and housing. This article challenges this picture by focusing on the first Scottish new town which made space for working people's aspiration and new models of the self manifested in new lifestyles and social relations. Drawing on archival data and oral history interviews, we identify how elective relocation fostered and enabled new forms of identity predicated upon new housing, new social relations, and lifestyle opportunities focused on the family and home and elective social networks no longer determined by traditional class and gender expectations. These findings permit an intervention in the historical debates on post-war housing and social change which go beyond the materialistic experience to deeper and affective dimensions of the new town self.

Background: Existing research points towards physical and mental health gains from housing improvements, but findings are inconsistent and often not statistically significant. The detailed characteristics and variability of housing improvement works are problematic and studies are often small, not experimental, with short follow-up times., Methods: A quasi-experimental design was used to assess the impact on physical health and mental health (using SF-12v2 Physical and Mental health component summary scales) of four types of housing improvement works-central heating, 'Secured By Design' front doors, fabric works, kitchens and bathrooms-both singly and in pairwise combinations. A longitudinal sample of 1933 residents from 15 deprived communities in Glasgow, UK was constructed from surveys carried out in 2006, 2008 and 2011. Sociodemographic characteristics and changes in employment status were taken into account., Results: Fabric works had positive associations with physical health (+2.09, 95% CI 0.13 to 4.04) and mental health (+1.84, 95% CI 0.04 to 3.65) in 1-2 years. Kitchens and bathrooms had a positive association with mental health in 1-2 years (+2.58, 95% CI 0.79 to 4.36). Central heating had a negative association with physical health (-2.21, 95% CI -3.74 to -0.68). New front doors had a positive association with mental health in <1 year (+5.89, 95% CI 0.65 to 11.14) and when provided alongside kitchens and bathrooms (+4.25, 95% CI 1.71 to 6.80). Gaining employment had strong associations with physical health (+7.14, 95% CI 4.72 to 9.55) as well as mental health (+5.50, 95% CI 3.27 to 7.73)., Conclusions: Fabric works may provide insulation benefits and visual amenity benefits to residents. Front doors may provide important security benefits in deprived communities. Economic regeneration is important alongside property-led regeneration., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Background: Housing-led regeneration has been shown to have limited effects on mental health. Considering housing and neighbourhoods as a psychosocial environment, regeneration may have greater impact on positive mental wellbeing than mental ill-health. This study examined the relationship between the positive mental wellbeing of residents living in deprived areas and their perceptions of their housing and neighbourhoods., Methods: A cross-sectional study of 3,911 residents in 15 deprived areas in Glasgow, Scotland. Positive mental wellbeing was measured using the Warwick-Edinburgh Mental Wellbeing Scale., Results: Using multivariate mulit-nomial logistic regressions and controlling for socio-demographic characteristics and physical health status, we found that several aspects of people's residential psychosocial environments were strongly associated with higher mental wellbeing. Mental wellbeing was higher when respondents considered the following: their neighbourhood had very good aesthetic qualities (RRR 3.3, 95% CI 1.9, 5.8); their home and neighbourhood represented personal progress (RRR 3.2 95% CI 2.2, 4.8; RRR 2.6, 95% CI 1.8, 3.7, respectively); their home had a very good external appearance (RRR 2.6, 95% CI 1.3, 5.1) and a very good front door (both an aesthetic and a security/control item) (RRR 2.1, 95% CI 1.2, 3.8); and when satisfaction with their landlord was very high (RRR 2.3, 95% CI 2.2,4.8). Perception of poor neighbourhood aesthetic quality was associated with lower wellbeing (RRR 0.4, 95% CI 0.3, 0.5)., Conclusions: This study has shown that for people living in deprived areas, the quality and aesthetics of housing and neighbourhoods are associated with mental wellbeing, but so too are feelings of respect, status and progress that may be derived from how places are created, serviced and talked about by those who live there. The implication for regeneration activities undertaken to improve housing and neighbourhoods is that it is not just the delivery of improved housing that is important for mental wellbeing, but also the quality and manner of delivery.

Objective: To establish whether rehousing people to new dwellings had impacts upon residents' mental health and psychosocial benefits derived from the home., Methods: A prospective controlled study across Scotland involving 723 householders (334 intervention; 389 control). Interviews were carried out just prior to the move, and 2 years thereafter., Results: Changes in self-reported psychosocial benefits were greater than changes in mental health. Respondents in family households appeared to have gained the most and those in older person households the least. For those in families, the most consistent effects flowed from improvements in space, privacy and change of location; for those in adult-only households, improvements in crime and safety mattered most. Gains in psychosocial benefits were associated with improved mental health (SF-36) scores., Conclusions: Rehousing has substantial impacts on residential conditions and on psychosocial benefits, and lesser (possibly indirect) impacts upon mental health. Housing is a complex intervention applied to a heterogeneous group for a range of reasons. Hence its impacts result from different aspects of residential change for particular types of household.

Background: The SHARP study was set up to evaluate the short (1 year) and longer-term (2 year) effects on health and wellbeing of providing new social housing to tenants. This paper presents the study background, the design and methods, and the findings at one year., Methods: Data were collected from social tenants who were rehoused into a new, general-purpose socially-rented home developed and let by a Scottish Registered Social Landlord (the "Intervention" group). These data were collected at three points in time: before moving (Wave 1), one year after moving (Wave 2) and two years after moving (Wave 3). Data were collected from a Comparison group using the same methods at Baseline (Wave 1) and after two years of follow-up (Wave 3). Qualitative data were also collected by means of individual interviews. This paper presents the quantitative and qualitative findings at 1 year (after Wave 2)., Results: 339 Intervention group interviews and 392 Comparison group interviews were completed. One year after moving to a new home there was a significant reduction in the proportion of Intervention group respondents reporting problems with the home, such as damp and noise. There was also a significant increase in neighbourhood satisfaction compared with Baseline (chi(2) = 35.51, p < 0.0001). Many aspects of the neighbourhood improved significantly, including antisocial behaviour. In terms of environmental aspects and services the greatest improvements were in the general appearance of the area, the reputation of the area, litter and rubbish, and speeding traffic. However, lack of facilities for children/young people and lack of safe children's play areas remained a concern for tenants., Conclusion: This study found that self-reported health changed little in the first year after moving. Nonetheless, the quantitative and qualitative data point to improvements in the quality of housing and of the local environment, as well as in tenant satisfaction and other related outcomes. Further analyses will explore whether these effects are sustained, and whether differences in health outcomes emerge at 2 years compared with the Comparison group.

Neighbourhoods may influence the health of individual residents in different ways: via the social and physical environment, as well as through facilities and services. Not all factors may be equally important for all population subgroups. A cross-sectional analysis of the Scottish Household Survey 2001 examined a range of neighbourhood factors for links with three health outcomes and two health-related behaviours. The results support the hypothesis that the neighbourhood has a multi-dimensional impact on health. There was also some evidence that the relationship between neighbourhood factors and health varied according to the population subgroup, although not in a consistent manner.

Background: It has been suggested that perceiving oneself to be inferior to those around one is a psychosocial risk factor associated with ill health. The aim of this study was to examine whether negative social comparisons of the worth of two common assets (homes and cars) were related to psychosocial health (i.e. lower self-esteem and mastery, higher anxiety, and depression)., Methods: A postal questionnaire was sent to a random sample of adults in the West of Scotland (sampling from the 1997 electoral roll, response rate was 50%, achieved sample 2838)., Results: Having adjusted for socio-demographic variables, rating one's house/flat as worth less than others was associated with lower self-esteem (P < 0.001) and mastery (P < 0.001) and higher depression (P < 0.007) and anxiety (P < 0.012). Rating one's car as worth less than others was not significantly associated with these psychosocial variables., Conclusions: Our findings lend some support, but only in relation to the home, to the hypothesis that perceiving oneself to be worse off in relation to those around is related to poorer psychosocial health.

Study Objective: To assess the health impacts of local public swimming pool and leisure provision., Design: Retrospective qualitative study using focus groups. Reports from two areas with contrasting experience of provision of a public swimming pool (opening and closure) were compared within the context of general reports about health and neighbourhood., Setting: Two deprived neighbourhoods in south Glasgow., Participants: Local adult residents of mixed ages, accessed through local community groups., Main Results: In both areas the swimming pool was reported as an important amenity that was linked to health and wellbeing. However, few residents reported regular use of the pool for physical activity. Use of the pool facility for social contact was directly linked to reports of relief of stress and isolation, and improved mental health. Pool closure was one in a series of amenity closures and area decline and was used to represent other area changes. Health impacts were strongly linked to the pool closure. The pool opening was associated with local area regeneration, similar but less prominent links between swimming pool provision and health were reported. Health benefits of social contact were diffuse and linked to other local amenities as well as the new pool facility., Conclusions: Although theoretically linked to increased physical activity, the health benefits conveyed by the swimming pool may be more closely linked to the facilitation of social contact, and a supervised facility for young children. The use of qualitative work to investigate area based change provides rich contextual data to strengthen and explain the reported health impacts.