Background Inequalities between different areas in the United Kingdom (UK) according to health an... more Background Inequalities between different areas in the United Kingdom (UK) according to health and employment outcomes are well-documented. Yet it is unclear which health indicator is most closely linked to labour market outcomes, and whether associations are restricted to the older population. Methods We used the Office for National Statistics (ONS) Longitudinal Study (LS) to analyse which measures of health-in-a-place were cross-sectionally associated with three employment outcomes in 2011: not being in paid work, working hours (part-time, full-time), and economic inactivity (unemployed, retired, sick/disabled, other). Seven health indicators from local-authority census and vital records data were chosen to represent the older working age population (self-rated health 50-74y, long-term illness 50-74y, Age-specific mortality rate 50-74y, avoidable mortality, life expectancy at birth and 65 years, disability-free life expectancy at 50 years, and healthy life expectancy at 50 years)....
BackgroundDepressive symptoms are highly prevalent among partnered dementia caregivers, but the m... more BackgroundDepressive symptoms are highly prevalent among partnered dementia caregivers, but the mechanisms are unclear. This study examined the mediating role of loneliness in the association between dementia and other types of care on subsequent depressive symptoms.MethodsProspective data from partnered caregivers were drawn from the English Longitudinal Study of Aging. The sample consisted of 4,672 partnered adults aged 50–70 living in England and Wales, followed up between 2006–2007 and 2014–2015. Caregiving was assessed across waves 3 (2006–2007), 4 (2008–2009), and 5 (2010–2011), loneliness at wave 6 (2012–2013), and subsequent depressive symptoms at wave 7 (2014–15). Multivariable logistic regression models were used to assess the association between caregiving for dementia and depressive symptoms compared to caregiving for other illnesses (e.g., diabetes, coronary heart disease (CHD), cancer, and stroke). Binary mediation analysis was used to estimate the indirect effects of ...
BackgroundInequalities between different areas in the UK according to health and employment outco... more BackgroundInequalities between different areas in the UK according to health and employment outcomes are well-documented. Yet it is unclear which health indicator is most closely linked to labour market outcomes, and whether associations are restricted to the older population.MethodsWe used the ONS Longitudinal Study (LS) to analyse which measures of health-in-a-place were cross-sectionally associated with three employment outcomes in 2011: not being in paid work, working hours (part-time, full-time), and economic inactivity (unemployed, retired, sick/disabled, other). Nine health indicators from local-authority census and vital records data were chosen to represent the older working age population (50-74y) and linked with LS data. Interactions by gender and age category (16-49y vs 50-74y) were tested.FindingsFor all health-in-a-place measures, LS members aged 16-74 who resided in the tertile of local authorities with the ‘unhealthiest’ older population, had higher odds of not being...
Background Children who spend time in non-parental care report worse health later in life on aver... more Background Children who spend time in non-parental care report worse health later in life on average, but less is known about differences by type of care. We examined whether self-rated health of adults who had been in non-parental care up to 30 years later varied by type of care. Methods We used longitudinal data from the office for National Statistics Longitudinal Study. Participants were aged <18 and never-married at baseline of each census year from 1971 to 2001. Separately for each follow-up period (10, 20 and 30 years later), multi-level logistic regression was used to compare self-rated health outcomes by different care types. Results For combined census years, sample sizes were 157 896 dependent children with 10 years of follow-up, 166 844 with 20 years of follow-up and 173 801 with 30 years of follow-up. For all follow-up cohorts, longitudinal study members who had been in care in childhood, had higher odds of rating their health as ‘not good’ vs. ‘good’; with highest od...
Numerous studies have documented ethnic differences in advance directive (AD) completion, with lo... more Numerous studies have documented ethnic differences in advance directive (AD) completion, with lower rates among minority groups. Among those with ADs, Blacks are more likely than whites to prefer aggressive care at the end of life. This nationally representative study aimed to investigate if these differences in AD development persisted after adjusting for income, assets, health conditions, and religious involvement. Further, for those with an AD, we investigated the association between these factors and electing aggressive care. Data from the Health and Retirement Study (HRS) Exit Interviews from 2000-2012 was used, with 8,552 decedents included in the analysis. Step-wise logistic regression analyses were conducted to determine the relationship between ethnicity and AD completion and preferences for aggressive care. Overall, 42.8% (n=3,658) completed an AD. Whites had the highest prevalence of AD completion at 51%, Hispanics 18% and Blacks 16%. Additionally, Blacks who completed an AD elected prolonged care nearly a quarter of the time (23.3%) compared to 13.5% of Hispanics and 3.8% of Whites. Logistic regression revealed that Blacks and Hispanics each had 73% lower odds of completing an AD as compared with Whites. Other factors associated with completing an AD included increased age, more than high school education, being widowed, higher income and assets, cancer, and attending religious services. In this nationally representative sample, significant ethnic differences persisted after adjusting for important variables. While covariates were significant in the model, they had a relatively small influence on ethnicity.
Methods Data from systematic reviews, dedicated methodological experimental studies and qualitati... more Methods Data from systematic reviews, dedicated methodological experimental studies and qualitative studies nested within behaviour change trials will be presented. Results Study findings indicate: (1) the existence of previously unrecognised recruitment effects on behaviour; (2), that assessment reactivity is a widespread form of contamination in behaviour change trials; (3) that randomisation itself may induce behaviour change; and (4) that these types of effects are highly unlikely to be additive to the effect of behavioural interventions, thus leading to biased estimates of effectiveness. Conclusions The scale of the problem, the implications for reviews of existing trials, and the reasons for the lack of development of study in this crucial area for behaviour change trials are discussed. Hypotheses and study designs are proposed to guide new research which seeks to quantify problems with existing practice in the design and conduct of trials.
All aspects of public health research require longitudinal analyses to fully capture the dynamics... more All aspects of public health research require longitudinal analyses to fully capture the dynamics of outcomes and risk factors such as ageing, human mobility, non-communicable diseases (NCDs), climate change, and endemic, emerging, and re-emerging infectious diseases. Studies in geospatial health are often limited to spatial and temporal cross sections. This generates uncertainty in the exposures and behavior of study populations. We discuss a research agenda, including key challenges and opportunities of working with longitudinal geospatial health data. Examples include accounting for residential and human mobility, recruiting new birth cohorts, geoimputation, international and interdisciplinary collaborations, spatial lifecourse studies, and qualitative and mixed-methods approaches. Highlights • Geospatial health studies can be limited by using spatial and temporal cross sections. • Geospatial longitudinal studies can better capture spatiotemporal dynamics of health. • We summarize the challenges and opportunities to improve research and collaboration. • For example, studying residential mobility, life course exposures, and geoimputation.
skilled/unskilled (IV/V)) based on the Registrar General Social Class classification and we looke... more skilled/unskilled (IV/V)) based on the Registrar General Social Class classification and we looked at absolute and relative differences between I/II and IV/V. To test differences in mean intake by demographic characteristics, we used t-tests and linear regression. All analyses were conducted in StataSE 13. Results Overall FV intake increased by 20% from 1986/87 (2.67 portions, 95% confidence interval [2.59,2.74]) to 2008/ 12 (3.21 portions [3.10,3.32]), but still fell short of the recommended 5 portions. We found higher FV intake in socioeconomic group I/II compared to IV/V across all years (difference of 0.96-1.28 portions; 26.09%-36.36%). FV intake also differed by age across all surveys, with older respondents eating more than younger respondents (1.03-2.08 portions; 51.76%-129.19%). Men ate significantly more FV than women in 1986/87 (0.18 portions; 6.52%) but there was no significant difference in the latter time points. Conclusion While FV consumption has increased in the UK since 1986, and sex differences in consumption have disappeared, socioeconomic and age-related inequalities persist. Population-level strategies to improve diet and increase FV intake are still needed in the promotion of public health. In order to redress inequalities, it is crucial that these strategies are at least or more effective in lower versus higher socioeconomic groups, and in younger versus older adults.
Including the editors, a team of 29 scholars have contributed some 80 short essays to this impres... more Including the editors, a team of 29 scholars have contributed some 80 short essays to this impressive volume, their discussions aided by no fewer than 309 specially prepared maps and diagrams reproduced in full colour. In most cases, four county-wide maps are provided to illustrate each essay, with a double-page layout being adopted. Most are concerned with depicting change over time, though some make comparisons at points in time. They are standardized by using a base map that divides the county into its constituent parishes and townships. It was compiled from the first-edition 25-inch Ordnance Survey maps of the county, which were surveyed and published during the last quarter of the nineteenth century. Tables, graphs, and contemporary illustrations are also included in the texts. An introductory section covers the geology and natural resources of the county, along with developments in its administrative areas, both secular and religious, and, from the sixteenth century, the ways in which it was mapped, with extracts from early small-scale maps being included. Sections follow in chronological order dealing with the county's history in pre-conquest times and at Domesday, going back to Roman times; during the later medieval period, reaching into the sixteenth century; and in the modern era, though not usually tending to extend into very recent times. Reflecting the amount of source material available, emphasis is on the modern period, discussion of which occupies about two-thirds of the book. Within each section, various common themes are covered. These are demography, agriculture, industry, urbanization, communications, distribution of wealth, political organization, and religion. In the modern period especially, the themes are explored using several double-page spreads, enabling discussion to be undertaken in some depth. Moreover, revisiting the themes in each of the sections brings advantage in enabling readers to obtain long-term perspectives on matters in which they have particular interests. Even so, the lengthy time periods covered in the sections mean that some elements of change can only be dealt with in summary fashion and without consideration of how they came about, nor their impact. In a study of this type, the identification and analysis of variations within the county inevitably comprise the major component of the book, with evidence being derived from a range of key primary sources. As might be anticipated, the patterns arising reveal marked variations between localities, serving as a reminder of the dangers and difficulties that arise in seeking to generalize about past developments. What emerges is a wide-ranging set of studies that provide original insights into matters of major historical concern and that demonstrate the types of historical analysis that can be meaningfully undertaken through locally based comparisons. They are presented in a highly accessible form-a matter of great importance in promoting and sustaining interest in social and economic history-that should appeal to a wide readership. The editors point out that, given the restricted length available for each essay, the analysis offered cannot be exhaustive. Accordingly, they aim to provoke readers into making their own enquiries and reaching their own conclusions, helped in so doing by a reference and bibliographical section that draws together the primary and secondary sources used in preparing the essays. In places, a little more in the way of critical comment on these sources, and of the broader historiographical bs_bs_banner
Background Children who spent time in non-parental care report poor outcomes in many aspects of t... more Background Children who spent time in non-parental care report poor outcomes in many aspects of their later lives on average, but less is known about differences by type of care. We examined whether socioeconomic, family, and living arrangements of adults who had been in non-parental care across the first three decades of adult life varied by type of care (residential, non-relative and relative). Methods We used longitudinal data from the Office for National Statistics Longitudinal Study (LS). Participants were aged<18 years and had never been married at baseline of each census year from 1971-2001 (n=242,843). Separately for each adult follow-up age (20 to 29; 30 to 39; 40 to 49), multi-level logistic regression models were used to compare socioeconomic, family, and living arrangements by different out-of-home care (OHC) experiences. Results Any OHC increased the likelihood of poorer functioning in the three domains of socioeconomic circumstances, family formation and relationships, and living arrangements. This was evident in their 20s, 30s and 40s; the most adverse outcomes were observed for those with a history of residential care, followed by non-relative OHC, and the least adverse outcomes for relative OHC. Moderation by childhood census year, age in OHC, and gender altered the relationship between OHC and some, but not all, adult outcomes. The strongest, most consistent, evidence was for widening of inequalities in age 20-29 outcomes across childhood census years and weakest evidence for any moderation of age 40-49 outcomes by age when in OHC. Conclusion Enduring inequalities in social and economic functioning for OHC-experienced adults were found. The evidence overwhelmingly supports the policy to place children in relative care whenever possible, with residential care the least favoured option.
Background The adverse life-long consequences of being looked-after as a child are well recognise... more Background The adverse life-long consequences of being looked-after as a child are well recognised, but follow-up periods for mortality risk have mostly ended in young adulthood and mortality suggested to differ by age of placement, gender and cohort in small samples. Methods Data on 353,601 Office for National Statistics Longitudinal Study (LS) members during census years 1971–2001, and Cox proportional hazards regression models with time-varying covariates (age as the timescale), were used to examine whether childhood out-of-home care was associated with all-cause mortality until the end of 2013. After adjusting for baseline age and age2, gender, born outside the United Kingdom, number of census observations in childhood and baseline census year we tested whether mortality risk varied for those in care by age, gender and baseline census year, by separate assessment of interaction terms. Supplementary analyses assessed robustness of findings. Results Adults who had been in care at ...
BackgroundChildren who spent time in non-parental care report poor outcomes in many aspects of th... more BackgroundChildren who spent time in non-parental care report poor outcomes in many aspects of their later lives on average, but less is known about differences by ethnicity. We examined whether the health, socioeconomic, family, and living arrangements of adults who had been in non-parental care across the first three decades of adult life varied by ethnicity (White, Black, South Asian).MethodsWe used longitudinal data from the Office for National Statistics Longitudinal Study (LS). Participants were aged<18 years and had never been married at baseline of each census year from 1971-2001 (n= 672,648). Separately for each adult follow-up age group (20 to 29; 30 to 39; 40 to 49), multi-level regression models were used to compare socioeconomic, family, and living arrangements by non-parental care and ethnicity interactions.ResultsAdverse adult outcomes following an experience of non-parental care were conditional on the interaction of non-parental care with ethnicity, mainly in the...
Background: Disability and caste are two different forms of oppression, however Dalits and people... more Background: Disability and caste are two different forms of oppression, however Dalits and people with disabilities commonly face similar types of marginalities. Dalit women with disabilities may experience double discrimination because of the intersectionality of disability and caste. This study examines whether the disability and caste identity of women together affects and compounds the utilization of maternal healthcare services. Methods: A cross-sectional survey was conducted using a semi-structured questionnaire among a total of 354 Dalit and non-Dalit women, with and without a disability aged between 15 – 49 years. Maternal healthcare service utilization was assessed by Ante-Natal Care (ANC), health facility (HF) delivery, and Post-Natal Care (PNC) during the last pregnancy. Logistic regression was performed to detect the predictors of service utilization and identify whether disability and caste were associated with service utilization. First, disability and caste were fitte...
Background: Suboptimal quality of care and disparities in services by healthcare providers are of... more Background: Suboptimal quality of care and disparities in services by healthcare providers are often reported in Nepal. Experience and perceptions about quality of care may differ according to women’s socio-cultural background, individual characteristics, their exposure and expectations. This study aimed to compare perceptions of the quality of maternal healthcare services between two groups that are consistently considered vulnerable, women with disabilities from both the non-Dalit population and Dalit population and their peers without disabilities from both non-Dalit and Dalit communities. Methods: A cross-sectional survey was conducted among 343 total women that included women with disabilities, Dalits and non-Dalits. Women were recruited for interview, who were aged 15–49 years, had been pregnant within the last five years and who had used maternal care services in one of the public health facilities of Rupandehi district. A 20-item, Likert-type scale with four sub-scales or dimensions: ‘Health Facility’, ‘Healthcare Delivery’, ‘Inter-personal’ and ‘Access to Care’ was used to measure women’s perceptions of quality of care. Chi-square test and t test were used to compare groups and to assess differences in perceptions; and linear regression was applied to assess confounding effects of socio-demographic factors. The mean score was compared for each item and separately for each dimension. Results: All groups, women with disabilities and women without disabilities, Dalit and non-Dalit rated their perceptions and experiences of quality of care lowly in a number of items. While perceived quality of care between women with disabilities and without disabilities in the ‘Health Facility’ dimension and associated items, was found to differ (p<0.05), this difference was linked to disability status, but was not linked to caste differences. For example, differences in mean scores relating to ‘Cleanliness and Facilities’, ‘Open and Friendliness’ and ‘Compassion and Kindness’ were highly significant (p<0.001), with women with disabilities rating these as better than women without disabilities. On the other hand, women without disabilities rated the ‘Availability of cash Incentives’ more highly (p<0.01). No significant differences were found between Dalit and non-Dalit women in perceived quality of care, except in relation to ‘Cleanliness and facilities’, which Dalit women rated lower than non-Dalits (p<0.05). Conclusions: Perceptions about the quality of care differed significantly by disability status but not by caste. All groups rated the quality of healthcare delivery, interpersonal and personal factors as well as access to services ‘low.’ Poor service user experiences and perceptions of quality of care undermine opportunities to translate increased healthcare coverage into improved access and outcomes. Greater attention is required by policy makers, health planners and providers to the improvement of quality of care in health facilities
Background Inequalities between different areas in the United Kingdom (UK) according to health an... more Background Inequalities between different areas in the United Kingdom (UK) according to health and employment outcomes are well-documented. Yet it is unclear which health indicator is most closely linked to labour market outcomes, and whether associations are restricted to the older population. Methods We used the Office for National Statistics (ONS) Longitudinal Study (LS) to analyse which measures of health-in-a-place were cross-sectionally associated with three employment outcomes in 2011: not being in paid work, working hours (part-time, full-time), and economic inactivity (unemployed, retired, sick/disabled, other). Seven health indicators from local-authority census and vital records data were chosen to represent the older working age population (self-rated health 50-74y, long-term illness 50-74y, Age-specific mortality rate 50-74y, avoidable mortality, life expectancy at birth and 65 years, disability-free life expectancy at 50 years, and healthy life expectancy at 50 years)....
BackgroundDepressive symptoms are highly prevalent among partnered dementia caregivers, but the m... more BackgroundDepressive symptoms are highly prevalent among partnered dementia caregivers, but the mechanisms are unclear. This study examined the mediating role of loneliness in the association between dementia and other types of care on subsequent depressive symptoms.MethodsProspective data from partnered caregivers were drawn from the English Longitudinal Study of Aging. The sample consisted of 4,672 partnered adults aged 50–70 living in England and Wales, followed up between 2006–2007 and 2014–2015. Caregiving was assessed across waves 3 (2006–2007), 4 (2008–2009), and 5 (2010–2011), loneliness at wave 6 (2012–2013), and subsequent depressive symptoms at wave 7 (2014–15). Multivariable logistic regression models were used to assess the association between caregiving for dementia and depressive symptoms compared to caregiving for other illnesses (e.g., diabetes, coronary heart disease (CHD), cancer, and stroke). Binary mediation analysis was used to estimate the indirect effects of ...
BackgroundInequalities between different areas in the UK according to health and employment outco... more BackgroundInequalities between different areas in the UK according to health and employment outcomes are well-documented. Yet it is unclear which health indicator is most closely linked to labour market outcomes, and whether associations are restricted to the older population.MethodsWe used the ONS Longitudinal Study (LS) to analyse which measures of health-in-a-place were cross-sectionally associated with three employment outcomes in 2011: not being in paid work, working hours (part-time, full-time), and economic inactivity (unemployed, retired, sick/disabled, other). Nine health indicators from local-authority census and vital records data were chosen to represent the older working age population (50-74y) and linked with LS data. Interactions by gender and age category (16-49y vs 50-74y) were tested.FindingsFor all health-in-a-place measures, LS members aged 16-74 who resided in the tertile of local authorities with the ‘unhealthiest’ older population, had higher odds of not being...
Background Children who spend time in non-parental care report worse health later in life on aver... more Background Children who spend time in non-parental care report worse health later in life on average, but less is known about differences by type of care. We examined whether self-rated health of adults who had been in non-parental care up to 30 years later varied by type of care. Methods We used longitudinal data from the office for National Statistics Longitudinal Study. Participants were aged <18 and never-married at baseline of each census year from 1971 to 2001. Separately for each follow-up period (10, 20 and 30 years later), multi-level logistic regression was used to compare self-rated health outcomes by different care types. Results For combined census years, sample sizes were 157 896 dependent children with 10 years of follow-up, 166 844 with 20 years of follow-up and 173 801 with 30 years of follow-up. For all follow-up cohorts, longitudinal study members who had been in care in childhood, had higher odds of rating their health as ‘not good’ vs. ‘good’; with highest od...
Numerous studies have documented ethnic differences in advance directive (AD) completion, with lo... more Numerous studies have documented ethnic differences in advance directive (AD) completion, with lower rates among minority groups. Among those with ADs, Blacks are more likely than whites to prefer aggressive care at the end of life. This nationally representative study aimed to investigate if these differences in AD development persisted after adjusting for income, assets, health conditions, and religious involvement. Further, for those with an AD, we investigated the association between these factors and electing aggressive care. Data from the Health and Retirement Study (HRS) Exit Interviews from 2000-2012 was used, with 8,552 decedents included in the analysis. Step-wise logistic regression analyses were conducted to determine the relationship between ethnicity and AD completion and preferences for aggressive care. Overall, 42.8% (n=3,658) completed an AD. Whites had the highest prevalence of AD completion at 51%, Hispanics 18% and Blacks 16%. Additionally, Blacks who completed an AD elected prolonged care nearly a quarter of the time (23.3%) compared to 13.5% of Hispanics and 3.8% of Whites. Logistic regression revealed that Blacks and Hispanics each had 73% lower odds of completing an AD as compared with Whites. Other factors associated with completing an AD included increased age, more than high school education, being widowed, higher income and assets, cancer, and attending religious services. In this nationally representative sample, significant ethnic differences persisted after adjusting for important variables. While covariates were significant in the model, they had a relatively small influence on ethnicity.
Methods Data from systematic reviews, dedicated methodological experimental studies and qualitati... more Methods Data from systematic reviews, dedicated methodological experimental studies and qualitative studies nested within behaviour change trials will be presented. Results Study findings indicate: (1) the existence of previously unrecognised recruitment effects on behaviour; (2), that assessment reactivity is a widespread form of contamination in behaviour change trials; (3) that randomisation itself may induce behaviour change; and (4) that these types of effects are highly unlikely to be additive to the effect of behavioural interventions, thus leading to biased estimates of effectiveness. Conclusions The scale of the problem, the implications for reviews of existing trials, and the reasons for the lack of development of study in this crucial area for behaviour change trials are discussed. Hypotheses and study designs are proposed to guide new research which seeks to quantify problems with existing practice in the design and conduct of trials.
All aspects of public health research require longitudinal analyses to fully capture the dynamics... more All aspects of public health research require longitudinal analyses to fully capture the dynamics of outcomes and risk factors such as ageing, human mobility, non-communicable diseases (NCDs), climate change, and endemic, emerging, and re-emerging infectious diseases. Studies in geospatial health are often limited to spatial and temporal cross sections. This generates uncertainty in the exposures and behavior of study populations. We discuss a research agenda, including key challenges and opportunities of working with longitudinal geospatial health data. Examples include accounting for residential and human mobility, recruiting new birth cohorts, geoimputation, international and interdisciplinary collaborations, spatial lifecourse studies, and qualitative and mixed-methods approaches. Highlights • Geospatial health studies can be limited by using spatial and temporal cross sections. • Geospatial longitudinal studies can better capture spatiotemporal dynamics of health. • We summarize the challenges and opportunities to improve research and collaboration. • For example, studying residential mobility, life course exposures, and geoimputation.
skilled/unskilled (IV/V)) based on the Registrar General Social Class classification and we looke... more skilled/unskilled (IV/V)) based on the Registrar General Social Class classification and we looked at absolute and relative differences between I/II and IV/V. To test differences in mean intake by demographic characteristics, we used t-tests and linear regression. All analyses were conducted in StataSE 13. Results Overall FV intake increased by 20% from 1986/87 (2.67 portions, 95% confidence interval [2.59,2.74]) to 2008/ 12 (3.21 portions [3.10,3.32]), but still fell short of the recommended 5 portions. We found higher FV intake in socioeconomic group I/II compared to IV/V across all years (difference of 0.96-1.28 portions; 26.09%-36.36%). FV intake also differed by age across all surveys, with older respondents eating more than younger respondents (1.03-2.08 portions; 51.76%-129.19%). Men ate significantly more FV than women in 1986/87 (0.18 portions; 6.52%) but there was no significant difference in the latter time points. Conclusion While FV consumption has increased in the UK since 1986, and sex differences in consumption have disappeared, socioeconomic and age-related inequalities persist. Population-level strategies to improve diet and increase FV intake are still needed in the promotion of public health. In order to redress inequalities, it is crucial that these strategies are at least or more effective in lower versus higher socioeconomic groups, and in younger versus older adults.
Including the editors, a team of 29 scholars have contributed some 80 short essays to this impres... more Including the editors, a team of 29 scholars have contributed some 80 short essays to this impressive volume, their discussions aided by no fewer than 309 specially prepared maps and diagrams reproduced in full colour. In most cases, four county-wide maps are provided to illustrate each essay, with a double-page layout being adopted. Most are concerned with depicting change over time, though some make comparisons at points in time. They are standardized by using a base map that divides the county into its constituent parishes and townships. It was compiled from the first-edition 25-inch Ordnance Survey maps of the county, which were surveyed and published during the last quarter of the nineteenth century. Tables, graphs, and contemporary illustrations are also included in the texts. An introductory section covers the geology and natural resources of the county, along with developments in its administrative areas, both secular and religious, and, from the sixteenth century, the ways in which it was mapped, with extracts from early small-scale maps being included. Sections follow in chronological order dealing with the county's history in pre-conquest times and at Domesday, going back to Roman times; during the later medieval period, reaching into the sixteenth century; and in the modern era, though not usually tending to extend into very recent times. Reflecting the amount of source material available, emphasis is on the modern period, discussion of which occupies about two-thirds of the book. Within each section, various common themes are covered. These are demography, agriculture, industry, urbanization, communications, distribution of wealth, political organization, and religion. In the modern period especially, the themes are explored using several double-page spreads, enabling discussion to be undertaken in some depth. Moreover, revisiting the themes in each of the sections brings advantage in enabling readers to obtain long-term perspectives on matters in which they have particular interests. Even so, the lengthy time periods covered in the sections mean that some elements of change can only be dealt with in summary fashion and without consideration of how they came about, nor their impact. In a study of this type, the identification and analysis of variations within the county inevitably comprise the major component of the book, with evidence being derived from a range of key primary sources. As might be anticipated, the patterns arising reveal marked variations between localities, serving as a reminder of the dangers and difficulties that arise in seeking to generalize about past developments. What emerges is a wide-ranging set of studies that provide original insights into matters of major historical concern and that demonstrate the types of historical analysis that can be meaningfully undertaken through locally based comparisons. They are presented in a highly accessible form-a matter of great importance in promoting and sustaining interest in social and economic history-that should appeal to a wide readership. The editors point out that, given the restricted length available for each essay, the analysis offered cannot be exhaustive. Accordingly, they aim to provoke readers into making their own enquiries and reaching their own conclusions, helped in so doing by a reference and bibliographical section that draws together the primary and secondary sources used in preparing the essays. In places, a little more in the way of critical comment on these sources, and of the broader historiographical bs_bs_banner
Background Children who spent time in non-parental care report poor outcomes in many aspects of t... more Background Children who spent time in non-parental care report poor outcomes in many aspects of their later lives on average, but less is known about differences by type of care. We examined whether socioeconomic, family, and living arrangements of adults who had been in non-parental care across the first three decades of adult life varied by type of care (residential, non-relative and relative). Methods We used longitudinal data from the Office for National Statistics Longitudinal Study (LS). Participants were aged<18 years and had never been married at baseline of each census year from 1971-2001 (n=242,843). Separately for each adult follow-up age (20 to 29; 30 to 39; 40 to 49), multi-level logistic regression models were used to compare socioeconomic, family, and living arrangements by different out-of-home care (OHC) experiences. Results Any OHC increased the likelihood of poorer functioning in the three domains of socioeconomic circumstances, family formation and relationships, and living arrangements. This was evident in their 20s, 30s and 40s; the most adverse outcomes were observed for those with a history of residential care, followed by non-relative OHC, and the least adverse outcomes for relative OHC. Moderation by childhood census year, age in OHC, and gender altered the relationship between OHC and some, but not all, adult outcomes. The strongest, most consistent, evidence was for widening of inequalities in age 20-29 outcomes across childhood census years and weakest evidence for any moderation of age 40-49 outcomes by age when in OHC. Conclusion Enduring inequalities in social and economic functioning for OHC-experienced adults were found. The evidence overwhelmingly supports the policy to place children in relative care whenever possible, with residential care the least favoured option.
Background The adverse life-long consequences of being looked-after as a child are well recognise... more Background The adverse life-long consequences of being looked-after as a child are well recognised, but follow-up periods for mortality risk have mostly ended in young adulthood and mortality suggested to differ by age of placement, gender and cohort in small samples. Methods Data on 353,601 Office for National Statistics Longitudinal Study (LS) members during census years 1971–2001, and Cox proportional hazards regression models with time-varying covariates (age as the timescale), were used to examine whether childhood out-of-home care was associated with all-cause mortality until the end of 2013. After adjusting for baseline age and age2, gender, born outside the United Kingdom, number of census observations in childhood and baseline census year we tested whether mortality risk varied for those in care by age, gender and baseline census year, by separate assessment of interaction terms. Supplementary analyses assessed robustness of findings. Results Adults who had been in care at ...
BackgroundChildren who spent time in non-parental care report poor outcomes in many aspects of th... more BackgroundChildren who spent time in non-parental care report poor outcomes in many aspects of their later lives on average, but less is known about differences by ethnicity. We examined whether the health, socioeconomic, family, and living arrangements of adults who had been in non-parental care across the first three decades of adult life varied by ethnicity (White, Black, South Asian).MethodsWe used longitudinal data from the Office for National Statistics Longitudinal Study (LS). Participants were aged<18 years and had never been married at baseline of each census year from 1971-2001 (n= 672,648). Separately for each adult follow-up age group (20 to 29; 30 to 39; 40 to 49), multi-level regression models were used to compare socioeconomic, family, and living arrangements by non-parental care and ethnicity interactions.ResultsAdverse adult outcomes following an experience of non-parental care were conditional on the interaction of non-parental care with ethnicity, mainly in the...
Background: Disability and caste are two different forms of oppression, however Dalits and people... more Background: Disability and caste are two different forms of oppression, however Dalits and people with disabilities commonly face similar types of marginalities. Dalit women with disabilities may experience double discrimination because of the intersectionality of disability and caste. This study examines whether the disability and caste identity of women together affects and compounds the utilization of maternal healthcare services. Methods: A cross-sectional survey was conducted using a semi-structured questionnaire among a total of 354 Dalit and non-Dalit women, with and without a disability aged between 15 – 49 years. Maternal healthcare service utilization was assessed by Ante-Natal Care (ANC), health facility (HF) delivery, and Post-Natal Care (PNC) during the last pregnancy. Logistic regression was performed to detect the predictors of service utilization and identify whether disability and caste were associated with service utilization. First, disability and caste were fitte...
Background: Suboptimal quality of care and disparities in services by healthcare providers are of... more Background: Suboptimal quality of care and disparities in services by healthcare providers are often reported in Nepal. Experience and perceptions about quality of care may differ according to women’s socio-cultural background, individual characteristics, their exposure and expectations. This study aimed to compare perceptions of the quality of maternal healthcare services between two groups that are consistently considered vulnerable, women with disabilities from both the non-Dalit population and Dalit population and their peers without disabilities from both non-Dalit and Dalit communities. Methods: A cross-sectional survey was conducted among 343 total women that included women with disabilities, Dalits and non-Dalits. Women were recruited for interview, who were aged 15–49 years, had been pregnant within the last five years and who had used maternal care services in one of the public health facilities of Rupandehi district. A 20-item, Likert-type scale with four sub-scales or dimensions: ‘Health Facility’, ‘Healthcare Delivery’, ‘Inter-personal’ and ‘Access to Care’ was used to measure women’s perceptions of quality of care. Chi-square test and t test were used to compare groups and to assess differences in perceptions; and linear regression was applied to assess confounding effects of socio-demographic factors. The mean score was compared for each item and separately for each dimension. Results: All groups, women with disabilities and women without disabilities, Dalit and non-Dalit rated their perceptions and experiences of quality of care lowly in a number of items. While perceived quality of care between women with disabilities and without disabilities in the ‘Health Facility’ dimension and associated items, was found to differ (p<0.05), this difference was linked to disability status, but was not linked to caste differences. For example, differences in mean scores relating to ‘Cleanliness and Facilities’, ‘Open and Friendliness’ and ‘Compassion and Kindness’ were highly significant (p<0.001), with women with disabilities rating these as better than women without disabilities. On the other hand, women without disabilities rated the ‘Availability of cash Incentives’ more highly (p<0.01). No significant differences were found between Dalit and non-Dalit women in perceived quality of care, except in relation to ‘Cleanliness and facilities’, which Dalit women rated lower than non-Dalits (p<0.05). Conclusions: Perceptions about the quality of care differed significantly by disability status but not by caste. All groups rated the quality of healthcare delivery, interpersonal and personal factors as well as access to services ‘low.’ Poor service user experiences and perceptions of quality of care undermine opportunities to translate increased healthcare coverage into improved access and outcomes. Greater attention is required by policy makers, health planners and providers to the improvement of quality of care in health facilities
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Papers by Emily Murray