An exploratory spatial data analysis approach to understanding the relationship between deprivation and mortality in Scotland

This paper considers the spatial characteristics of the relationship between deprivation and mortality rates in Scotland. Scotland not only has higher average mortality rates than England and Wales but the greatest spatial concentrations of the poorest health areas in Britain. Recent analysis has suggested that degree of deprivation alone cannot explain the majority of Scotland's 'excess' poor health relative to England and Wales, a finding referred to as the 'Scottish effect'. This analysis considers if the spatial patterning of deprivation could be significant to understanding of high mortality in Scotland. Exploratory spatial data analysis methods are implemented to study the spatial relationships between deprivation and standardised mortality ratios (SMRs) in post-code sectors in Scotland. Deprivation was measured using the 2001 Carstairs score, and the total number of deaths during a 3-year period around the 2001 census was used to calculate SMRs. A strong spatial relationship is observed between deprivation and mortality. Deprivation impacts mortality levels not only within the same areas but also in spatially proximate areas. It is concluded that, further research on the 'Scottish effect' can benefit from new methodological approaches which assess the variation in both the extent and spatial arrangement of deprivation and mortality in small areas.     

Material and social deprivation and health and social services utilisation in Québec: a local-scale evaluation system

Very few studies have employed local-scale analyses to evaluate how well primary health care and social services reach the most socially and economically deprived individuals. This paper describes a project, conducted in close partnership with decision-makers and practitioners at selected local community service centres (in French, CLSCs) in Quebec, Canada, that developed a system for assessing primary care and social services utilisation by applying deprivation levels defined at the local scale (i.e., according to the distribution of deprivation in individual CLSC service areas). More than 25 years ago, Québec started setting up a province-wide network of publicly financed CLSCs whose mission was to offer first-line health and social services at the local level. Now approximately one Quebecer in four receives at least one service a year from a CLSC. The evaluation system presented in this article is built on deprivation profiles for each CLSC service area and comprises maps, relative indices of service utilisation, and an interpretation framework that facilitates the integration of new data into the decision-making and services planning processes. Study results show that deprivation levels, when defined using local perspectives, correspond more closely to decision-makers' perceptions, that relative indices are sensitive to key determinants of services provision and utilisation, and that the interpretation framework is useful for reassessing intervention strategies.     

The brain as a self-organizing system

Summary Clinical evidence and numerous results from animal experimentation indicate that cognitive functions have to be learned. Brain structures subserving these functions require sensory experience for their maturation. Genetic instructions are in principle not sufficient to specify neuronal connections with sufficient precision. Self-organization processes are implemented in addition which allow to optimize genetically determined blue prints of connectivity by making use of functional criteria. Thus, neuronal activity becomes an important shaping factor in the development of the structural and functional architecture of the forebrain. To the extent that this neuronal activity is modulated by sensory signals, environmental factors can influence the development of neuronal networks. Recent experiments indicate that these shaping processes are additionally controlled by modulatory systems. Both, the noradrenergic projection from the locus coeruleus and the cholinergic projection from the basal forebrain facilitate activity-dependent long-term changes of neuronal connections during development. The activity of these modulatory systems in turn depends on central states such as arousal, attention, and perhaps also motivation. It is inferred from this evidence that experience-dependent self-organization should not be considered as a passive imprinting process but rather as an active dialogue between the brain and its environment. The hypothesis is discussed that many developmental disturbances which are commonly attributed to deprivation are in fact due to defaults of the CNS which either lead to the formulation of wrong questions or to the reduction of exploratory drive.     

The equity of access to orthodontic dental care for children in the North East of England

OBJECTIVES: To assess the equity of access to primary care orthodontic treatment in relation to deprivation in the County Durham and Tees Valley Strategic Health Authority area. STUDY DESIGN: An observational study based on Dental Practice Board data for the County Durham and Tees Valley Strategic Health Authority area with a population of 1.13 million. METHODS: The postcode of all orthodontic claims made by National Health Service dentists across the area in the financial years 2002/2003 and 2003/2004 were obtained and the claim rate per 1000 at risk population calculated for each ward. These ward rates were then compared to both the level of deprivation measured by the Index of Multiple Deprivation 2000 and the children's dental registration rate of the area. RESULTS: Inequity in access to orthodontic care was observed. There was a moderate negative correlation r = -0.40 suggesting wards with the lowest claim rates had the greatest deprivation. In addition, the wards with the lowest child dental registration rates also had the lowest claim rates for orthodontic treatment. CONCLUSIONS: Currently, there is inequity of access to orthodontic treatment for children in County Durham and Tees Valley. The move towards local commissioning for dental services within the NHS will provide an opportunity to reduce inequalities in access.     

6-OHDA lesions of the hypothalamus: interaction of aphagia, food palatability, set-point for weight regulation, and recovery of feeding

6-Hydroxydopamine (6-OHDA) exerted a marked effect on normal eating behavior when injected bilaterally into certain regions of the brainstem of the rat. The drug was administered in a volume ranging from 0.5 to 1.5 μl at sites in the hypothalamus and mesencephalon extending from AP 7.0 to 2.2. In 41 of 42 rats, 6-OHDA did not elicit an ingestive response following its injection in doses of 5, 8, 15, or 30μg per site. Rather, the immediate effect of the drug was a profound aphagia and adipsia which was either short-lived, chronic, or lethal depending on the anatomical locus of injection and the concentration of the drug given. The crucial factor in the reversal of anorexia and the reinstatement of a normal feeding pattern was the nature of the diet itself. Recovery from a 6-OHDA syndrome was enhanced or attenuated in 28 of 42 rats simply by altering the esculent property of the diet. In a test of the Powley-Keesey hypothesis for weight regulation, 4 of 5 of those rats reduced by food deprivation to 75% of their normal body weight recovered from the highest dose (30 μg) of 6-OHDA, whereas all but one rat died in another high dose group in which body weight had not been previously reduced. However, when 6-OHDA was injected in lower doses into the hypothalamus, the level of body weight did not necessarily determine the time course of recovery nor the extent to which drinking and feeding resumed. At 50 of 57 sites in which 6-OHDA had been injected, 5 μg of norepinephrine failed to elicit any eating response. Neither eating nor drinking was evoked by the micro-injection of acetylcholine-eserine, angiotensin, or dopamine at many of these sites or by calcium (Ca⁺⁺) injected into the cerebral ventricle. Although these findings give experimental support to the supposition that a catecholaminergic mechanism may be involved in food and water intake, it is clear that the metabolic weight regulation system, gustatory, motor and other factors required for ingestive behavior are all affected to a differential degree by the chemical lesion produced by 6-OHDA.     

The concomitant effects of mild sleep loss and an anticholinergic drug

Thirty-seven young men were tested in drug-along, sleep-loss-alone, and sleep-loss-drug groups to determine the separate and combined effects of mild sleep loss and scopolamine hydrobromide. Scopolamine was administered intravenously in either a sedative dose (5 g/kg) or a low deliriant dose (10 g/kg); sleep deprivation was for either one or two nights. Attention, accuracy, motor skill and behavior were measured and rated.An analysis of the results revealed that either dose of scopolamine given after loss of sleep caused significantly more intense and prolonged psychotomimetic effects than were noted in the drug-alone condition. Unlike the psychotomimetic effects, the results on sedation were not uniform. Those men who recieved 5 g/kg of scopolamine following sleep deprivation showed increased somnolence, whereas the reverse was true for the 10 g/kg scopolamine-sleep-loss subjects.Formerly Cpt., MC, U.S.A. Edgewood Arsenal, Md., where this work was done.     

The spatial localization deficit in visually deprived kittens

We measured the spatial localization abilities (alignment accuracy) of visually deprived kittens by use of similar spatially bandpass stimuli (Gaussian blobs) to those employed for the assessment of human amblyopes. The tests of vision were conducted on kittens reared with either strabismus or following different periods of monocular deprivation. As with amblyopic humans, the deficits in alignment accuracy were scaled in proportion to blob size and were not only considerably larger than those of grating acuity but also were not correlated with either the acuity or contrast sensitivity losses. Tests with stimuli of various contrast revealed that the deficits could not be explained in terms of the contrast sensitivity loss in this eye. The positional deficits that arise from anomalous visual development are independent of the contrast sensitivity loss and profound.     

The Alcohol Deprivation Effect in C57BL/6J Mice is Observed Using Operant Self-Administration Procedures and is Modulated by CRF-1 Receptor Signaling

Background: The alcohol deprivation effect (ADE) is characterized by transient excessive alcohol consumption upon reinstatement of ethanol following a period of ethanol deprivation. While this phenomenon has been observed in rats using both bottle drinking (consummatory behavior) and operant self‐administration (consummatory and appetitive “ethanol‐seeking” behavior) procedures, ADE studies in mice have primarily relied on bottle drinking measures. Furthermore, the neurochemical pathways that modulate the ADE are not well understood. Therefore, we determined whether the ADE can be observed in C57BL/6J mice using operant self‐administration procedures and if expression of the ADE is modulated by the corticotropin releasing factor‐1 (CRF‐1) receptor. Methods: C57BL/6J mice were trained in a 2‐hour operant self‐administration paradigm to lever press for 10% ethanol or water on separate response keys. Between operant sessions, mice had access to ethanol in their homecage. Once stable responding occurred, mice were deprived of ethanol for 4 days and were then retested with ethanol in the operant paradigm for 3 consecutive days. Next, to assess the role of the CRF‐1 receptor, mice were given intraperitoneal (i.p.) injection (0, 10, or 20 mg/kg) of the CRF‐1 receptor antagonist CP‐154,526 30 minutes before ADE testing. Additional experiments assessed (i) ADE responding in which the alternate response lever was inactive, (ii) the effects of CP‐154,526 on self‐administration of a 1% sucrose solution following 4 days of deprivation, and (iii) ADE responding in which mice did not received i.p. injections throughout the experiment. Results: Mice exhibited a significant increase in postdeprivation lever responding for ethanol with either a water reinforced or inactive alternate lever. Interestingly, i.p. injection of a 10 mg/kg dose of CP‐154,526 protected against the ADE while not affecting lever responding for a sucrose solution. Finally, baseline and deprivation‐induced increases of ethanol reinforced lever responding were greater in mice not given i.p. injections. Conclusions: The ADE in C57BL/6J mice can be modeled using the operant self‐administration paradigm and increased ethanol self‐administration associated with the ADE is modulated by CRF‐1 receptor signaling.