In recent years there has been an increasing interest in the observation that rates of psychiatric disorder and of educational problems in children may vary considerably according to area and to types of living conditions. However, very little is known concerning the extent to which rates actually differ, and even less about how particular area characteristics co-vary with the rates of different types of child disorder. Gath et al. (1972) found that child psychiatric referral rates were higher in areas of low social status, but data were not available to determine whether the difference lay in the preyalence of disorder or in the likelihood of detection or referral. Reading backwardness has also been associated with low social class areas (Miller et al., 1957; Eisenberg, 1966). In addition, it has been found that reading standards are lower in England than in Scotland (Davie et al., 1972). None of the studies of reading have taken IQ, into account, and it is not known whether the correlates are mainly with IQ or with a specific disability in reading. The present investigation was designed to examine these issues by determining if there were differences in the rates of child psychiatric disorder and of specific reading retardation between an inner London borough and the Isle of Wight. If differences were found, it also sought to examine the reasons for them, in order to elucidate possible causal or precipitating factors.

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Summary Subcutaneous insulin absorption kineticswere assessed in 50 healthy study subjects (21 female, 29 male; age 26 + 3 years, BMI 22.5 + 1.8 kg/m2; mean + SD) during 45 min after periumbilical injection of soluble human U40-or U100-insulin (0.15 IU/kg). Subcutaneous fat thickness was measured by ultrasound, and skin temperature at the injection site was registered. Serum insulin concentrations increased within 30 min from basal values of 37 + 15 to 140 + 46 pmol/1 after U40-insulin and from 36 + 10 to 116 _+ 37 pmol/1 after U100-insulin (p < 0.001). After 45 min serum insulin concentrations were 164 _+ 43 pmol/1 with U40-insulin and 128 + 35 pmol/1 with U100-insulin (p < 0.001).Decline in blood glucose levels and suppression of Cpeptide were comparable. The serum insulin levels reached 30 and 45 min after U40-and U100-insulin injection were positively correlated with skin temperature (p < 0.0008), and negatively correlated with subcutaneous fat thickness (p < 0.009). In conclusion, the lower insulin concentration of U40-insulin, higher skin temperature, and a thinner subcutaneous fat tissue at the injection site are associated with accelerated and enhanced subcutaneous insulin absorption. [Diabetologia (1994) 37: 377-380]

It was found that emotional disorders, conduct disorders and specific reading retardation were all twice as common in ten-year-old children attending schools in an inner London borough as in children of the same age on the Isle of Wight. The correlates of these disorders in the two areas were investigated in order to explore possible reasons for these differences in prevalence. It was possible to identify four sets of variables (family discord, parental deviance, social disadvantage and certain school characteristics) which were associated with child disorder and deviance within both the two areas. As in almost all cases these same adverse factors were more commonly found in London, it may be concluded that the high rates of psychiatric disorder and specific reading retardation in London ten-year-olds are due in part to the fact that a relatively high proportion of London families experience marital discord and disruption, that many of the parents show mental disorder and antisocial behaviour, that families often live in poor social circumstances, and that the schools are more often characterized by a high rate of turnover in staff and pupils. The evidence suggests that these problems stemmed from living in an inner London borough, but further research is required to identify what it is about life in a metropolitan area that predisposes to the development of disorder and deviance.

Improving the efficiency of mental healthcare service delivery by learning from international best-practice examples requires valid data, including robust unit costs, which currently often lack cross-country comparability. The European ProgrammE in Costing, resource use measurement and outcome valuation for Use in multi-sectoral National and International health economic evaluAtions (PECUNIA) aimed to harmonize the international unit cost development. This article presents the methodology and set of 36 externally validated, standardized reference unit costs (RUCs) for five health and social care services (general practitioner, dentist, help-line, day-care center, nursing home) in Austria, England, Germany, Hungary, The Netherlands, and Spain based on unambiguous service definitions using the extended DESDE PECUNIA coding framework. The resulting PECUNIA RUCs are largely comparable across countries, with any causes for deviations (e.g., country-specific scope of services) transparently documented. Even under standardized methods, notable limitations due to data-driven divergences in key costing parameters remain. Increased cross-country comparability by adopting a uniform methodology and definitions can advance the quality of evidence-based policy guidance derived from health economic evaluations. The PECUNIA RUCs are available free of charge and aim to significantly improve the quality and feasibility of future economic evaluations and their transferability across mental health systems.