Not in our back yard: media coverage of community opposition to mobile phone towers--an application of Sandman's outrage model of risk perception

Australia has the world's second highest per capita use of mobile phones. To meet rapid expansion in use, transmission towers are being erected hastily, backed by federal government exemptions from normal local government planning procedures. In a case study of media reportage of a successful resident protest about the placement of transmitters adjacent to a kindergarten, uncertain risks to health were the ostensible concerns voiced by the protesters. Eleven of the 12 primary components and six out of eight secondary components of Sandman's model of community risk perception were consistent with both the protesters' expressed concerns about the transmission towers and the way in which the issues involved were framed by the media.

Experimental simulation of the thrust phases of fast-start swimming of fish

Measurements of the thrust and forward impulse of a simulated fish tail and mathematical modeling indicate that the propulsive forces of fast-start swimming can be optimized by three different effects: (i) exactly inverting the tail tip vortex that is generated with the initial stroke, (ii) using a moderately flexible tail, and (iii) introducing a specific delay between the initial stroke and the return stroke. Experiments were performed with a new computer-controlled fish-tail simulation apparatus, and the results confirm the theoretical predictions of a previous study.

Podophyllin 0.5% or 2.0% v podophyllotoxin 0.5% for the self treatment of penile warts: a double blind randomised study

OBJECTIVE

To compare the effectiveness and cost of self treatment of penile warts with a commercial preparation of podophyllotoxin 0.5% (PDX 0.5%) with podophyllin 0.5% and podophyllin 2.0% sourced from Podophyllum emodii.

DESIGN

A prospective double blind randomised study.

SUBJECTS

315 patients with penile warts attending two departments of genitourinary medicine.

MAIN OUTCOME MEASURES

Absence of warts, cessation of treatment due to severe side effects at 5 weeks.

RESULTS

Of the 315 patients, 244 conformed to the protocol. Analysis was on an intention to treat basis. At 5 weeks no significant differences were found in the extent of healing of warts or in side effects for the three treatment groups. The costs of drug treatment (excluding staff time) are at least pounds 10.00 less for podophyllin than podophyllotoxin. A fourfold variation in the active constituents of the podophyllin preparations did not produce appreciably different clinical responses. In a subanalysis no evidence of deterioration in effectiveness of podophyllin over time was demonstrated.

CONCLUSIONS

Penile warts in selected cases can be safely treated with 0.5-2.0% podophyllin self applied by the patient at a fraction of the cost of commercially available podophyllotoxin. The shelf life of the podophyllin extracts is at least 3 months. These findings may be especially relevant in countries where resources for health care are limited.

A multicomponent insulin response sequence mediates a strong repression of mouse glucose-6-phosphatase gene transcription by insulin

Glucose-6-phosphatase (G6Pase) catalyzes the final step in the gluconeogenic and glycogenolytic pathways. The transcription of the gene encoding the catalytic subunit of G6Pase is stimulated by glucocorticoids, whereas insulin strongly inhibits both basal G6Pase gene transcription and the stimulatory effect of glucocorticoids. To identify the insulin response sequence (IRS) in the G6Pase promoter through which insulin mediates its action, we have analyzed the effect of insulin on the basal expression of mouse G6Pase-chloramphenicol acetyltransferase (CAT) fusion genes transiently expressed in hepatoma cells. Deletion of the G6Pase promoter sequence between -271 and -199 partially reduces the inhibitory effect of insulin, whereas deletion of additional sequence between -198 and -159 completely abolishes the insulin response. The presence of this multicomponent IRS may explain why insulin potently inhibits basal G6Pase-CAT expression. The G6Pase promoter region between -198 and -159 contains an IRS, since it can confer an inhibitory effect of insulin on the expression of a heterologous fusion gene. This region contains three copies of the T(G/A)TTTTG sequence, which is the core motif of the phosphoenolpyruvate carboxykinase (PEPCK) gene IRS. This suggests that a coordinate increase in both G6Pase and PEPCK gene transcription is likely to contribute to the increased hepatic glucose production characteristic of patients with non-insulin-dependent diabetes mellitus.

Do work-place smoking bans cause smokers to smoke "harder"? Results from a naturalistic observational study

The purpose of this study was to investigate whether smokers outside buildings with work-place smoking bans smoke "harder" than those smoking in social settings. An unobtrusive random observational study of smokers followed by structured interview was used, with 143 smokers taking smoking breaks outside their office buildings and 113 smokers in social settings. The main outcome measurements were number of puffs per cigarette and cigarette smoking duration. The mean number of puffs per cigarette for the office building group was 18.7% greater than that for the social settings group (10.7 +/- 3.2 vs. 8.7 +/- 2.7, t = 5.58, df = 253, p < 0.001); 74.8% of smokers outside offices took more than the mean number of puffs for the group compared to 42.5% of smokers in social settings (chi 2 df 1 = 26.31, p < 0.0001). Mean cigarette smoking duration was 30.4% shorter for the work-place group than the social settings group (3.9 +/- 1.2 minutes vs. 5.6 +/- 2.6 minutes). Of smokers outside offices, 55.2% had a cigarette smoking duration between 3 and 4.59 minutes, while 53.1% of smokers in social settings took > or = 5 minutes to smoke the observed cigarette (chi 2 df 2 = 31.55, p < 0.0001). Smokers who scored at the 75th percentile on the Fagerstrom Tolerance Scale took a mean 9.5 +/- 2.6 puffs per cigarette compared to 9.3 +/- 2.7 puffs by those who scored in the 25th percentile on the scale (t = 0.34, df = 145, p = 0.73). Regardless of degree of nicotine dependency, smokers leaving work-stations to smoke outside buildings smoked their cigarettes nearly 19% "harder" than cigarettes smoked in social settings. The individual and public health benefits of reduced smoking frequency engendered by work-place smoking bans may be lessened by policies which allow smokers to take smoking breaks.

Transverse leukonychia in patients receiving cancer chemotherapy

Transverse white nail banding can be inherited or caused by a variety of diseases and medications, including cancer chemotherapeutic agents. We report three cases in which patients with cancer had antineoplastic therapy-induced transverse leukonychia and summarize previously published reports. There is no specific cancer chemotherapeutic drug, combination of drugs, or drug class that causes transverse leukonychia; however, cyclophosphamide, doxorubicin, and vincristine are the therapeutic agents most frequently involved. For patients receiving cancer chemotherapy, white transverse nail banding is a side effect of the medication rather than a consequence of underlying malignancy.

Non-accidental injury or brittle bones

When a child presents with one or more unexplained fractures, non-accidental injury (NAI) should be considered in the differential diagnosis. This article reviews some of the other differential diagnoses, particularly osteogenesis imperfecta and the alleged "temporary brittle bone disease".

Use of an extension-assisting brace following anterior cruciate ligament reconstruction

Despite changes in rehabilitation protocols, an extension deficit remains an important potential cause of significant morbidity following anterior cruciate ligament (ACL) reconstruction. An extension-assisting brace was designed using a limited motion brace and an elastic strap across a fulcrum on the anterior aspect of the knee joint. The effects of the brace were investigated in 40 patients undergoing primary ACL reconstruction using an autogenous central third patellar tendon graft. The patients were randomized either to use the brace in the first 6 weeks postoperatively or to undertake the same accelerated rehabilitation programme but without any brace, and they were reviewed at 4 months postoperatively. The following data were recorded: passive and active extension and flexion deficits compared with the non-operated limb. KT-1000 assessment of anterior laxity and isometric quadriceps and hamstring strength. There was no difference between the two groups for any of the recorded variables. This was largely attributed to satisfactory tunnel placement and emphasis on the restoration of extension and quadriceps function during the early postoperative rehabilitation.

When outcomes threaten incomes: a case study of the obstruction of research to reduce teenage smoking

A case study is presented of Australian efforts to promote an evidence-based, outcome-oriented intervention designed to reduce purchasing of cigarettes by minors. The intervention was supported by a wealth of international research literature, yet for several years was declared unethical by local institutional ethics committees. Eight objections that were raised are reviewed. Each of these objections was spurious yet initially influential. Various advocacy strategies were employed by proponents of the intervention to reframe its public definition. These gradually transformed perceptions of the intervention from one that considered it unethical, to one that considered it a virtual 'vaccine against teenage access to cigarettes' that should be incorporated into routine public health best practice. Those advocating outcome-oriented interventions should not assume that the imperative of influencing health outcomes will dominate perceptions of best practice within the health care system. In situations where competing definitions of the meaning of an intervention dominate decision makers' perceptions of outcome-oriented research, advocacy can be used to reframe these definitions more toward perceptions which are conducive to support and implementation.

Wrath

Images

Infinitesimal risk as public health crisis: news media coverage of a doctor-patient HIV contact tracing investigation

Among the most prominent health or medical stories covered in 1994 by the Australian news media was that concerning an HIV positive hospital obstetrician and the attempt by the New South Wales Health Department to trace and test 149 women on whom he had operated. All press and television coverage of the issue was reviewed. The surface news narrative of the search for missing, "innocent" mothers potentially infected with a deadly and infectious illness is shown to serve as a "hard news" pretext enabling a wider major discourse to operate about a health system accused as being captive to gay and civil libertarian politics, allowing "guilty" doctors at high risk of HIV to endanger "innocent" patients. Expert consensus held that the women were at "infinitesimal risk" of acquiring HIV. However, media accounts of the investigation all but belied this, illustrating that the news media's framing of risk has more to do with its reproduction of moral outrage components than with "scientific" notions of calculable risk.

Is the ratio of inhaled corticosteroid to bronchodilator a good indicator of the quality of asthma prescribing? Cross sectional study linking prescribing data to data on admissions

OBJECTIVE

To investigate the ratio of inhaled corticosteroid to bronchodilator as a measure of the quality of asthma prescribing by general practitioners.

DESIGN

Ecological cross sectional study linking general practitioner asthma prescribing with hospital admission data and a measure of deprivation.

SUBJECTS

11 family health services authorities in the West Midlands region and 99 general practices in North Staffordshire.

MAIN OUTCOME MEASURES

Hospital admission rates for asthma; the ratio of inhaled corticosteroid to bronchodilator; and Townsend deprivation scores.

RESULTS

No overall significant correlation was found between admission rates for asthma and corticosteroid:bronchodilator ratios for family health services authorities (Spearman's rs = -0.109, P = 0.750) or general practices (rs = -0.084, P = 0.407). In deprived family health services authority areas and general practices an inverse non-significant correlation existed between admission rates for asthma and corticosteroid:bronchodilator ratios (rs = -0.300, P = 0.624; rs = -0.218, P = 0.136). In contrast, in more affluent areas and general practices a positive non-significant correlation existed between admission rates and corticosteroid:bronchodilator ratios (rs = 0.371, P = 0.468; rs = 0.038, P = 0.792).

CONCLUSION

Although the corticosteroid:bronchodilator ratio may be a valid indicator of the quality of prescribing for individual patients with asthma, caution should be applied in interpreting aggregated ratios. Differences in the severity of asthma or the prevalence of chronic obstructive pulmonary disease may explain inconsistent associations between admission rates for asthma and corticosteroid:bronchodilator ratios in family health services authorities and general practices with different deprivation scores.