Identifying 'non-medical' datasets to monitor community health and well-being

BACKGROUND

The aim of the study was to identify 'non-medical' datasets holding routinely collected information that might be used to measure and monitor the wider determinants of community health and well-being.

METHODS

An expert panel discussion, involving public health and environmental health academics and professionals with expertise in a variety of backgrounds (including environmental health, housing, transport, community safety, public health, primary and secondary care), and interrogation of the Office for National Statistics database were carried out for the West Midlands region. The aim was to identify routinely collected 'non-medical' datasets containing information on the following factors: physical environment, crime, housing and homelessness, social services, socio-economic environment including employment, lifestyles, education, leisure and culture, transport and accidents.

RESULTS

Fifty-six datasets were identified. Although 43 (77 per cent) were collected at least annually, few (17; 30 per cent) held data that were disaggregated and routinely available at the sub-local authority level.

CONCLUSIONS

This study has identified a number of datasets that hold information relevant to health. However, no single dataset is likely to provide information on all dimensions of health and the determinants of health, and local agencies should consider carefully the strengths and weaknesses of each. Through the development of inter-sectoral working and multi-agency involvement at the local level there is now considerable scope to improve the quality of many of these datasets and to promote their use in the measurement and monitoring of community health.

Archetypes, complexes and self-organization

There has always been confusion and disagreement about the nature of the terms archetype and complex in Jungian circles, not to mention non-Jungian ones. Another ongoing concern is whether Jung's concept of the archetype and complex can be justified in terms of current scientific research, most notably that of neurophysiologists and others interested in the brain and consciousness. This paper proposes a theory of the formation of complexes, namely, that they are created through self-organization within the brain/mind. Self-organization is a process typical of large complex systems, and is generally accepted to operate within the brain and to be important in its functioning. Examples of self-organization in biology are related to the psychic processes that form the complexes. It is then natural to define the archetype in terms of the complex, and the authors propose a definition of the archetype as an equivalence class of complexes. On this view, the archetype is an emergent property of the activity of the brain/mind, and is, appropriately, defined at the level at which it emerges. This definition is in line with the original development of Jung's ideas, in that he derived the concept of the archetype from his earlier discovery of the feeling-toned complex.

Stress-induced decrease of the intestinal barrier function. The role of muscarinic receptor activation

Recently the breakdown of the barrier function of the intestinal epithelium after application of an experimental psychological and physical stress protocol in rats has been observed. Not only did smaller molecules pass from the luminal to the serosal side, but so also did larger proteins with the dimensions of luminal antigens and toxins. The increased permeability for macromolecules is primarily due to a decrease of the tightness of the zonula occludens, but an increased endocytotic uptake indicates that transcytosis is increased also. From studies of model systems it can be concluded that activation of the intracellular protein kinase C route by muscarinic receptor activation or histamine receptor activation can be one of the underlying cellular pathways. The physical pathway relaying the stress from the brain to the intestinal tract appears to be the parasympathetic branch of the autonomic nervous system. The difference in reaction of different strains suggests that coping style is an important determinant of the response of the intestinal barrier to stress.

Primary care workshops can reduce and rationalize antibiotic prescribing

We describe a controlled study comparing the effects on primary care prescribing in west Gloucestershire, UK, where antibiotic workshops were offered, with those in east Gloucestershire, where microbiology tutorials were given. The year-on-year changes in quantity and costs of antibiotics dispensed following general practice prescriptions were measured. There was no significant difference in the number of antibiotic items prescribed across the county, but the number of prescriptions for broad-spectrum agents (quinolones, cephalosporins and co-amoxiclav) declined by 15.4% in west Gloucestershire, compared with a 6.5% increase in east Gloucestershire (P: = 0.002). Use of narrow-spectrum antibiotics (penicillin V, trimethoprim and nitrofurantoin), whose use was encouraged, did not change in west Gloucestershire practices, but decreased by 12% in east Gloucestershire practices (P: = 0.003). There was increased use of clarithromycin and azithromycin in both groups of practices. Antibiotic workshops held in the primary care setting can rationalize antibiotic prescribing. This can reduce prescribing costs and selection pressure by broad-spectrum antimicrobial agents and, perhaps, go some way to reducing the development of resistance.

Endothelial cell chemotaxic activity expressed in rat placenta is not associated with prolactin-like proteins B and C

Conditioned medium from gestation day 18 rat placental cultures showed potent stimulation of the directional migration of human retinal endothelial cells. To examine the role of major secreted placental proteins in this chemotaxic activity, prolactin-like proteins (PLPs)-B and C were purified from rat placenta using immuno-affinity chromatography. In contrast to conditioned medium, native PLP-B and PLP-C preparations failed to show any significant stimulation of endothelial cell migration. This study further examined the ability of PLP-B to bind to rat receptors for growth hormone (GH-R) and prolactin (PRL-R). In competitive binding assays with [125I]-hGH, neither native nor recombinant PLP-B preparations showed significant high affinity binding to the transfected rat GH-R or PRL-R. In summary, neither PLP-B nor PLP-C exhibit the potent chemotaxis stimulatory activity of placental conditioned media, nor does PLP-B show evidence of ability to act via rat GH or PRL receptors.

Northern region asplenia register--analysis of first two years

OBJECTIVES

To assess the feasibility of setting up a register of patients with asplenia within a defined geographical area; to ensure that guidelines on best practice were implemented; to obtain information on antibody levels to pneumococcal capsular polysaccharides and Haemophilus influenzae type b capsular polysaccharide, before and after immunisation and annually thereafter; to raise awareness of risks among clinicians and to offer advice on management.

DESIGN

Prospective recruitment using multiple sources of recruitment. Annual follow up reminders sent from Registration Centre.

SUBJECTS

Population of (old, pre-1995) Northern Health Region: approximately 3.1 million.

MAIN OUTCOME MEASURES

Data were obtained on reasons for asplenia, duration of asplenia, use of prophylactic antibiotics, Medic-Alert bracelets, immunisations, antibody levels, death.

RESULTS

The register was initiated at the beginning of April 1995 and ran to the end of March 1997. After two years of operation, 1111 cases had been registered but the response from some health districts was poor. Major primary causes of asplenia were trauma (264), other surgical (198), lymphoproliferative disease (154), and idiopathic thrombocytopenic purpura (147). There were 664 patients on prophylactic antibiotics, of whom 498 were on continuous antibiotics. Only 18 had any type of warning bracelet. Antibody measurements were carried out at least once on 75% of patients; 306 patients had satisfactory antibody levels on first blood sample in year 1, rising to 405 in year 2; 43 patients failed to make any antibody response to Pneumovax despite multiple immunisations, and three patients failed to respond to Hib vaccine. Sixteen patients with satisfactory antibody levels in year 1 had low levels in year 2 requiring vaccine boosters. Sixteen deaths were reported, two of which were directly attributable to overwhelming sepsis.

CONCLUSIONS

Registration has been successful and has raised awareness of the management of asplenia. Compliance with antibiotic prophylaxis and immunisation was initially poor. A potential high risk group of vaccine non-responders has been identified and poor persistence of pneumococcal antibodies has been identified which is likely to alter approaches to immunisation in asplenic patients.

Routes of success: influences on the occupational attainment of young British males

Using data from the National Child Development Study, the paper develops a complex path model predicting the occupational grade achieved by 4,298 employed British males at age 33. Most British social mobility research has been based in the 'class structurationist' tradition, and the paper begins by comparing this with the 'status attainment' tradition, which is more common in the USA. The class structurationist approach has rarely analysed the factors influencing individual occupational attainment, and those working in this tradition in Britain have often assumed that people from working-class origins fare worse on average than those from the middle class because of factors associated with their class disadvantage rather than any difference in individual characteristics such as ability or ambition. Status attainment research, however, has generally found that individual ability and motivation are the key factors influencing occupational attainment, and that class origins count for comparatively little. Using various measures of class origins, parental support, qualifications, and individual ability and ambition, the paper goes on to develop a linear structural equations model which achieves a good fit to the data. The model demonstrates that individual ability is by far the strongest influence on occupational achievement, that motivation is also important, and that factors like class background and parental support, while significant, are relatively much weaker. The paper concludes that occupational selection in Britain appears to take place largely on meritocratic principles.

Colonization with enteroadherent, enterotoxigenic and enterohemorrhagic Escherichia coli among day-care center attendees in New Orleans, Louisiana

BACKGROUND

E. coli strains producing specific virulence factors are frequently cited as causes of pediatric diarrhea in developing areas, although many well children from the same areas are colonized with these organisms. The role of these Escherichia coli in day-care center (DCC)-associated diarrhea in the United States has not been evaluated.

METHODS

A cohort of 112 DCC attendees from 5 DCC in urban New Orleans were followed longitudinally with demographic data, biweekly routine stool samples and additional stool samples with episodes of diarrhea. E. coli isolates were routinely saved; diarrhea stool samples were tested to detect enterotoxigenic, enterohemorrhagic and enteroadherent strains; and the prevalence of these E. coli in children with and without diarrhea was investigated.

RESULTS

During 225 child months of observation 21 episodes of diarrhea were documented and microbiologic data were available for 18. HEp-2 cell enteroadherent E. coli [mostly enteroaggregative (EAggEC) pattern] were identified in 6 of 18 (33.3%) diarrhea cases vs. 6 of 36 (16.6%) age-matched controls. However, the prevalence of EAggEC was very DCC-specific, with EAggEC found in 12 of 22 routine specimens from a DCC with recent EAggEC-related diarrhea vs. 0 of 11 routine specimens from age-matched children in another DCC without EAggEC-related diarrhea (P=0.002). Enterotoxigenic E. coli were uncommon in both ill and well children, and no enterohemorrhagic E. coli were detected.

CONCLUSION

EAggEC were commonly isolated from children with and without diarrhea in certain DCC settings, although we cannot determine whether these strains caused diarrhea. Diarrhea-producing E. coli were not associated with diarrhea in this DCC population.

Reflectometer for measuring the bidirectional reflectance of rough surfaces

A fully automatic, four-axis gonioreflectometer is described. It has an angular accuracy of 0.3 degrees and a range of 90 degrees in both the theta(i) and the theta(r) zenith angles. The gonioreflectometer is simpler than previous designs because of its use of rotating arms rather than moving carriages to mount the optical components. Where possible, commercial components have been used to reduce the cost. A novel off-axis angular encoding scheme is also described.

Poverty and health: exploring the links between financial stress and emotional stress in Australia

The links between poverty and health have been investigated in a number of independent studies, as well as by the Poverty Commission in the 1970s and, more recently, the National Health Strategy. However, much of the poverty research suffers from the lack of detailed information on health status, while the work conducted in the public health sphere has used rather rudimentary poverty measures. The research reported here attempts to overcome these limitations by using unit record data from two national household surveys conducted by the Australian Bureau of Statistics in 1990. Together, these two data sets contain an enormous amount of detailed information on household incomes and the health status of individuals. Data from the two surveys are combined in a way which allows the links between poverty and health to be explored in greater detail than has hitherto been possible in Australia. Analysis of the integrated data set focuses on the links between poverty and several measures of stress-related poor health. The results from a variety of different methods point to the existence of significant differences between the reported incidence of stress of those whose incomes place them either side of a poverty threshold. The size of the statistical association between poverty and stress is of both numerical and statistical significance, although further work, preferably using longitudinal data, is needed on the important issues of causation.

The good practice of the police: an alternative approach in dealing with offenders who abuse/misuse alcohol

The office of constable is taken by declaration and specifically says '... prevent all offences against the persons and properties ...'. The police service, like many hospitals and particularly casualty units, comes into initial contact with a high proportion of society's problems, including those related to people who cannot handle alcohol. This results directly or indirectly in a significant number of issues affecting social life detrimentally and at a tremendous cost to the public purse. These points at some time or another have been adequately illustrated by articles or television documentaries. The police service has a duty to prevent crime. The author maintains that, through the collaboration of the criminal justice agencies and health services, and using a simple approach, behaviour could be altered significantly enough to contribute towards a reduction in repeat offending and a consequent decline in the use of public funds. The author believes that a great number of people, too large to even contemplate quantifying, would have a better quality of life, a goal sought by many, and that the police service is well placed to participate constructively in the rehabilitation of offenders who have a 'drink' problem.

The mouse Dazla gene encodes a cytoplasmic protein essential for gametogenesis

RBM and DAZ/SPGY are two families of genes located on the Y chromosome that encode proteins containing RNA-binding motifs, and both have been described as candidate human spermatogenesis genes. Transmission of deletions from father to son has been observed in the case of DAZ, but neither gene family has been shown to be essential for spermatogenesis in human males. The DAZ/SPGY genes are particularly amenable to a knockout approach, as they are found on the Y chromosome in Old World primates and apes, but in other mammals, they are represented only by an autosomal gene, DAZLA, which is also present in Old World primates and apes. It has also been shown that a Dazla homologue is essential for spermatogenesis in Drosophila. Here we show that Dazla protein is cytoplasmic in male and female germ cells, unlike the nuclear RBM protein. Disruption of the Dazla gene leads to loss of germ cells and complete absence of gamete production, demonstrating that Dazla is essential for the differentiation of germ cells.

Paying for water

Water has been taken for granted as an essential public health need since the Victorian sanitary revolution. Water has come back on to the public health agenda in the United Kingdom because of recent policy changes and their untoward environmental and social impacts; along with water privatization and tough new environmental directives, there have been serious water pollution incidents, water shortages, water debt and disconnection. Along with concern about protecting individual rights to a clean safe water supply, there is concern about the ability of national water resources to meet all our communities' needs, without unacceptable environmental damage. A national plan is needed for the conservation of water and protection of water resources and the environment; adequate central funds are needed to see that this happens. There should be greater emphasis on local water management and a key role for local authorities; there should be fair pricing, protection of water supplies for the poorest and most vulnerable, and a ban on water disconnection to domestic users, on public health grounds. More research is needed into the potential adverse health impact of people on prepayment meters disconnecting themselves. There is a place for water metering as the most rapidly deliverable means of controlling peak demand, reducing overall consumption and avoiding a large-scale environmentally damaging solution to supply more water. However, control of leakage offers the largest potential saving and is the most cost-effective means to protect existing water supply. We question whether private water companies, geared to maximizing profit and share dividends, can deliver a national plan for the protection and management of water resources, for the good of the environment and future generations. The public health lobby must become more actively engaged in the debate about the supply, protection and price of our most precious public health asset-water.