bluuebunny/crossref_metadata_2025 huggingface dataset:
Infectious diseases in air travellers arriving in the UK
Authors: Gerard E
Published: November 2005

The ease of access to air travel and its increased popularity over the last 30 years have led to a significant incidence of imported infectious diseases and potential infectious hazards. The commonest type of illness found is acute gastroenteritis.

Tuberculosis and malaria are not currently common conditions encountered in the UK, but medical vigilance is increasingly necessary as a result of these and other infectious diseases being carried by arriving air travellers. Risks of transmission to other passengers have been considered, and tuberculosis has been shown to have relatively low infectivity on commercial flights. Incidence of serious communicable disease occurring in arriving passengers is low, and should be referred to communicable disease specialists for advice on management. High standards of precautionary hygiene measures are mandatory to commercial aircraft to prevent spread of infectious agents.

Disease vectors and products of animal origin pose additional potential threats to public health. Vigilance by environmental health specialists helps maintain national defences against this group of threats.

Alertness to recent travel history and awareness of international public health concerns is essential for clinicians likely to encounter sick members of the travelling public. The largest commercial airports have health surveillance units, tasked with acting as a first line of defence against infectious disease. The majority of cases do not present in flight or at the airport, so they can present to any primary care clinician or emergency department. An integrated strategy for health protection will be developed in the UK with the setting up of a Health Protection Agency.
Community self-help and the homeless poor in Latin America
Authors: Stewart J , Balchin P
Published: November 2005

Finding realistic housing solutions that are able to respond to the realities of poverty in the developing, or newly industrialising, world are frequently distinct from those suited to the developed world due to levels of poverty and differing welfare regimes. This requires a different understanding of the concept of housing and shelter for developing and developed countries. Population increase and emerging habitation patterns in parts of Latin America have required that policy-makers review traditional ‘top down’ approaches to the way the homeless poor are treated and how self-help or ‘bottom up’ schemes are increasingly seen as a sustainable way forward in providing affordable housing options to both governments and communities.

Over the last decades, mass in-migration to cities has put pressure on governments to provide public housing - but two major problems arose: firstly, governments found it difficult to finance the increasing demand for public housing; and secondly, the nature of employment and the informal economy in the developing world meant that this new housing was often too costly for the urban poor, in some cases increasing homelessness still further.

Recent policy developments tend to favour supporting what the poor are and have been able to achieve for themselves, with appropriate government support. Upgrading shack settlements is now recognised as a community driven and cost-effective response that can, if appropriately supported, offer an initial and sustainable solution to urban housing need by tapping into additional non-governmental sources of funding. In the absence of a major public sector housing stock to meet demand, governments are also recognising that self-help housing schemes for families able to access funding and resources offer a further innovative approach to meeting housing need.

The nature of housing and shelter in the developing world requires a unique response so that it remains attainable and affordable to the poor. Neo-liberal policies, increasingly adopted in Latin America, are not able to provide suitable, sustainable and affordable housing delivery and alternatives need to be explored. This paper traces some developments in Latin American housing policy and explores some of the challenges that are faced in responding to the unique housing needs of the urban poor.
Audit of primary care angina management in Sandwell, England
Authors: Stewart A , Rao J , Osho-Williams G , Fairfield M , Ahmad R
Published: November 2005

This audit aimed to assess the identification and treatment of coronary risk factors, lifestyle advice given and use of drug therapy, among patients with angina in Sandwell. It was designed to help general practices evaluate their angina management, and highlight areas where practice could be improved. Criteria were based on Sandwell’s published angina audit and local clinical guidelines.

Each participating practice was asked to identify all patients with angina, from which a 10% sample was randomly selected. The notes of each selected patient were examined for evidence showing whether agreed standards of care had been achieved.

Fifteen practices took part, and contributed data on a total of 358 patients. Of patients without contraindications, 66.5% were taking aspirin, 62.1% were prescribed short-acting nitrates and 58.4% were prescribed beta-blockers. Non-white patients were significantly less likely to receive short-acting nitrates (p<0.001) and women were significantly less likely to receive beta-blockers (p<0.01). A total of 83.5% of patients had received smoking cessation advice, 75.1% had weight advice, 75.1% were advised about alcohol use and 64.5% about exercise. Overall, 77.4% had a blood pressure check within the previous twelve months, 40.5% had their cholesterol measured and 33.5% had their blood glucose measured. Non-white patients were significantly less likely to receive smoking cessation, weight, exercise and alcohol advice and were less likely to have their blood pressure checked (all p<0.0001). Patients aged 65 and over were significantly less likely to receive a cholesterol check (p<0.0001).

None of the auditable standards were actually met. This study shows that there is considerable scope to improve the management of angina patients, with particular regard to aspirin. We recommend that practices develop systems to ensure that the appropriate treatment, advice and checks are given to all patients with angina, paying particular attention to those from ethnic minority backgrounds.
With recent changes in environmental factors among Africans in South Africa, how have cancer occurrences been affected?
Authors: Walker A R P
Published: November 2005

In South Africa, with changes in environmental factors, varyingly, there have been measures of westernization of diet, with slight rises in intakes of energy and fat, with more of animal, but less of plant foods, being eaten, and with a fall in dietary fibre intake. Smoking practice has increased, particularly in males, likewise alcohol consumption. Physical activity has fallen, especially in urban dwellers. Changes in cancer incidence rates, as reported in the South African Cancer Registry for the periods 1986 and 1993-1995 have been investigated. Additionally, changes in percentages of cancers in hospitals in Johannesburg during 1953-1955 and in Durban during 1994-1996, have been looked into. The high occurrences of oesophageal and cervix cancers have fallen slightly, although more so in respect of liver cancer. But there have been rises, widely varying, in the cases of cancers of the lung, prostate and breast. While some of these changes would be expected from the changes in environmental factors, many cancer occurrence situations remain problematical, e.g. the continuing low occurrence of colorectal cancer. Recently, the rapidly rising epidemic of HIV/AIDS has slightly increased the occurrence of certain cancers, particularly Kaposi’s sarcoma and non-Hodgkin’s lymphoma. Regarding prevention, chances of cancer control in Africans, through lessening personal risk factors, are very remote, which unfortunately also prevails in large measure in western populations, regarding their reluctance to make the recommended beneficial changes.
Lessons to be learned: a case study approach
Authors: Macdonald J , Southgate H J
Published: November 2005

A man of 56 years presented with severe hypercalcaemia shortly after returning from a holiday in the sun. The final diagnosis was sarcoidosis. Measurement of the metabolites of vitamin D did not support sunshine exposure as being a contributary factor to the hypercalcaemia. The effects of sarcoid tissue on calcium metabolism are discussed.
Risks associated with herbal slimming remedies
Authors: Corns C , Metcalfe K
Published: November 2005

The market for non-conventional, natural herbal medicines is growing. This marketing opportunity has been seized upon by some unscrupulous practitioners to sell potentially unsafe ‘herbal’ products. Several people attended a Chinese herbalist for weight loss advice and were sold ‘herbal’ preparations that contained fenfluramine, a drug which was withdrawn from sale in the West in 1997 after its use was linked to primary pulmonary hypertension and valvular heart disease. Adulteration of Chinese medicines with Western drugs is becoming an increasing problem, and deaths have been reported from Japan and other Far Eastern countries linked to Chinese slimming aids containing N-nitroso-fenfluramine.

There is a need for increased public awareness of such risks associated with the use of unlicensed medicines; a system of registration for medical herbalists is also required to protect both the reputable practitioners and the general public.
Integrating Western medicine and Traditional Chinese Medicine in GP surgeries and the community: a review of two pilot schemes
Authors: Au S , Hiew S
Published: November 2005

The popularity of complementary medicine has been relentless over the past decade. Among the most popular are Traditional Chinese Medicine (TCM) which has a long and unbroken history.

This article reports on two integrated health care pilot schemes where TCM and Western medicine are merged, to varying degrees, for the benefits of patients. One of the schemes focuses on general medicine whilst the other focuses on mental health.

The authors conclude that the integrated schemes have many advantages and, on the whole, are beneficial for patients. The issues involved and learning points are discussed.
Strategy development in dealing with violence against employees in the workplace
Authors: Fleming P , Harvey H D
Published: November 2005

The creation of health promoting work-places is a key development in contemporary workplace health. This paper focuses on the issue of workplace violence and the efforts which must be made to address its prevention and to deal with its consequences as a contribution towards developing a health promoting workplace. A critical overview of the issue as it is currently addressed in the international literature is a precursor to the formulation of an inclusive definition of workplace violence. This forms the basis for a framework for the development and implementation of workplace violence policies. The framework takes account of needs assessment, policy formulation in terms of prevention, incident management and reporting, and post-incident support strategies. The needs for effective education and training and good internal and external communications are also explored. The paper concludes by highlighting the necessity for workplaces to take seriously the need for a coherent and well-planned workplace violence strategy.
Physicians of the future: Renaissance of polymaths?
Authors: Piko B F , Stempsey W E
Published: November 2005

Science and technology are crucial in modern medicine; societies devote enormous amounts of time, money and effort to developing new diagnostic and therapeutic procedures. However, the fact that people now report higher rates of disability, symptoms and general dissatisfaction with their health and well-being calls us to rethink the functions of health care and medical education. There is a need for a new medical paradigm, which should involve and reconcile the natural and the social scientific paradigms (‘two cultures’).

Medicine should be viewed as an integrative, biopsychosocial science. Therefore, medical education must involve the study of the biological structures and psychosocial functioning of human beings not as separate systems, but as interactive ones. This mandate suggests that the physician needs to become a sort of ‘neo-polymath’ in a ‘new Renaissance’. The new paradigm, however, should not demand the acquisition of more and more information. Instead, the crucial principle would focus on the appropriate selection of information.
Does the stress in childhood and adolescence matter? A psychological perspective
Authors: Lau B W K
Published: November 2005

Although stress in adults is well researched and acknowledged, little has been discussed on the existence and reactions of children and adolescents to stress, despite the mounting evidence that they are frequently among the most affected victims of a variety of threatening events. In reality stress is a normal part of a child’s or adolescent’s life and encompasses common, developmental stressors of daily life and those arising from unusual or traumatic experiences. Apart from more well known stress from family instability, poverty and life transitions, it is easy to forget or ignore the many school pressures and increasingly common social phenomenon of the ‘hurried child’ in modern life. We can make plans of intervention and prevention only when the condition is recognised by the health care professionals.
Reducing waiting times associated with an integrated child health service
Authors: Clow D , Mustafa A , Szollar J , Wood N , Reid J , Sinden S
Published: November 2005

Following an increase in average waiting times associated with a child health service in East London, an initiative to rapidly reduce the numbers of children waiting long periods following a referral was undertaken over the period May to June 1999. A multi-disciplinary cooperative approach was adopted operating within the existing available resources and involved medical, nursing, managerial and administrative staff.

The initiative involved a review of the accuracy of the waiting list, followed by an invitation to remaining patients to provide an option of continuing to wait to be seen or offering attendance at a rapid response clinic associated with reduced waiting and consultation times. Half-hourly appointments were routinely offered instead of hourly appointments and proformas were adopted for history taking and onward referrals to save time spent on administration. A total of 162 patients were seen over the course of a month and a satisfaction questionnaire completed by relatives indicated a preference for the new service. The mean waiting time was reduced to under a quarter of the time at the start of the initiative to a mean of less than two months.

The purpose of the study was to see if the waiting list could be reduced by using existing staff. We wanted to ascertain the parents’ views whether shorter waits and shorter consultation periods were acceptable, and to ascertain if the waiting list could be kept down or whether the waiting list would rapidly recur after the rapid response clinics stopped.

The findings are discussed in relation to initiatives elsewhere and the need to maintain a high quality service.
Levelling the playing fields of England: promoting health in deprived communities
Authors: Roff M
Published: November 2005

Health promotion is about focusing on systems in which those ‘waiting to be ill’ are living their lives now. Unlike the old, the new public health agenda is about developing and implementing healthy public policies. This stance involves everyone working together to develop change in the conditions of living.

This article presents a brief overview of the role of the health promotion specialist in a Primary Care Trust working with six Sure Start Programmes in a town that has high levels of poverty and deprivation. To demonstrate the principles of ‘health for all’, the article concludes with an overview of the development of a partnership to promote initiation and continued exclusive breastfeeding using collaborative working, community participation and equity.
Mixed signals from Kerala’s improving health status
Authors: Michael E J , Singh B
Published: November 2005

It can be said that health policy is about creating the conditions to free a population from disease and impairment, and so prolong the quality of life for all. If this is its purpose, then the practice of public health policy in the Indian state of Kerala presents a conundrum for health promotion analysts. On the one hand, Kerala has had remarkable success in reducing its infant mortality rates to around one-third of the Indian average, but on the other, its morbidity rates have risen to impose an economic cost more than three times the national level.

This paper sets out to explain this apparent contradiction in outcomes, serving both to provide a review of Kerala’s health status and as an illustrative guide for the interpretation of the effects of health policy in some other developing areas. While the essential health data for Kerala might imply an unsatisfactory future, the authors argue that the rapid improvements that have occurred simultaneously in public education are more likely to explain an increase in the effective reporting of disease conditions, thus suggesting a more optimistic scenario for future practice that can lead to a sustained improvement in health care.
The survival and recovery of bacteria in vacuum cleaner dust
Authors: Haysom I W , Sharp K
Published: November 2005

The possibility exists that environmental dust could be a source of gastro-intestinal infection in the domestic environment and that the causative microbes are collected during vacuum cleaning. This study examines the survival of total bacterial populations, Enterobacteriaceae and salmonella species in vacuum cleaner dust in vitro and in use.

Total counts remain constant at around 106-108 colony forming units (cfu) g-1 for at least 60 days. Enterobacteriaceae showed only a slight decline over the same period. Recovery of salmonellae artificially inoculated into vacuum dust was dose and time dependent: even relatively small inocula (<100 cfu g-1) were recoverable more than one month after inoculation.

Questionnaires and vacuum cleaner dust samples were received from 76 households. A significant association was found between total bacterial counts and whether the household was in a rural or urban situation and the number of people in the household. No association was found between total bacterial counts and the number of children in the household, the presence of pets, wearing shoes indoors, the make, model and age of the vacuum cleaner, the type of dust collector or dust bag, how often the vacuum cleaner was used and the length of time between sample collection and microbiological testing.

Salmonella species were isolated from vacuum cleaner dust from three of the 76 households although no factors could be identified linking the homes.

This study shows that vacuum cleaners are effective collectors and reservoirs of microbial contamination and that these contaminants are able to survive for up to two months. Vacuum cleaner dust could thus be a useful indicator of environmental contamination in the home.
Historical perspectives on health
Authors: Bergman B P , Miller S A J
Published: November 2005

The Parkes Museum was founded in 1876 to commemorate the life and work of Edmund Alexander Parkes (1819-1876), who was the first Professor of Military Hygiene at the Army Medical School and one of the pioneers of the public health reforms of the nineteenth century. The Museum was a multi-disciplinary institution which aimed to teach an awareness of public health matters to the general public and members of the building trade, thereby encouraging healthy design of living accommodation. The Sanitary Institute had been founded in the same year and sought to improve public health practice by setting standards for health professionals. The aims of the two organisations were therefore complementary. From 1883 they occupied the same premises in Margaret Street, London, and in 1888 they amalgamated to form a joint organisation known as The Sanitary Institute. Despite a move of location in 1909, the Parkes Museum continued to exist until the mid-1950s when an extensive refurbishment, together with a change of focus from museum to exhibition, led to its reopening in 1961 as the Health Exhibition Centre. It closed in 1971 when The Royal Society for the Promotion of Health, the successor to The Sanitary Institute, moved to new accommodation in Grosvenor Place, London.
Stress at work: the current perspective
Authors: Anderson R
Published: November 2005

Stress caused by work is costing UK organisations dearly. However, despite numerous appalling statistics and increased publicity around the problem, many organisations are still failing to do anything to reduce it. This article suggests reasons why this is the case and outlines attempts by the Health and Safety Executive (HSE) to try to overcome the problem. It also explains the background behind health and safety initiatives for stress, and provides an overview of the guidelines for employers and employees put forward by the HSE in June 2001. Finally, it describes the latest guidelines for work-related stress which resulted from the Hatton v. Sutherland Court of Appeal verdict in February 2002.
Recognising the psychosocial issues involved in hand hygiene
Authors: Elliott P
Published: November 2005

Non-adherence to hand hygiene among those involved in the provision of health care is the principal route by which infection is spread. However, despite an extensive research base, regular education and the application of prescriptive rules there has been a consistent failure to achieve long-term adherence in appropriate hand hygiene practice. Where improved adherence has been achieved there has been little evidence to show that it was for anything other than a limited period with individuals ultimately reverting back to their original practice. This paper therefore proposes that the principal cause of non-adherence to safe hand hygiene practice among those involved in the provision of health care is psychosocial in its nature. Further, until strategies are developed that will reflect this, the well-being of individuals seeking health care intervention will continue to be compromised.
Human genetics information on the web
Authors: Abu-Amero K
Published: November 2005

The genetics revolution is in full swing, especially following the recent release of the complete human genome sequence which will change forever the world in which we live by providing potential for new drugs and therapies and the means of preventing inherited genetic diseases. As a result of establishing the whole human genome sequence and the associated media publicity, the general public have become familiar with and more eager to learn about the subject of genetics and its potential impact on both their own lives and those of their families.

One of the main sources of information available to the public today is the World Wide Web. Vast amounts of information are contained in the numerous websites available through the Internet. However, finding the right information can be very tedious, especially with the huge number of websites currently available.

This article guides the public to key websites and webpages that cover information on genetics. All sites listed here have been tested and proven to be beneficial and informative.
Prevalence of HIV-1 infection among patients with leprosy and pulmonary tuberculosis in a semi-arid region, Nigeria
Authors: Moses A E , Adelowo K A , Ajayi B B
Published: November 2005

Much evidence exists on pulmonary tuberculosis (PTB) as a presenting feature of HIV infection or AIDS-related complex, while few reports exist of a direct association between HIV infection and leprosy.

This study was carried out to see whether or not an association between leprosy and HIV infection existed, similar to that of PTB in the region of Maiduguri, Nigeria.

Of 105 patients with leprosy, 11(10.5%) were positive for HIV antibody. Of 58 patients with suspected PTB, 11(19%) were positive for HIV antibody. Twenty-seven (47%) of the 58 had active PTB, with results of sputum smear and culture positive for mycobacterium, and six of these (22.2%) were also positive for HIV antibody. Odds ratios (OR) obtained by conditional logistic regression (matched) analysis were 3.52 (95%, CI 1.03-12.07) and 2.53 (95%, CI 1.04-6.15) for association between HIV-1 and PTB and leprosy, respectively. HIV infection was more prevalent among leprosy patients aged under 30 years, OR=4.25 (95%, CI 1.25-14.42). The prevalence of HIV-1 infection was at borderline significance, higher in PTB and leprosy patients than in blood donors, Fisher’s exact test (two-tailed) p=0.07 and p=0.05, respectively.
Lessons to be learned: a case study approach
Authors: Redgrave K
Published: November 2005

Posttraumatic stress disorder (PTSD) is commonly treated by psychotherapy, which may draw upon behavioural psychology or cognitive-behavioural psychology, thereby making use of desensitisation techniques - amongst others; hypnotherapy may also be used. Hypnotherapy and psychotherapy are also available for helping patients who suffer from symptoms associated with general stress or who show phobic symptoms, such as a fear of heights or of walking across bridges.

Studies of patients with such disorders have not always linked emotional (affective) and behavioural symptoms with psychophysical factors, which correlate with the symptoms. The present article not only does this, but also shows that it is possible for brain function and psycho-emotional outcome to mislead a person and ‘trick’ him or her into believing that certain fears or panics appear ‘out of the blue’ or might be due to experiences other than the true cause. These may be important when, for instance, childhood memories form an issue in any court case.
Do we really know vitamin and mineral requirements for infants and children?
Authors: Bender D A
Published: November 2005

Infants and young children require vitamins and minerals not only to replace losses through metabolic turnover, but also to increase body reserves as they grow. For infants up to six months of age it is generally assumed that breast milk provides adequate intakes, and average breast milk composition provides the basis of reference intakes for this age group, and the basis for infant formula. It is questionable to what extent the micronutrient content of breast milk reflects the infant’s requirements as opposed to the mother’s nutritional status.

For obvious ethical reasons there have been very few (if any) experiments to determine the micronutrient requirements of infants and children, although studies of intakes in areas where deficiency is common provide an estimate of minimum requirements in some cases. Different national and international authorities have approached the problem of estimating reference intakes for infants and young children in four main ways: linear interpolation between adequate intakes estimated from breast milk composition and the experimentally-determined requirements of young adults; extrapolation forwards from breast milk composition and backwards from the requirements of young adults on the basis of metabolic body weight (body weight0.75), corrected by growth factors; extrapolation backwards from the requirements of young adults on the basis of the energy density of the diet; and by factorial calculation. Despite this, there is considerable concordance between the figures published by different authorities as a result of rounding off to avoid spurious precision.
Advances in the nutrition of preterm infants
Authors: Marriott L D , Foote K D
Published: November 2005

The greatly improved survival rate of infants born both preterm and low birth weight (LBW) has led to the subsequent growth and development of these infants becoming an important focus for research. Preterm infants begin life with, or acquire as a result of their prematurity, greater morbidity than term born babies, growth deficits, an increased risk of developmental delay and an increased risk of later adult diseases compared with appropriate for gestational age (AGA) term born babies.

Research in recent decades has confirmed that there are marked differences in the nutritional requirements of preterm LBW infants compared with their AGA term born counterparts, both in the neonatal period and probably for all of infancy. In addition to the increased requirement for energy and protein, preterm LBW infants demonstrate a greatly increased requirement for some of the mineral elements, particularly iron, zinc and calcium, when compared with the needs of term AGA infants. In the UK, feeding practices for preterm infants in neonatal units and throughout infancy after hospital discharge are variable and many questions remain as to the optimal nutritional regimen for preterm LBW infants (and for subgroups of these infants) at different stages of infancy. There is some concern that the 2002 World Health Organization recommendations on infant feeding may be applied to all infants, including preterm infants, without consideration of their special nutritional needs, which may further compromise their growth and development.

A brief résumé of the work of prominent researchers in the field of preterm infant nutrition in the UK, notably Lucas, Cooke and Fewtrell, is included in the review, together with information from papers published by the authors of the review. The review concludes with a summary of the generally accepted recommendations on feeding preterm LBW infants after hospital discharge and information on some practical help available to the parents of these children and to health workers in the field.
Some aspects of the public health importance of measurement of growth
Authors: Dickerson J W T
Published: November 2005

Growth is a fundamental process of life which in complex animals is influenced by genetic constitution, nurture and nutrition. Increase in size is accompanied by processes of development and both growth and development are closely linked with time - the age of the individual. This paper considers ways in which simple measurements of different aspects of the growth of children have contributed, and are continuing to contribute, to our understanding of the origins of disease.

The results of these measurements can help those involved in the care of children to identify individuals at risk of disturbances of growth and the possibility of the development of diseases associated with them. It can also help instigate preventative measures that may help children to develop more fruitful and longer disease-free lives.
Is breast best? Is early solid feeding harmful?
Authors: MacDonald A
Published: November 2005

The health benefits of breastfeeding for babies and mothers have long been recognised and it is now globally recommended that it be continued exclusively for six months. Although there are few controlled trials to support this recommendation, the most important advantage is less morbidity from gastrointestinal infection in developing countries. There is also evidence that respiratory tract infections and atopic dermatitis is reduced, and the maternal risk of breast cancer decreases, particularly with a longer duration of breastfeeding and a high parity. There is little to suggest that exclusive breastfeeding for six months adversely affects infant growth, nutritional status or infant feeding skills, but more studies are needed. Equally, there is no evidence that introduction of solids from 17 weeks is harmful in developed countries. However, in the UK breastfeeding prevalence is low and solids are introduced early for the majority of infants and much can be done to positively encourage and support all mothers to continue breastfeeding for a longer period.
Estimation of the impact on children’s health of environmental tobacco smoke in England and Wales
Authors: Rushton L , Courage C , Green E
Published: November 2005

In this paper, the population attributable risk (PAR), a measure of the excess risk of disease associated with a risk factor, is calculated for some of the common adverse health effects that have been associated with exposure of children to environmental tobacco smoke (ETS): childhood lower respiratory illness, chronic middle ear disease, asthma and sudden infant death syndrome (SIDS). Published data on both risk estimates and the percentage of children exposed to ETS in the home (prevalence of ETS) have been utilised. The percentage of childhood lower respiratory illness and middle ear disease typically attributable to ETS from either parent smoking ranged from 9% for asthma prevalence and for referral for glue ear, to 25% for hospital admission for lower respiratory illness. Where data were available to calculate PARs separately for mother only smoking and father only smoking, the PARs were generally larger for mothers only smoking, due mainly to higher odds ratios for mothers only smoking. The PAR for SIDS attributable to ETS from mother only smoking was 11%. Although based on a small number of studies, the PAR for SIDS attributable to smoking of fathers only was similar to that attributable to the smoking of mothers only, largely due to the higher prevalence of households where only the father smokes. This study has shown that the impact of ETS on childhood illness can be considerable, emphasising the importance of the need to develop effective strategies for reducing the risk of ETS exposure in the home and elsewhere.
Background influences on dietary choice in early old age
Authors: Blane D , Abraham L , Gunnell D , Maynard M , Ness A
Published: November 2005

The contemporary increase in life expectancy is opening up a new stage in the life course - early old age. Diet during early old age makes an important contribution to disease prevention, the management of established disease and postponing the onset of physical dependency. Despite its importance, few specifically medical, dietary interventions have been designed for this age group. The presently reported study aims to supply background information for such an endeavour. Qualitative interviews have been conducted with people in early old age, sampled purposively from members of a longitudinal study cohort. A number of background influences on the dietary choices of the interviewees have been identified. Some of these influences are specific to the present generation of people in early old age, such as eating in NAAFI canteens during National Service. However, the more general categories of which they are a part will have enduring usefulness. The findings are discussed in relation to: future dietary advice; the potential for interventions in primary care; enhancing the policy of free school fruit and research on the next age cohort to enter early old age.
Accumulating aerobic exercise for effective weight control
Authors: Sykes Kevin , Choo Lau Leong , Cotterrell Mary
Published: November 2005

Purpose: To compare the effects of different patterns of regular treadmill walking and cycle ergometry on body weight, body composition, waist and hip circumferences in overweight adult Singaporean females.

Methods: Thirty overweight (BMI > 23 kg/m2) Singaporean females, aged 42.2 ± 5.4 yr (mean ± SD), all spasmodically physically active, were randomly assigned to two different eight-week programmes of aerobic exercise. One programme involved walking and cycling on indoor exercise machines at a moderate, comfortable intensity until 400 kcals had been expended, five times a week, thus giving a total weekly energy expenditure of 2,000 kcal. The other programme involved the same type of exercise but expending 1,000 kcal per session on two days a week, thereby giving the same weekly energy expenditure. Body weight, body mass index, body composition, waist and hip circumferences were measured before and after each programme. Prior to commencement of the study all subjects attended a one hour seminar on nutrition, health and fitness where the project structure was explained. They were asked not to change their eating habits during the intervention period and food diaries were kept and monitored weekly.

Results: All subjects completed the eight-week programmes of exercise. Both programmes significantly reduced body weight, body mass index, percentage body fat and waist circumference (all p<0.05). These reductions were identical in both the short-bout and long-bout programmes. No changes were observed in either group for hip circumference or lean body mass.

Conclusion: These findings demonstrated the effectiveness of moderate aerobic exercise in reducing body weight, body fat percentage and waist circumference whilst maintaining lean body mass in moderately overweight Singaporean females. The study also demonstrated that whether the exercise is performed in a series of short bouts five times a week or in longer bouts twice a week, the results are identical, providing that the total weekly energy expenditure remains the same.
Physical activity and sedentary behaviours in youth: issues and controversies
Authors: Biddle Stuart JH , Gorely Trish , Marshall Simon J , Murdey Ian , Cameron Noel
Published: November 2005

There is growing concern over the effects of sedentary lifestyles on the health of young people. Recent rapid increases in juvenile obesity have received a great deal of attention in the scientific and popular press and have been attributed partly to television viewing, computer games and other sedentary behaviours. These are thought to compete with physical activity. There is a ‘moral panic’ concerning the ‘couch kids’ culture in modern western society. Project STIL (Sedentary Teenagers and Inactive Lifestyles) at Loughborough University is investigating ‘what young people do’ and focuses on active and inactive pursuits chosen in their leisure time. The following issues are addressed in this paper with specific reference to young people: how do we define ‘sedentary behaviour’ and do key sedentary behaviours displace physical activity? Are key sedentary behaviours obesogenic? What are the secular trends for children and youth for TV viewing? Our results for young people suggest that:1. TV viewing and video-game playing are largely uncorrelated with physical activity, suggesting that there is time for both2. meta-analytic findings show that body fatness is not related in any clinically meaningful way with key sedentary behaviours3. although more children and youth have greater access to TVs than in previous generations, the amount of TV watched per head has not changed for 40 years.

Preliminary findings from Project STIL suggest that inactivity is more complex than we sometimes think. Indeed, measures of ‘couch potato-ism’, such as TV viewing, may be inappropriate markers of inactivity.
Socio-economic differences in cardiovascular disease and physical activity: stereotypes and reality
Authors: Macintyre Sally , Mutrie Nanette
Published: November 2005

Cardiovascular disease (CVD) is patterned by socio-economic status, being more common in lower social classes. Since physical inactivity is a risk factor for CVD it might be assumed that it is more common in lower social classes. We examine major recent UK population surveys and show that this assumption is incorrect; although higher social class adults engage in more formal sports activities, they are less likely to engage in other (e.g. occupational) activities. Lower social class children are more likely to engage in sports and active play. We also show that although Scotland has higher rates of CVD than England, it does not have higher prevalences of all CVD risk factors.
Health promotion and health education about diabetes mellitus
Authors: Anthony Sony , Odgers Tina , Kelly William
Published: November 2005

Diabetes mellitus, especially if poorly controlled, is a major contributory cause for blindness, heart attacks, amputations, strokes, kidney failure and impotence. The prevalence of diabetes is increasing globally. Fortunately there is compelling evidence from clinical trials that lifestyle modifications and education can minimise the risk of diabetes, and new treatments can reduce the burden of morbidity and mortality. We now have modified insulin, infusion pumps, dialysis, kidney and pancreas transplants, and effective therapies for reducing lipids and blood pressure.

However, important as these advances are, diabetes and its complications can be prevented, or delayed, by modifying risk factors. Persons with diabetes must understand their disease and be empowered to avoid obesity, smoking and unhealthy diets, and encouraged to exercise, and control blood glucose. Good health education, health promotion and access to professional care are essential for persons with diabetes mellitus. Valuable health information is available from Diabetes UK and the Internet.
The effects of exclusion of dietary egg and milk in the management of asthmatic children: a pilot study
Authors: Yusoff Noor Aini Mohd , Hampton Shelagh M , Dickerson J W T , Morgan Jane B
Published: November 2005

Current understanding of the use of exclusion diets in the management of asthma in children is limited and controversial.

The aim of this study was to examine the effects of excluding eggs and milk on the occurrence of symptoms in children with asthma and involved 22 children aged between three and 14 years clinically diagnosed as having mild to moderate disease. The investigation was single blind and prospective, and parents were given the option of volunteering to join the ‘experiment’ group, avoiding eggs, milk and their products for eight weeks, or the ‘control’ group, who consumed their customary food.

Thirteen children were recruited to the experimental group and nine to the control group. A trained paediatrician at the beginning and end of the study period assessed the children. A seven-day assessment of food intake was made before, during and immediately after the period of dietary intervention in both groups. A blood sample was taken from each child for determination of food specific antibodies and in those children who could do so, the peak expiratory flow rate (PEFR) was measured.

Based on the recommended nutrient intake (RNI), the mean percentage energy intake of the children in the experimental group was significantly lower (p<0.05) in the experimental group. After the eight-week study period and compared with baseline values, the mean serum anti-ovalbumin IgG and anti-beta lactoglobulin IgG concentrations were statistically significantly reduced (p<0.05) for both in the experimental group. In contrast, the values for anti-ovalbumin IgG in the control group were significantly increased and those for anti-beta lactoglobulin IgG were practically unchanged. The total IgE values were unchanged in both groups.

Over the study period, the PEFR in those children in the experimental group able to perform the test was significantly increased, but no such change was noted in the children in the control group who could do the test.

These results suggest that even over the short time period of eight weeks, an egg- and milk-free diet can reduce atopic symptoms and improve lung function in asthmatic children.
Central obesity and coronary risk factors
Authors: Ghosh Arnab , Bose Kaushik , Chakravarti Shila , Chaudhuri Asit Baran Das , Chattopadhyay Jayanti , Dasgupta Gautam , Sengupta Sivaji
Published: November 2005

A cross-sectional study of 130 Bengalee Hindu men (mean age=50.3 years; SD=10.5 years) was undertaken to investigate the relationship of body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR) with total cholesterol (TC), high density (HDL-C), low density (LDL-C) and very low-density (VLDL-C) lipoprotein cholesterol, fasting plasma glucose (FPG) and triglycerides (FTG). Correlation studies revealed that WHR was significantly correlated (r=0.245, p<0.01) with TC. WC and WHR had significant correlations with VLDL-C, FPG and FTG. All subjects were further divided into two groups based on WHR<0.95 (centrally non-obese, CNO) and WHR>0.95 (centrally obese, CO) following the US Joint National Committee (JNC) guidelines. Students’ t-test revealed that CO subjects (n=83) had a significantly higher mean TC (p<0.05), VLDL (p<0.05), FPG (p<0.01) and FTG (p<0.05) compared with CNO individuals (n=47). Results of analysis of variance (ANOVA) of central obesity status (CNO=no, CO=yes) and BMI (BMI tertiles used as a categorical variable) with these metabolic variables revealed that CO status had a significant effect (p<0.05) on TC, VLDL-C, FPG and FTG. BMI tertiles did not a have significant effect on any of these metabolic variables. There was no significant BMI tertile-central obesity status interaction. It can therefore be concluded that the JNC guidelines of WHR>0.95 to define central obesity can be used, irrespective of BMI, among this population, to identify individuals who have enhanced metabolic risk factors of coronary heart disease (CHD). Furthermore, it can be routinely used for health promotion purposes among Bengalee men.
Temporal trends in the prevalence of diabetes mellitus in a rural community in Sri Lanka
Authors: Illangasekera Upali , Rambodagalla Samanthi , Tennakoon Silumini
Published: November 2005

In developing countries the prevalence of diabetes mellitus is reported to be lower in rural areas compared to urban areas. This difference has been attributed to lifestyle factors associated with the higher socio-economic status of those living in urban areas. However, recent clinical observations indicate that the prevalence of diabetes is on the increase even in the rural sector. The aims of the present study were to objectively assess whether the prevalence of diabetes has increased in a named rural community in Sri Lanka during a period of ten years and whether there has been a change in the socio-economic status of the community during this period. The study was conducted on a sample of 220 subjects randomly selected from an adult population of 25,605 residents in a rural area in central Sri Lanka. Each of these subjects had the fasting blood sugar estimated and the height, weight, resting blood pressure and socio-economic parameters, such as the level of education, occupation and monthly income, recorded. These data were compared with those of a similar study conducted by the main author in the same community ten years ago.

The results revealed that the age-standardised prevalence of diabetes had increased from 2.5% in 1990 to 8.5% in 2000 (p=0.008) and that this was accompanied by an increase in the monthly income, level of education and body mass indices. Since nearly 70% of all Sri Lankans live in villages, continuation of the present trend would result in a dramatic increase in the number of patients with diabetes in the future. Suitable strategies should be implemented to arrest this trend and manage a large number of patients with diabetes in the future.