Questionnaire Assessment of Change in an Occupational Environment

Lighting and heating conditions at work may cause subjectiveill health and lead to requests for improvement of these aspectsof the working environment. Self-administration of a semi-structuredquestionnaire can provide a quick and useful method to evaluatealterations which are subsequently made. Requests for reprints should be addressed to: Dr R. Philipp, Department of Community Health, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR.     

Online Medical Database Searching

A wide range of databases and databanks are presently availableto medical researchers. This paper outlines the scope of thedatabases available through a commercial host system and describesthe procedures required for their access and use. A discussionof some of the limitations and likely future developments ispresented in the context of our experience of their use. Requests for reprints should be addressed to: Dr N. Wood, Department of Epidemiology and Community Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK     

Toxicological Assessment of Potential Hazards from New Inorganic Fibres

An experimental programme to evaluate the potential hazard ofinorganic fibres is described. Model systems (both in vitroand in vivo) which may be used to evaluate the probable effectsof fibres are critically examined and the problems inherentin interpretation of results are discussed. The use of suchsystems both individually and in combination is illustratedby reference to results obtained from ICE experimental fibres. Dr F. H. Tyrer, Employment Medical Adviser, Health and Safety Executive, Inter City House, Mitchell Lane, Bristol BS1 6AN.     

Mass Media Techniques to Reduce Smoking Prevalence in Staff Groups

Alteration of personal habits through the mass media is reportedto be difficult and not considered effective for smoking behaviour.Nevertheless, amongst 62 heavy smokers in four workplaces whowere followed up for 12 months, the BBC television series, ‘SoYou Want To Stop Smoking’, helped nine persons to stopsmoking, and 25 people to reduce their smoking patterns. Thefindings are comparable to reports for other long term follow-ups.Although only an estimated 3.4 per cent of smokers chose totake part in the study, the response was similar to reportedattendance rates at anti-smoking clinics.As home videocassettesof the series will become available, and BBC Television hopeto re-run the series, it seems likely that other staff groupscould benefit from encouragement to view the programmes andsustained interest in their efforts to stop smoking. Requests for reprints should be addressed to: R. Philipp, Department of Epidemiology and Community Medicine, University of Bristol Canynge Hall, Whiteladies Road, Bristol BS8 2PR     

An Evaluation of Undergraduate Occupational Health Teaching

It has been reported that at present, UK medical schools donot have a uniform approach to undergraduate occupational healthteaching. Consequently, a suggested educational framework forthis teaching has been prepared. In this study a problem managementquestionnaire was used to evaluate a course based on this framework.Patterns of student understanding about hazards, risk groups,and staff responsible for occupational health in the hospitalenvironment, were compared before and after the courses. Thisenvironment was chosen for study because after graduation alldoctors work for some time in hospitals and different doctorsmay treat hospital staff for problems acquired at work. Thefindings show that although specific teaching of hospital occupationalhealth is not given, students grasp the introductory conceptsand then modify their approaches to the prevention and clinicalcare of health problems associated with hospital employment.In particular, they become more aware of different risk groupsand the sources of professional advice. Findings from such studiesbefore and after tuition help tutors to identify gaps in knowledgeand can be used with student groups to reinforce their interestin learning. Requests for reprints should be addressed to: Dr Robin Philipp, Department of Epidemiology and Public Health Medicine, Canynge Hall, University of Bristol, Whiteladies Road, Bristol BS8 2PR, UK     

Smoking patterns at a British and at an American medical school

Cigarette smoking among medical students at the University of Bristol (Bristol) and the New York University School of Medicine (NYU) was investigated and differences were subjected to statistical analysis.
At Bristol 34–6% and at NYU 14–3% of respondents classified themselves as regular smokers. Among students in the pre-clinical phase of training the difference between the number of smokers at Bristol and at NYU was not significant. At both schools more clinical students smoked than preclinical students, but only at Bristol did the difference between the number of smokers in the two grade levels reach statistical significance.
There are fewer heavy smokers (consumers of more than twenty cigarettes per day) among the pre-clinical students at Bristol than among preclinicals at NYU. In the clinical year, however, there were slightly (insignificantly) fewer heavy smokers at NYU while there were significantly more at Bristol.
Smokers at NYU acquired the habit at a somewhat earlier age than the smokers at Bristol.
The majority of students at both schools indicated that medical education had not influenced their decision to smoke or not to smoke.
Most smokers—more among the clinical than the pre-clinical students—reported that they were displeased with their habit and that they wished to give it up. Somewhat fewer smokers at Bristol gave that response than students at NYU.
Factors contributing, at least in part, to the differences between smoking patterns observed may be variables of age and years of education.
The widely held but untested belief that precept and example by medical school teachers may be a potent force for modifying the smoking behaviour of health professionals, is in need of research.     

Patient-Centredness in the Consultation. 1: A Method for Measurement

Henbest R J and Stewart M A. Patient-centredness in the consultation.1: A method for measurement. Family Practice 1989; 6: 249–254. This paper presents a method for assessing the doctor-patientinteraction in terms of its patientcentredness. Patient-centrednesswas defined in terms of doctor responses which enabled patientsto express all of their reasons for coming, including symptoms,thoughts, feelings and expectations. The method was tested andfound to be valid (correlations for criterion validity rs =0.51 and 0.89), reliable (inter-rater correlation rs = 0.91,intra-rater correlation rs = 0.88), and sensitive, in that itwas able to detect differences among doctors (P < 0.001)and among doctor responses to different patient offers (P<0.001). The method was also found to be practical in that itwas inexpensive and could be used for a variety of purposessuch as by tutors to give feedback to their students, by examinersas part of the evaluation of candidates' consultation skills,and by students and clinicians alike, for self-assessment. Thefinding that the score for the first two minutes of the consultationcorrelated highly with the score for the entire consultation(rs = 0.806) greatly increases the time effectiveness of themethod, suggesting that it would be practical for use on a largescale, including student assessment and future studies of therelationship between patient-centredness and patient outcomes.     

A factor analysis of the important people inventory

Aims:For well over a decade, the Important People Inventory(IP, Clifford and Longabaugh, 1991; Clifford et al., 1992) hasbeen used to collect a wide range of valuable information regardingnetwork support for alcohol use. However, because of psychometriclimitations and varied adaptations of the IP, the followingstudy performed factor analyses to develop a more structurallyconsistent model of the scaleas compared to the existing model.MethodsA first principal components analysis (Varimax rotation) wasrun on the indices of the IP using data from a national investigationof residents within a recovery community (N = 897).Next, a second principal components analysis was run using datacollected from participants recruited from inpatient treatmentsettings (N = 150).Results Results indicated a nine-index,three-factor model, which explained about two thirds of thecommon variance. These three factors included: Support for Drinkingfrom Network Members (3 items), Drinking Behaviours of NetworkMembers (3 items), and General Social Support (3 items).ConclusionsResultsof both studies suggest that the IP fits a multi-component structure.It is recommended that Drinking Behaviours of Network Membersbe examined for predictive validity and that General SocialSupport be removed from the scale or have additional items added.     

Citizens' juries in planning research priorities: process, engagement and outcome

Background  Involving members of the public in setting priorities for health research in becoming increasingly common practice. One method used in public involvement exercises is the citizens' jury.
Objective  This article examines some challenges and benefits of citizens' juries, including issues relating to process, public engagement and outcome.
Design  In Bristol, UK, a citizens' jury was held with the aim of identifying local priorities for research into health and social care. This jury is used as an example through which key issues in public involvement and jury processes are explored.
Setting and Participants  The Bristol Citizens' Jury comprised 20 members of the public (`jurors'), an oversight panel and a steering group. The jurors met at 11 consecutive sessions during 2006 over a period of 16 weeks, which culminated in a written report. All the sessions were audio-recorded, five sessions were observed and video-recorded, and 16 jurors completed written feedback forms at the end of the jury process.
Findings and conclusion  In this article we discuss degree and timing of public involvement in the process of health research; the role of context; representation of communities; processes of deliberation and knowledge production; and how constraints of time and cost may affect public involvement. It was clear that jurors who took part in the Bristol Citizens' Jury were engaged and committed. This engagement may be related to jurors' belief in their ability to shape future research alongside concern about the relevance of the issues under discussion. Opposing emotions of tension and harmony are a crucial part of the deliberation process.     

Health status and occupation: use of a health status index to measure the health of occupations

A total of 4466 employed persons completed the short AucklandUniversity Health Status Index (AUHSI) questionnaire and a healthscore was assigned to each individual on the basis of theirresponses. This health score was found to have statisticallysignificant associations with a number of health-related measures,including socio-economic status (P<0.001), and with occupationalgroup: administrative, clerical/sales/service, skilled tradesand unskilled labour (P<0.001). Within the occupational groups,3361 employees could be assigned to 42 specific occupationshaving 19 or more members each. After controlling for age andgender, significant differences in mean health score for specificoccupation were found in the clerical/sales/service (P<0.05),skilled trades (P=0.002) and unskilled manual (P<0.005) groups.It is postulated that these differences may be due to the natureof the specific occupation. Some possible reasons are listed.It is concluded that a global measure of health status suchas this may be useful in the planning and evaluation of occupationalhealth services.     

Aetiology of Acute Pharyngitis and Clinical Response to Empirical Therapy with Erythromycin Versus Amoxicillin

Guthrie R M, Ruoff G E, Rofman BA, Ginsberg D, Karp R R, BrownS M and Schulz GA. Aetiology of acute pharyngitis and clinicalresponse to empirical therapy with erythromycin versus amoxicillin.Family Practice 1988; 5: 29–35. One hundred and eighty-nine adults with acute pharyngitis hadculture and serological evaluation for groupA beta haemolyticstreptococci (GABHS), Mycoplasma pneumoniae, and Branhamellacatarrhalis. Sixteen patients had evidence for infection withGABHS, none for M. pneumoniae, and one for B. catarrhalis. Forthose with GABHS, there was no significant difference betweenempirical treatment by erythromycin or amoxicillin. For thosewithout GABHS, empirical treatment with erythromycin appearedto result in a statistically significant reduction in coughand a noticeable but less than significant reduction of othersymptoms when compared to empirical treatment with amoxicillin.The new formula tion of erythromycin utilized in this study(PCE) may be associated with a reduction in gastrointestinalintolerance from that reported with other erythromycin products.     

Population structure and genetic diversity of the parasite Trichomonas vaginalis in Bristol,UK

The protozoan parasite Trichomonas vaginalis is the causative agent of trichomoniasis, an extremely common, but non-life-threatening, sexually-transmitted disease throughout the world. Recent population genetics studies of T. vaginalis have detected high genetic diversity and revealed a two-type population structure, associated with phenotypic differences in sensitivity to metronidazole, the drug commonly used for treatment, and presence of T. vaginalis virus. There is currently a lack of data on UK isolates; most isolates examined to date are from the US. Here we used a recently described system for multilocus sequence typing (MLST) of T. vaginalis to study diversity of clinical isolates from Bristol, UK. We used MLST to characterise 23 clinical isolates of T. vaginalis collected from female patients during 2013. Seven housekeeping genes were PCR-amplified for each isolate and sequenced. The concatenated sequences were then compared with data from other MLST-characterised isolates available from http://tvaginalis.mlst.net/ to analyse the population structure and construct phylogenetic trees. Among the 23 isolates from the Bristol population of T. vaginalis, we found 23 polymorphic nucleotide sites, 25 different alleles and 19 sequence types (genotypes). Most isolates had a unique genotype, in agreement with the high levels of heterogeneity observed elsewhere in the world. A two-type population structure was evident from population genetic analysis and phylogenetic reconstruction split the isolates into two major clades. Tests for recombination in the Bristol population of T. vaginalis gave conflicting results, suggesting overall a clonal pattern of reproduction. We conclude that the Bristol population of T. vaginalis parasites conforms to the two-type population structure found in most other regions of the world. We found the MLST scheme to be an efficient genotyping method. The online MLST database provides a useful repository and resource that will prove invaluable in future studies linking the genetics of T. vaginalis with the clinical manifestation of trichomoniasis.     

The impact of Family Practice

Someone once remarked that only three things matter if a restaurantis to be successful—position, position and position. Thesame could be said about journals, where the most importantcriteria are citation, citation and citation. It was a particularpleasure, therefore, to learn that the steadily rising ImpactFactor of Family Practice now stands at 1.16, which is higherthan journals such as the American Family Physician (0.94),the Canadian Family Physician (0.35), the Journal of the RoyalCollege of Physicians of London (0.83), the Journal of the RoyalSociety of Medicine (0.72), the Postgraduate Medical Journal(0.44), Primary     

Cholinesterase Problems arising in a Plant Manufacturing Tri-aryl Phosphates

Eight cases with an abnormal cholinesterase, either in quantityor quality or both, are described. Case 1 falls in the subgroupU₁, and Case 2 most likely also falls into this subgroup. Cases3 and 4 fall into the intermediate group with a reduced cholinesteraseactivity. Cases 5,6,7 and 8 fall into the usual group with aprogressive reduction in the esterase activity in Cases 5 and6, a severe fall in the cholinesterase level in Case 7 and amarkedly low initial pre-employment level in Case 8. The assessmentand method of dealing with these cases are discussed. Requests for reprints should be addressed to:Dr A. A. Morgan, 37 Holcombe Road, llford, Essex IG1 4XF.     

Sickness Absence and Control of Insulin-treated Diabetes as Assessed by Glycosylated Haemoglobin

The sickness absence records for 1986 were obtained for 63 employedinsulin-treated diabetic patients who had glycosylated haemoglobin(HbA1) measurements during that year. One subject whose absencewas associated with attempts to improve control because of pregnancywas excluded from the analysis. Fifteen had good control (HbA18.5 per cent or less) and 47 had poor control (HbA1>8.5%).The groups were similar for age, sex, duration of diabetes andoccupation. The distribution of sickness absence showed greaterfrequency of absence (p<0.05), greater number of workingdays lost (p<0.02), and greater average duration of absence(p<0.04) among those diabetic workers with poor control comparedto those with good control. Because some individuals with poorcontrol had no absence, HbA1 measurement cannot be recommendedon its own to identify those workers who will be absent fromwork. Its use may lie in indicating a level below which sicknessabsence is minimized. Requests for reprints should be addressed to: E. R. Waclawski, Institute of Occupational Medicine Ltd, 8 Roxburgh Place, Edinburgh EH8 9SU, UK     

1985-2005: Twenty Years of Excellence

On the platinum anniversary of the pilot issue of Health EducationResearch, it gives me great pride and humility to assume theposition of Executive Editor for the Americas. In the shortspan of two decades, Health Education Research has become apremier journal in public health, continuing to further itsinitial mission of using research to advance the theory andpractice of health education. Twenty years ago, Douglas Leathar, the founding editor of HealthEducation Research, put forward a vision that is as true nowas it was two decades ago. He envisioned a journal that wouldstrengthen the rigor of health education research and that woulddirectly inform practice. In his inaugural editorial he said:

"Althoughthe journal is to be published to academic standards, practitionersshould be aware that the journal aims for a practical perspectiveon     

Neurological Problems Arising in a Plant Manufacturing Tri-aryl Phosphates

Three neurological cases are described whose clinical picturemight cause problems in the differential diagnosis from thatof tri-aryl phosphate poisoning. Case I is a case of disseminatedsclerosis, Case 2 is one of primary muscular dystrophy and Case3 is that of a peripheral neuropathy associated with perniciousanaemia. In this last case consideration was given to the possibilitythat the low serum cholinesterase, initially present, mightbe specific to the neurological condition per se rather thanto the associated anaemia. The difficulties encountered withneurological disorders occurring in a factory manufacturingtri-aryl phosphates, demonstrate that full clinical neurologicalexamination is of paramount importance and that the estimationof cholinesterase level cannot be used as a substitute for suchan examination ⁰Requests for reprints should be addressed to: Dr A. A. Morgan, 37 Holcombe Road, llford, Essex, IGI 4XF.     

Recording the Diseased and Deceased: A Historical Look at Medical Illustration in 19th century Bristol.

In 2012 a relic from the Medical Illustration department at the Bristol Royal Infirmary (BRI) was unearthed. The forgotten Victorian photographic album contains examples of medical photography from the late 1800s. This historic memento provides a valuable insight into the inception of medical photography at the BRI, as well as allowing 21^st century physicians to assess common Victorian ailments perhaps not regularly seen in western hospitals today. Since the initial finding of the captivating collection, presumed now to be a 19^th century surgeon's scrapbook, the author felt a certain obligation to embark on a research project with the intention of revealing more about the intriguing characters preserved in these antiquated medical photographs and to gain a greater understanding of where they fit in to the wider history of medical illustration. This research project led to the discovery of further evidence of Medical Illustration being undertaken in the region, in the form of a collection of historic drawings discovered at the Bristol Record Office.     

META-ANALYSIS OF THE EFFECTS OF ALCOHOL DEHYDROGENASE GENOTYPE ON ALCOHOL DEPENDENCE AND ALCOHOLIC LIVER DISEASE

The purpose of this paper is to assemble and evaluate existingdata on the effect of genetic variation in ADH2 and ADH3 onthe risk of alcohol dependence, and on the risk of alcoholicliver disease. Calculations of odds ratios and their confidencelinuts, and tests for heterogeneity of the results from theavailable studies, have been performed. It is clear that possessionof the ADH2-2 allele decreases the risk of alcohol dependence,but it increases the risk of alcoholic liver disease among alcoholics.ADH3 variation also has significant effects on alcohol dependence,which may be due to linkage to ADH2; the ADH3 effect differssignificantly between Asian and European subjects. ThereforeADH genotype has substantial effects on risk of alcohol dependenceand alcoholic liver disease, but more work is needed on thegeneralizability of these findings to non-Asian populations,and on possible mechanisms.