Do we practise what we preach?

There are recommendations regarding many facets of lifestyle. We proposed to look at hospital doctors' habits in East Yorkshire. METHOD: A simple questionnaire was sent out to 574 doctors in the Hull and East Yorkshire Hospitals NHS Trust. Non-responders were re-mailed. Age, sex, grade, specialty, number of portions of fruit and vegetable per day, alcohol intake, smoking, exercise and hours worked. RESULTS: 301 doctors (238 males, 60 females) responded (response rate 58%). Approximately half of doctors who responded were consultants. Few respondents smoked (6.6%), and the mean alcohol consumption, 8.35 units per week (SE 0.54), was less than the recommended limits for men and women. Most doctors fell short of the "recommended" 5 portions of fruit and vegetables per day (median 3 per day) and nearly half worked more than 56 hours per week. Most respondents took at least the recommended amount of exercise per week (112 SE25 minutes) although 26% of doctors took no exercise at all.     

Are we getting what we pay for?

The British NHS delivers health care free at the point of access to whomever needs it. It is often claimed to be the envy of the world. But does it deliver health? Or could the resource put into the health service be better spent elsewhere? In this article, we discuss the determinants of health in the United Kingdom in the past, the rise of public health and the impact medical technology has had on health. We discuss resource distribution in health care, and apply the principles of health economics to the wider context of the delivery of health, rather than health care. With a background of rising demand for health care and rationing of resources in the UK, combined with inequalities in life expectancy related to position in society, we conclude that wealth redistribution, environmental regulation, improved nutrition and better education must come first in the priorities for achieving a healthy population.     

Where we are in retail food safety,how we got to where we are,and how do we get there?

Food safety has not yet been attained. This is evident from reported foodborne-disease outbreaks, laboratory-confirmed cases of diseases that can be foodborne, estimates of foodborne illness based on surveillance data, and out-of-compliance risk factors. Several activities have had an impact on food safety, but there are limitations in the way each of those activities has been or is being conducted. The activities include foodborne-disease surveillance; food sampling and testing; swabbing and testing of utensils; inspection and enforcement of regulations; use of the Food Code; on-site hazard analyses, on-site monitoring of critical control points and prompt corrective actions; applied research and challenge testing; training of public-health and food regulatory personnel; training of food workers, supervisors, and managers; and education of the public. To attain food safety, we must use common (microbiological) sense and understand the principles of transmission of foodborne-disease etiological agents and their control. A change of attitudes and program focus is necessary.     

Can we, should we, eradicate the meningococcus?

The eradication of infectious agents is an attractive means of disease control that, to date, has been achieved for only one human pathogen, the smallpox virus. The introduction of vaccines against Neisseria meningitidis into immunisation schedules, and particularly the conjugate polysaccharide vaccines which can interrupt transmission, raises the question of whether disease caused by this obligate human bacterium can be controlled, eliminated, or even eradicated. The limited number of meningococcal serogroups, lack of an animal reservoir, and importance of meningococcal disease are considerations in favour of eradication; however, the commensal nature of most infections, the high diversity of meningococcal populations, and the lack of comprehensive vaccines are all factors that suggest that this is not feasible. Indeed, any such attempt might be harmful by perturbing the human microbiome and its interaction with the immune system. On balance, the control and possible elimination of disease caused by particular disease-associated meningococcal genotypes is a more achievable and worthwhile goal.     

Researching routine immunization-do we know what we don't know?

Background

The Expanded Programme on Immunization (EPI), launched in 1974, has developed and implemented a range of strategies and practices over the last three decades to ensure that children and adults receive the vaccines they need to help protect them against vaccine-preventable diseases. Many of these strategies have been implemented, resulting in immunization coverage exceeding 80% among children one year of age in many countries. Yet millions of infants remain under-immunized or unimmunized, particularly in poorer countries. In November 2009, a panel of external experts met at the United States Centers for Disease Control and Prevention (CDC) to review and identify areas of research required to strengthen routine service delivery in developing countries.

Methods

Research opportunities were identified utilizing presentations emphasizing existing research, gaps in knowledge and key questions. Panel members prioritized the topics, as did other meeting participants.

Findings

Several hundred research topics covering a wide range were identified by the panel members and participants. However there were relatively few topics for which there was a consensus that immediate investment in research is warranted. The panel identified 28 topics as priorities. 18 topics were identified as priorities by at least 50% of non-panel participants; of these, five were also identified as priorities by the panel. Research needs included identifying the best ways to increase coverage with existing vaccines and introduce new vaccines, integrate other services with immunizations, and finance immunization programmes.

Interpretation

There is an enormous range of research that could be undertaken to support routine immunization. However, implementation of strategic plans, rather than additional research will have the greatest impact on raising immunization coverage and preventing disease, disability, and death from vaccine-preventable diseases. The panel emphasized the importance of tying operational research to programmatic needs, with a focus on efforts to scale up proven best practices in each country, facilitating the full implementation of immunization strategies.     

What do we mean when we say "palatable food"?

The word palatability and related words have not been used in a consistent way. Palatability may be a property of a food, of the organism eating the food, or both. Investigators have failed to distinguish different possible meanings of the statement: "palatable foods increase intake". This may indicate: (1) a simple observation that some foods stimulate more intake than others, (2) an innate response to the taste of foods that alters appetite, (3) a correlate of food intake that does not itself affect intake, and (4) a link in a causal chain involving prior associations between foods and their postingestive consequences.     

Medicare: Where have we been? Where are we going?

This is an edited version of the paper delivered by Professor John Deeble as the Gordon Oration at the 31st Public Health Association of Australia Annual Conference in Darwin, Northern Territory, on September 29, 1999.     

What will we do without to get what we really want?

Successful clinical governance can only occur if staff, managers and commissioners are prepared to accept that traditional solutions are not necessarily the most appropriate. Accurate assessment of clinical risk and the development of strong and effective clinical teams with clear leadership, multidisciplinary appraisal and clearly defined implementation plans will help to shape good practice.