Synthesis and antimicrobial properties of new cepham and penam derivatives with the carboxylic group in the “wrong” β-configuration

The cepham (9) and the penam (10) derivatives, with their carboxylic group in the “wrong” β-configuration, which is opposite to that exhibited by the common penicillins, were synthesized and assayed in vitro for antimicrobial properties. Compounds 9 and 10, tested on Gram-positive and Gram-negative bacteria, both sensitive and resistant to β-lactamase inactivation, exhibited a very poor activity, directed only against non-β-lactamase-producing Gram-positive bacteria. One of the possible explanations for these results may be found in unfavourable steric and electronic effects deriving from the α-oriented methoxy group which is adjacent to the pharmacophoric carboxylic function.     

Regional risk factors for health inequalities in Scotland and England and the “Scottish effect”

This paper uses data from the Scottish Health Survey 2003 and the comparable Health Survey for England 2003 to look at whether Scotland's poor health image and mortality profile is reflected in regional inequalities in prevalence of four risk factors for cardiovascular disease: fruit and vegetable consumption, smoking, obesity and diabetes. It also looks at the “Scottish effect” – how much of any difference between and within Scotland and England remains once socio-demographic factors have been taken in to account. The paper then uses regional analyses to determine the extent to which areas within England and Scotland contribute to their national health advantage and disadvantage. All 2003 strategic health authorities in England and Scottish health boards were compared with Greater Glasgow health board as the reference category.The results showed that significant geographic variation in the risk factors remained once individual economic status was taken into account, but the relationship was complex and varied in strength and direction depending upon risk factor involved and gender of respondent. A small number of areas had significantly lower odds of fruit and vegetable consumption of five portions or more a day in men, compared with Greater Glasgow. In contrast some areas had significantly higher odds of fruit and vegetable consumption for women compared with Greater Glasgow.There was greater geographic variation in the odds of smoking in women than in men. Respondents in the south west and southeast of England (areas which usually show health advantage) did not show significantly lower odds of smoking compared with Greater Glasgow once socio-economic variation, age and urban residence was taken into account. It was respondents from central England that had lower odds of smoking than might be expected. Obesity stood out as the single risk factor that had demonstrated a “Scottish effect” in women only.     

Hormonal consequences of “missing the pill”

The hormonal effects of the deliberate omission of a low-dose combined oral contraceptive pill (150 μg levonorgestrel + 30 μg ethinyl estradiol) were studied in 32 apparently healthy women of the fertile age. Four groups of eight subjects each were requested to omit pill-taking on two consecutive days of the study, namely days 9 and 10 (Group I), 11 and 12 (Group II), 14 and 15 (Group III) and 17 and 18 (Group IV), respectively, and the peripheral plasma levels of progesterone (P), levonorgestrel (NOG) and estradiol (E₂) were measured daily for 29 days.The analysis of NOG levels revealed that one subject did not take any pill during the last cycle preceding the study and did not start pill-taking before day 10 of the study cycle. In this subject, a biphasic P profile with significantly, but insufficiently (up to 8.0 nmol/l), elevated P levels was found.In the remaining 31 subjects, the P levels remained invariably below 1.5 nmol/l; however, the mean P levels of days 1–15 were significantly (P < 0.01) higher than those of days 16–29.The assay of NOG levels indicated measurable values in each of the 31 subjects even six days after the discontinuation of pill-taking. From the peripheral NOG levels, an average removal half-life of 29 hours was calculated.The E₂ levels were uniformly suppressed (below 400 pmol/l) in 26 of the 31 subjects (hereafter: “low” E₂-group), whereas five subjects (“high” Eg-group) exhibited a cyclic E₂ profile, with peak levels between 530 and 1200 pmol/l. A linear increase with time in E₂ levels (P < 0.001) was found during the pill-free week in both groups of subjects.     

Primordial Prevention of Cardiovascular Disease among African-Americans: A Social Epidemiological Perspective

Background. The primordial prevention of cardiovascular disease (CVD) among African-Americans represents a formidable challenge for public health. This paper discusses the nature of this challenge, highlighting the role that economic and cultural factors play in shaping the distributions of major CVD risk factors among African-Americans. The paper concludes with specific suggestions for research.Methods. Data from recent national health surveys on black/white differences in major CVD risk factors like hypertension, obesity, cholesterol, cigarette smoking, and physical inactivity were reviewed for the purpose of identifying promising avenues for primordial prevention research among African-Americans.Results. Cigarette smoking has a delayed onset among African-Americans compared to whites. Black/white differences in “vigorous” leisure-time physical activity (e.g., social dancing and team sports) are not apparent until around age 40. These findings have relevance for primordial prevention work in black communities since they suggest the existence of broad-based, health-relevant cultural norms which could support primordial prevention programs, such as regular physical activity, across the life cycle.Conclusions. CVD primordial prevention programs among African-Americans must be grounded in an understanding of how cultural values as well as economic conditions shape CVD risk factor distributions in this population. Ultimate success will depend on the strength of the partnerships that public health researchers, primary care providers, and community residents are able to build.     

The “U” technique: A new method for Norplant implants removal

The standard technique for Norplant implants removal was compared with a new technique called the “U” technique, which employs the use of a modified no-scalpel vas deferens holding forceps to grasp and remove the capsules. Seventy-six women requesting Norplant implants removal were randomly assigned to Group 1 (standard removal technique) or Group 2 (“U” removal technique). Variables measured included: (a) time required for complete removal, (b) number of capsules not broken or damaged during removal, and (c) number of incisions required for removal of all six capsules. In clients with visible or palpable capsules, the standard removal technique required significantly more time to remove all six capsules, on average, than the “U” technique (19 versus 7 minutes, p < 0.001); also more capsules were damaged during removal (5.6 undamaged versus 6.0,p < 0.01). In addition, with the standard technique, five clients required two incisions for removal of all six capsules while none of the clients required more than one incision with the “U” technique. Our conclusion is that the “U” technique is a quicker and easier method of removing Norplant capsules than the standard technique.     

Oxford Handbook of Public Health Practice

This handbook is intended to be used by a wide variety of professionals in the public health domain, providing a practical and pocket-sized guide to public health skills and issues. We have therefore asked four Public Health professionals at different stages of their careers to give their views on this book.Public Health (2002) 116, 383–385.     

Smoking and respiratory disease symptoms inrural Bangladesh

Respiratory disease (excluding tuberculosis) is a largely untargetted health problem in Bangladesh. This study emphasises both that existing morbidity is considerable and that it is sure to increase if smoking spreads further. In two poor village populations 71% of men though only 1% of women were current smokers (one or more cigarettes or bidi per day); about one in five had begun smoking before the age of 10 years. Most heavy smokers and all women smoked bidi (hand-rolled coarse tobacco sticks). Expenditure on smoking absorbed up to 5% of household income but, seemingly paradoxically, one of the lowest socio-economic groups had the heaviest consumption.For men the striking effect of smoking in increasing respiratory disease symptom prevalence at all ages is clear. Nearly all male smokers reported “cough” but so did four out of five men and women who had never smoked. There were too few women smokers for meaningful analysis. However, “morning phlegm”, “an episode of increased phlegm” and “wheezing” as well as being common for non-smokers of both sexes, were two to three times more frequent among women than men who had never smoked. In women there must certainly be other causal factors for respiratory symptoms apart from smoking, the most important are likely to be smoke from cooking fires and respiratory infections in childhood. Improving immunization coverage and the treatment of respiratory infections in childhood would be useful preventive strategies for both men and women. The most urgent public health measure is to reduce the prevalence of smoking.     

Gene–Environment Interaction: Definitions and Study Design

Study of gene–environment interaction is important for improving accuracy and precision in the assessment of both genetic and environmental influences. This overview presents a simple definition of gene–environment interaction and suggests study designs for detecting it. Gene–environment interaction is defined as “a different effect of an environmental exposure on disease risk in persons with different genotypes,” or, alternatively, “a different effect of a genotype on disease risk in persons with different environmental exposures.” Under this strictly statistical definition, the presence or absence of interaction depends upon the scale of measurement (additive or multiplicative). The decision of which scale is appropriate will be governed by many factors, including the main objective of an investigation (discovery of etiology, public health prediction, etc.) and the hypothesized pathophysiologic model. Five biologically plausible models are described for the relations between genotypes and environmental exposures, in terms of their effects on disease risk. Each of these models leads to a different set of predictions about disease risk in individuals classified by presence or absence of a high-risk genotype and environmental exposure. Classification according to the exposure is relatively easy, using conventional epidemiologic methods. Classification according to the high-risk genotype is more difficult, but several alternative strategies are suggested.     

The impact of corporate practices on health: implications for health policy

Although corporate practices play a substantial role in shaping health and health behavior, public health researchers have rarely systematically studied these practices as a social determinant of health. We consider case studies of three products - trans fat, a food additive and a preservative; Vioxx, a pain killer; and sports utility vehicles - to illustrate the role of corporate policies and practices in the production of health and disease and the implications for health policy. In recent years, public health advocates, researchers, and lawyers have used strategies to reduce the adverse health impact of corporate practices. Systematic analysis of these experiences yields insights that can guide the development of health policies that increase opportunities for primary prevention by discouraging harmful corporate practices.     

Mass Media, Secular Trends, and the Future of Cardiovascular Disease Health Promotion: An Interpretive Analysis

Mass media roles in promoting cardiovascular health in the context of lessons learned from major U.S. community studies, changing media technology, and emergent models of media-community partnerships are discussed. Three principal issues are explored: (1) implications of the current expansion, convergence, and harmonization of mass media technology;(2) recent trends in media coverage of heart disease and population practices; and (3) implications for the future relationship between the media and public health in cardiovascular health promotion. It is concluded that classic campaign models focusing on individual-level change have evolved to recognize environmental-level influences on behavior. Emergent public health campaign models have moved toward “agenda-building,” in which the focus is on a more unified approach to influencing public and community agendas for social, behavioral, and policy change. Recent developments among the commercial mass media may offer new opportunities for public health partnerships to promote cardiovascular health.     

Trends in Physical Fitness and Nutritional Status among School-Aged Children and Adolescents during the COVID-19 Pandemic in Shaanxi,China—A Cross-Sectional Study

Background: This study aimed to explore the characteristics of trends in physical fitness and nutritional status among school-aged students during the COVID-19 pandemic, which could help to develop targeted guidelines and policies for students (adolescents) to promote health during lockdowns resulting from public health emergencies. Methods: The physical fitness and nutritional status were measured from 2019 to 2021; the correlation between years and grade were analyzed. Results: a declining trend was found in aerobic fitness, strength fitness, speed fitness, and BMI during this lockdown. Conclusion: The changes in dietary behavior and the decrease in outdoor physical activities may be the reason for the decline. Furthermore, differences in subjects’ growth and limited space at home must be considered in the formulation of exercise and nutritional plans. According to the results of our study, exercise for aerobic fitness should receive more attention when students are enduring a pandemic lockdown. In addition, saying “no” to high-calorie foods in the form of snacking and ultra-processed food was the key to improving subjects’ nutritional status.     

Consumer Acceptance of Foods Lower in Sodium

Objective To assess the magnitude of sodium reduction that can be made without significantly changing the perception of saltiness and acceptability of a broad range of common food items.Design The investigation was carried out in two phases. Military and civilian volunteers (N=190 in study 1; N=380 in study 2) from the US Army Natick Research, Development and Engineering Center rated the saltiness and acceptability of foods containing differing sodium concentrations.Setting Consumers rated food items in the sensory testing laboratory.Intervention “Regular” and “low-sodium” entrees were rated for saltiness and acceptability in study 1. Prepared food, commercially prepared food, and beverages containing various concentrations of sodium were rated for saltiness and acceptability in study 2.Statistical analyses performed Results were analyzed using Pearson correlation coefficients, Student's t test, and analysis of variance.Results The perception of saltiness increased as the concentration of sodium increased. Acceptance ratings varied considerably over a broad range of sodium concentrations, which indicates that the relationship was product specific. Results suggest that a reduction of one third or more in added sodium can be made to some foods without significantly affecting consumer acceptance.Applications The sodium content of food can be reduced by consumer-guided food engineering and food preparation. Alterations in food preparation and product formulation, in conjunction with alterations in diet, can be effective methods for reducing sodium consumption. J Am Diet Assoc. 1995; 95:447–453.     

Health Departments Do It Better: Prenatal Care Site and Prone Infant Sleep Position

Objectives: Reduction of prone infant sleep position has been the main public health effort to reduce the incidence of Sudden Infant Death Syndrome (SIDS). Methods: Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) surveys a stratified random sample of women after a live birth. In 1998–1999, 1867 women completed the survey (64.0% unweighted response; 73.5% weighted response). Results: Overall, 9.2% of all women “usually” chose prone infant sleep position, while 24.2% chose side and 66.5% chose supine position. Women receiving care from private physicians or HMOs more often chose prone position (10.6%) than women receiving prenatal care from health department clinics (2.5%), hospital clinics (6.1%) or other sites (8.3%). Compared to health department prenatal clinic patients, private prenatal patients were more likely to choose prone infant sleep position, adjusted odds ratio = 4.78 (95% confidence interval [CI] 1.64–13.92). Conclusions: Health Department clinics have done a better job than private physicians in educating mothers about putting infants to sleep on their backs. Providers—especially private providers—should continue to stress the importance of supine sleep position for infants.     

Synthesis, photochemical E (trans) → Z (cis) isomerization and antimicrobial activity of 2-chloro-5-methylpyridine-3-olefin derivatives

2-Chloro-5-methylpyridine-3-olefin derivatives (3a-e) have been synthesized from 2-chloro-5-methylnicotinaldehyde (1) and studied their photochemical E (trans) → Z (cis) isomerization upon direct irradiation and triplet sensitized excitation for the first time. The triplet sensitized excitations of the compounds yielded high Z (4a–e) isomer composition, whereas the direct excitation results in less Z (4a–e) isomer composition, indicating triplet pathway is very efficient in converting the E (trans) → Z (cis) isomer. Thus synthesized E (3a–c and 3e) and generated Z (4a–c and 4e) isomers were tested for antimicrobial activity. Antifungal activity of these pyridine derivatives are closely comparable to the standard used.     

“The citizen is stepping into a new role”—Policy interpretations of patient and public involvement in Finland

Involving patients and the public in healthcare decision‐making is on the policy agenda in several countries. The aim of our study was to describe and analyse the development of patient and public involvement from a policy perspective. We argue that the language of health policies can influence both the aims and the development of involvement methods. In this study health policy documents, which have guided the development of patient and public involvement in Finland have been analysed using methods of Membership Categorisation Analysis. This has enabled us to explore how health policy documents categorise patients and the wider public in relation to involvement and orientate the involvement activities in which people are able to participate. Different set of abilities, expectations, responsibilities and opportunities is attached to the categories of patient, risk group, service user, customer and expert. Health policy documents often equate involvement with choice making by service users and customers; or as involvement in service development by experts. In both of these cases, involvement is depicted as an individual activity that requires personal responsibility and specialist knowledge. Although involvement opportunities have overall increased, they are primarily available to people that are “participation ready” and able to adopt roles promoted in policies. Health policy documents produce one interpretation of involvement, nevertheless it is important that diverse groups of patients, the public and health professionals participate in the discussion and express their views, which may differ from those of policy makers.     

Community paediatrics moves on—an analysis of changing work patterns 1994–97

Objectives: To describe the current clinical workload of the modern community paediatrician; to outline the changes in this role over recent years and examine the reasons for these.Design and setting: The design is a retrospective analysis of data routinely collected for contracting purposes. Nottingham community paediatric service 1994–97 is the setting.Main outcome measures: These are the characteristics of patients seen, sources of referral, locations of clinical contact, referral rates by area.Results: 36 710 appointments were offered over the time period studied. The non-attendance rate was 17%. Pre-school children made up the largest group seen. Most referrals were from health visitors (23%) and school nurses (29%). There has been a small but significant increase in the numbers of children seen who have developmental problems and disability, and due to child protection issues between the time periods. There has been a shift in the proportions of children seen in a local health centre referral clinic (9.8% increase during 1994–97) rather than in a school setting. Twice as many children are referred to the community paediatrician from inner city areas than from the surrounding county areas.Conclusion: The transfer of child health surveillance to the primary health care team and the increased training of community paediatricians, has resulted in community paediatricians developing an increasingly specialised role particularly in the areas of child growth and development, disability, social and behavioural paediatrics.Public Health (2000) 114, 61–64.     

Effects of Health Information in Youth and Young Adulthood on Risk Factors for Chronic Diseases—20-Year Study Results from the Amsterdam Growth and Health Longitudinal Study

In the Amsterdam Growth and Health Longitudinal Study (AGAHLS) biological risk factors for chronic diseases were measured on eight separate occasions over a period of 20 years in a group of apparently healthy males and females (n = 164). Data were first collected from participants at 13 years of age. At each of the eight measurements, a medical checkup was performed and participants were given information about their current health status based on their personal biological risk factor profile (cholesterol, blood pressure, body composition, and physical fitness). A comparable group (n = 113) was measured on two occasions only: at age 13 and again at age 33. It was hypothesized that the group with eight measurements would present a more favorable 20-year development of the risk factors than the group with only two measurements. In the present article the six additional measurements with personal feedback of one's health status were perceived as an “intervention,” even though the AGAHLS never intended to improve the lifestyle or health of its subjects. The intervention appeared to have had a positive effect on body fat distribution and, in men, on systolic blood pressure. However, it was expected that these significant results were not true effects of the intervention, but that they were type-I errors. For the other variables, total cholesterol, high-density lipoprotein cholesterol, and the ratio between these two, for the sum of four skinfolds, diastolic blood pressure, neuromotor fitness, and for maximal oxygen uptake, the 20-year development did not differ between the two groups. Thus, the effects of a 20-year health measurement and information intervention begun in youth on biologic risk factors for chronic diseases were limited. The absence of clear significant findings may be due to the low contrast between the two groups, as only six intervention measurements were conducted over a period of 20 years. Another reason may be that the young and relatively healthy population under study here was not amenable to changing their fitness and health.