Proposals for collaboration in European public health training

The drastic changes in European politics, economy, environmentand technology during the last decade have profoundly influencedthe role and scope of public health practice and training. Aresponse to training in public health was given by the Associationof Schools of Public Health in the European Region (ASPHER)and WHO by creating a joint task force in order to propose aEuropean Master's Degree in Public Health, based on the ‘healthfor all’ principles. Attempts to develop curricula andlearning materials were not very successful and, instead, apeer review system as a means of establishing a European standardin public health training, together with mutual recognitionand a common standard in professional qualifications has beensuggested. Principles, criteria and practical steps for thisPublic Health Education European Review(PEER) are outlined.     

Serum zinc and retinol-binding protein in acne

The serum levels of zinc and retinol-binding protein (RBP) have been determined in 173 patients with acne and compared with those of a control group. The RBP is a specific transport protein and its level in plasma reflects the amount of vitamin A available to the tissues. Patients with severe acne were found to have lower levels of RBP than either patients with mild acne or healthy subjects of the same age. In the case of males with severe acne, the mean serum zinc level was significantly lower than that of the control group. No such difference was observed for girls. The observed condition of low levels of zinc and vitamin A in the serum of patients with severe acne may provide a rationale for the clinically good effect of oral zinc treatment.     

Effects of the Calcium Antagonist Felodipine on the Sympathetic and Renin-Angiotensin-Aldosterone Systems in Essential Hypertension

ABSTRACT Studies were performed in 10 male patients with untreated essential hypertension, WHO grade I-II, aged 25–62 years, to explore the acute (single dose) and long-term (8 weeks) effects of felodipine on sympathetic activity—evaluated by plasma and urinary catecholamines—as related to blood pressure, heart rate and the activity in the renin-angiotensin-aldosterone system. The patients were hospitalized for 8 (acute) and 6 (long-term) days and were maintained on a standardized daily intake of sodium (150 mmol), potassium (75 mmol) and water (2500 ml). Acute felodipine administration (10 mg) significantly reduced blood pressure and increased heart rate. Plasma and urinary noradrenaline, plasma renin activity and angiotensin II increased, whereas plasma and urinary adrenaline, dopamine, aldosterone and plasma vasopressin were unaltered. Long-term felodipine treatment, 10 mg twice daily, reduced blood pressure to a similar extent as acute felodipine administration, but heart rate was not significantly changed. Plasma noradrenaline 3 and 12 hours after the last dose and urinary noradrenaline were increased, whereas plasma and urinary adrenaline and dopamine were unchanged. Plasma renin activity and angiotensin II were increased 3 hours, but unchanged 12 hours after the last dose. Plasma aldosterone was unchanged but urinary aldosterone increased. Plasma vasopressin was unchanged. The changes in plasma noradrenaline as related to blood pressure, heart rate, plasma renin activity and angiotensin II during long-term felodipine treatment may reflect decreased cardiac and renal β-adrenoceptor-mediated responses. Increased renal clearance of aldosterone could partly explain the unaltered plasma aldosterone level in spite of increased plasma angiotensin II following long-term felodipine treatment.     

Recurrent urticaria: clinical investigation of 330 patients

A questionnaire was used from 1972–1978 for 330 consecutive patients with recurrent urticaria of 3 months to 40 years duration. Fifty men and fifty women had only urticaria. The rest had both urticaria and angio-oedema and most of them were women between 24 and 38 years of age. Urticarial attacks were less frequent during the daytime. A personal history of rhinitis, asthma or atopic dermatitis was recorded in more than one-third. Nasal polyps, migraine and arthralgia were found in 6–7% of the patients. Severe psychiatric problems were mentioned by 16%. Abdominal problems, mainly gastritis, were described by 44%. A history of side effects from drugs was found in 32% of the patients. Food was mentioned as a factor worsening the weals by 30% and drinks by 18%. Fruits, vegetables and nuts were the most common. Despite all cases with physical urticaria having been excluded, physical factors such as exercise were considered by 20% to make the urticaria worse. Provocation tests with various food additives such as azo dyes, benzoates, butylated hydroxytoluene (BHT), butylated hydroxyanisole (BHA) sorbic acid, quinoline yellow, carotene, canthaxanthine, annatto and nitrite revealed one or more positive reactions in one-third of the patients, one-third showed negative provocation tests and, in the rest, one or several tests were questionable. Routine laboratory investigations and X-rays of sinuses or teeth were of little value if there was no sign or history of other diseases. The fibrin microclot generation test which indicates the presence of circulating endotoxins was positive in 24%.     

Working time and strength in relation to consistency of composite resins

abstract – Composite resin pastes can be made more fluid for injection purposes by adding small amounts of enamel bond resin before mixing. The aim of this work was to study the influence of the added resin on the working time and on the early and final strength of the composite. The pastes of two different brands were diluted with their respective resins and the working time of the mix was determined by measuring the time during which it was possible to squeeze the material from a Centrix syringe. The results revealed that adding universal resin reduced the working time of both brands. The catalyst resin increased the working time of Adaptic® but with Concise® the amount of the catalyst paste had also to be increased to gain more working time. Adding catalyst resin did not affect the early strength or the strength after 24 h. Furthermore, it was observed that adding resin reduced the amount of porosities in the composite.     

HEALTH AND BEHAVIOUR IN FOUR-YEAR-OLD CHILDREN

ABSTRACT: Köhler, E.-M. and Köhler, L. (Department of Paediatrics, University Hospital, Lund, Sweden). Health and behaviour in four-year-old children. Acta Paediatr Scand, 64:225, 1975.–A health control of an unselected population of 2447 4-year-oId-children included a thorough somatic examination as well as an analysis of child upbringing practice and problems. The relation between the children's physical health, as defined by presence or absence or "functionally important health problems" and the children's behaviour, as reported by their mothers, was elucidated. On the whole, children with health problems were not perceived as more troublesome, although children with some special kinds of disturbances, e.g. neurological and dental, constituted problems in certain areas, e.g. toilet training and hyperactivity. The use of blame as a method of upbringing was very frequent and especially frequent in children with dental defects and visual disturbances. The perception of behaviour problems and the use of methods in upbringing were the same in children with newly detected health problems as in children with previously known health problems. The implications for the Child Health Service are to identify these risk-groups, to advice and support them in order to reduce parent-child conflicts.     

PHYSICAL HEALTH OF 7-YEAR-OLD CHILDREN An Epidemiological Study of School Entrants and a Comparison with Their Preschool Health

Abstract. At 7 years of age, all 649 7-year-old children in a school district underwent a physical examination, a vision screening and an auditory screening. 210 of the children were previously examined in an extensive health control at 4 years of age. The purpose of the present study was to describe the children's health situation and to evaluate the special health control performed at 4 years of age. In 15% of the children, functionally important health problems were found. Visual defects were most common, comprising 7.5%, then came physical health problems such as motor disturbances, obesity, bacteriuria in 6.5%, and hearing defects in 1%. About half of the important health problems were previously known. Children who had passed the special health control at 4 years of age had fewer newly detected important health problems and more previously known ones than other children, which means that many children with above all visual defects but also motor disturbances, bacteriuria and testis retention, were detected and treated earlier than would have happened without the special control at 4 years. It is concluded that the "ordinary" preschool Child Health Services did fulfill their purpose to detect handicapping disorders in an acceptable way; by the introduction of the special health control at 4 years of age, this function was further improved.     

VISION SCREENING OF FOUR-YEAR-OLD CHILDREN

Included in a general health control of an un-selected population of 2 447 four-year-old children, a vision screening was performed, using a visual acuity test (Marquez-Bostrom's hooks), cover test and Wirt Fly Stereo test. The screening could be carried out in 98% of the children. 364 children (15.2%) were referred because of newly detected visual defects, and 358 children (15.0%) were professionally examined. Of these, 40.8% had a visual acuity of ≤0.6 and 5.9% of ≤0.1. Functional amblyopia was found in 12.3% and manifest strabismus in 10.3%, The main error of refraction was hyperopia (≥ 2.5 D), diagnosed in 28.5%, while myopia was infrequent, 3.9%. The children examined by the ophthalmologist were also classified into four groups, according to their need of professional care, where group 0 means overreferral and groups 2–3 represent “significant eye disorders”, in need of ophthalmological treatment and/or observation. Overreferral was found in 16.5% and significant eye disorders in 43%. With the visual acuity test, 97% of the children with eye disorders were detected. Retesting children, who failed the tests, reduced the over-referral from 39.5% to 12.5% (p<0.001). By lowering the passing standards of the visual acuity test, still fewer children would have been overreferred, but, at the same time, 1/5 of children needing treatment would then have remained undiscovered. Including children already under professional care, the prevalence of strabismus in this unselected material of 4-year-old children was just below 4%, and the need for corrective glasses around 8%. Children reported to have family eye disorders, partus complications or present eye complaints were in the risk zone for suffering significant eye disorders, but this information from the parents was not sufficiently selective to be of practical value as a screening method. A small control group of 73 children and a follow-up of 479 children at school 3 years later, revealed that no children with functional amblyopia were missed at the screening test.     

Hemodynamic Effects of Loud Noise before and after Central Sympathetic Nervous Stimulation

ABSTRACT. The hemodynamic effects of loud noise after central α₂-adrenoceptor stimulation were studied in 13 patients with mild (WHO 1) essential hypertension. The patients were randomized (double-blind) to treatment with either placebo or guanfacine 1–2 mg for four weeks and then crossed over and treated for another four weeks. All patients were exposed to a loud broad-band noise (105 dBA for 30 min) and all were studied both on placebo and guanfacine. Guanfacine significantly reduced the resting blood pressure from 141/92 to 134/ 88 mmHg (p<0.01) as well as heart rate at rest from 63 to 58 beats/min (p<0.05). Noise stimulation caused a significant increase in blood pressure and resistance in the placebo-treated group, while cardiac output decreased significantly. Pretreatment for one month with the central α₂-adrenoceptor stimulating agent guanfacine did not block the noise-induced pressor response nor the increase in peripheral resistance. A significant decrease in stroke volume was observed and cardiac output also tended to decrease in this group. It could be concluded that loud noise is a potent pressor stimulus which causes vasoconstriction and that the blood pressure response during noise could not be blocked by the centrally acting an-tihypertensive agent guanfacine. Since noise causes vasoconstriction it also induces an increased tone in the small arteries and, if the noise stimulus is sufficiently strong and repeated for a long time, it might cause structural changes in the resistance vessels and permanent arterial hypertension in humans.