Social capital and its relevance to health and family policy

It is important to consider the global context in which we operate and in which the association between society and health is to be explored. We are in a democratic world, with an economy that emphasises the market and a post-modern culture. The ancient elements of state, market and community are discernible in avaricious combinations and, if we are seeking a just social order, it is important that we apply appropriate analytical methods to social understanding. While social capital is an arresting term, its ambiguity limits its broad applicability and even makes it dangerous. Sir Richard Doll and his colleague Richard Peto once described epidemiological insight as a boundary-setting exercise, delimiting territory within which basic and clinical science can explore mechanisms. When it comes to matters of social and personal well-being, the same approach may serve us well. Social capital, defined differently by everyone who uses it, must be given some stability and be subject to good quality epidemiological research, not too dissimilar to that which has underpinned epidemiology's immense success in public health over the decades. Despite social capital's complexity, there are growing efforts to measure it and relate it to desirable social functions, but the ability of social capital to capture fully the subtle interplay of individuals and society so essential for their health and happiness is questionable.     

GAD65 and insulin B chain peptide (9-23) are not primary autoantigens in the type 1 diabetes syndrome of the BB rat

To investigate whether GAD65 whole molecule, GAD65 p35 or insulin B chain peptide (amino acids 9-23) play an essential role in the pathogenesis of type 1 diabetes in the BioBreeding (BB) rat, we gave serial injections of GAD65, p35 or insulin B chain (9-23) to six groups of BB/Worcester rats. The individual antigens were administered either intrathymically on day 2 and intraperitoneally in MF 59-0 adjuvant 5 times during the first 5 weeks, or by intranasal instillation once neonatally and 5 days/week for the following 6 weeks. Control groups were injected with vehicle only. Age of onset of diabetes and degree of insulitis were not different between controls and antigen-treated rats. Rats that received GAD65 intrathymically and intraperitoneally developed high GAD65-antibody titers without altering diabetes development. In GAD65-treated animals, serum antibodies recognized epitopes at 3 sites on GAD65 in diabetic animals but only at 1 site in non-diabetic animals. GAD65-injected animals also showed a significant reduction of IFN-gamma mRNA expression in the thymus. This study provides evidence against the hypothesis that GAD65 and insulin B chain peptide (9-23) are primary diabetogenic autoantigens in BB rats because immunizations with these antigens and GAD65-induced immune deviation did not alter the development of diabetes.     

Family suite: an innovative method to provide inexpensive postpartum care

The postpartum hospital stay has been decreasing in the United States in recent decades. Early discharge to achieve cost savings has been criticized by many inside and outside the health care community as sometimes being detrimental to the mother and infant. This article describes the efforts of the administration, nursing staff, and medical staff of a large public urban hospital to develop an alternative to the forced early discharge of mothers and infants.     

Sternotomy infections: sternal salvage and the importance of sternal stability

Objective

To review the management of sternal wound infections after cardiovascular surgery.

Design

Retrospective case study.

Setting

All management took place in a single tertiary-care university hospital.

Patients

Twenty-one consecutive patients seen over a 3-year period who had infected median sternotomy incisions after cardiovascular surgery.

Interventions

Surgical eradication of infection, including sternal débridement and rewiring or placement of vascularized muscle flaps, or both.

Main Outcome Measures

Resolution of infection and restoration of sternal stability.

Results

The development of sternal wound infection was found to be associated with sternal instability. In 12 of 17 patients treated initially with sternal débridement and rewiring the infection was cured. Vascularized muscle flap transfers were required to eradicate the infection in the remaining patients.

Conclusions

Sternal débridement and rewiring is an effective initial treatment for sternal wound infections in selected patients. Some patients may require placement of muscle flaps for definitive treatment.