Diversity, inequality and official data: some problems of method and measurement in Britain

This paper reviews the ways in which diversity and inequality are represented in the major sources of health data in Britain. It examines how identities linked to disability, ‘race’, class and sexuality are represented in official statistics and national surveys. The paper argues that (1) the methods of data-collection and data-analysis result in the exclusion of minority group experiences and (2) the measures of social position mask and misrepresent dimensions of inequality that the new social movements have sought to make visible. Illustrations of these processes are given.     

下腔静脉采超测定在血透者干体重确定中的应用

目的 :探讨维持性血液透析患者干体重确定的安全、准确的方法。方法 :对 6 8例维持性血液透析患者应用彩色多普勒超声仪 ,在透析前后测定下腔静脉直径 (IVCD) ,计算IVCD与体表面积之比 (VCD)同时结合临床及检查等。并分组观察血压、超滤量等相关影响因素 ,进行对照分析。结果 :整体透析超滤之后 ,VCD均值为 (9.4 5± 2 .2 9) ,较透析前显著减小 ,与正常对照组无显著性差异 ,结合胸片血压及临床症状 ,确定达到干体重。高血压、超滤率≥ 2 .5时IVCD、VCD值大于整体均值。结论 :彩色多普勒测定IVCD及VCD是确定维持性血透患者干体重的好方法。     

Intrathecal synthesis of soluble class I antigens in multiple sclerosis

We have studied the intrathecal synthesis of soluble class I antigens (sHLA), reflected by the index IH = (CSF sHLA/serum sHLA)/(CSF albumin/serum albumin), in multiple sclerosis (MS). IH was increased in patients in relapse, but normal in patients in remission; these findings show that there is a high lymphocyte activation within the central nervous system in patients with clinically active MS.     

Allergy to olive pollen: T-cell response from olive allergic patients is restricted by DR7-DQ2 antigens

Backgound We have recently described the association between the IgE antibody response to Ole e I (the major antigen from olive tree pollen) and the DR7-DQ2 haplotype in a Spanish population. Objeectivc and methods Due to the linkage disequilibrium between DR7 and DQ2, and thus the dillicult distinction between the role of these two antigens in the T-cell activation response, we decided to solve this question by two approaches: 1. The study of another ethnic group, individuals of Arabic origin, with a presumably distinct disequilibrium linkage between DR and DQ antigens. Genomic DNA typing was performed in 46 subjects (allergic and non-allergic) by Restriction Fragment Length Polytnotphism (RFLP) and results showed that patients with specific IgE antibodies α-Ole e I, were DR7 and or DQ2. These data show a similar restriction pattern to those previously described for Spanish patients. The phenolypic frequency of DR7 antigen is significantly greater than in the non-allergic population, with a corrected P(PJ value of O.O.3 2 The analysis of the genetic requirements of Ole e I response, using T-cell lines speific for this antigen. This was first carried out by blocking the proliferative response of these T-cell lines with specific anti-human HLA class II antibodies and then testing the genetic restriction of this response using a panel of histoeompatible and histoincompatible Antigen Presenting Cells (APCs). Both experiments corroborate the hypothesis that DR7 and DQ2 are implicated in the recognition o(Ole e I.     

关于急救医学模式的探讨

介绍了在创建三级特等医院过程中,将急救医学模式转变纳入以患者为中心的轨道,采取在岗继续教育 和规范急救医学住院医师培训的途径,形成独立布局、独立临床专业和独立临床专业医师的模式,从而对中国急救医 学模式进行了初步探讨。     

Exposure,susceptibility, and breast cancer risk: A hypothesis regarding exogenous carcinogens,breast tissue development,and social gradients,including black/white differences,in breast cancer incidence

Summary At present, known risk factors account for only one-third of breast cancer cases diagnosed in the United States. They explain an even smaller fraction of the ten-fold variation in international breast cancer incidence rates. The low population-attributable risk of these identified risk factors, plus the existence of phenomena that cannot be easily explained by current etiologic hypotheses (such as the higher rate of breast cancer among black as compared to white women under age 40 within the United States), suggests that unidentified risk factors contribute substantially to breast cancer causation. This paper summarizes evidence to propose that two socially-conditioned factors determine a society's breast cancer incidence and its social gradients in risk: 1) the extent of exposure to exogenous carcinogens, and 2) breast tissue susceptibility to these exposures. It is further hypothesized that breast tissue susceptibility is inversely related to breast tissue differentiation, and that socially-mediated reproductive patterns (involving both early-terminated and full-term pregnancies) affect susceptibility both by altering (via hormonally-mediated mechanisms) the number and ratio of undifferentiated and differentiated cells, and by stimulating the growth of initiated and transformed cells. This view is presented in contrast to hypotheses that propose exposure to endogenous hormones as the major determinant of breast cancer risk.     

Relationship between fluoridation and socioeconomic status on dental caries experience in 5-year-old New Zealand children

This article examines the relationship between fluoridation and socioeconomic status on caries experience, as measured by the dmf index, in 5-yr-old New Zealand children in the city of Dunedin (fluoridated in 1967) and in adjacent non-fluoride communities. The children were subdivided into six socioeconomic status groups (SES 1, professional and managerial-SES 6, unskilled workers), but then for simplicity they were combined to form three groups. A two-way analysis of variance demonstrated that interaction between fluoride history and socioeconomic status was not significant. In all three SES groups, dmf was higher in non-fluoride communities, but the difference was significant only in SES group (5&6) (P less than 0.01). Caries experience increased with decreasing socioeconomic status in both fluoride and non-fluoride communities, but this effect was only significant between SES groups (1&2) and (3&4) in the fluoridated community (P less than 0.05), and between SES groups (3&4) and (5&6) in non-fluoride communities (P less than 0.01). These results are compared with those of similar studies, and it is concluded that so far, the relationship between fluoridation and socioeconomic status on caries experience remains equivocal. A note of caution is sounded regarding the interpretation of such results, and the difficulties faced when comparing studies is discussed.     

A functional basis for the association of HLA class II genes adn susceptibility to multiple sclerosis: cellular immune responses to myelin basic protein in a multiplex family

This study has examined the cellular response to myelin basic protein (MBP) ina multiplex family with multiple sclerosis (MS). A total of 81 MBP-specific T cell liens (TCLs) were derived from three affected siblings and four healthy siblings. No difference was observed in estimated precursor frequenceis of MBP-specific TCLs or peptide specificity of TCLs when comparing affected and unaffected siblings. MPB-specific TCLs from affected siblings, however, were restricted to the DRw15/DQw6 allele more frequently than those from unaffected siblings (P < 0.02). These data suggest that restriction of autoantigen-specific T cells may be the functional basis for disease susceptibility related to HLA class II inheritance.     

Activation of virus-specific major histocompatibility complex class II-restricted CD8+ cytotoxic T cells in CD4-deficient mice

Acute enteritic or respiratory disease is a consequence of coronavirus infection in man and rodents. Mouse hepatitis virus, stain A59 (MHV-A59) causes acute hepatitis in mice and rats and induces a response of major histocompatibility complex (MHC) class II-restricted CD4⁺ cytotoxic T cells, protecting mice against acute infection. In the present study we show that MHV-A59 infection of mice that lack a functional CD4 gene activates effector cells of the CD8⁺ phenotype. These cytotoxic T cells lyse virus-infected target cells in a MHC class II-restricted fashion. The results indicate that CD8⁺ T cells have the potential to utilize MHC class II as restriction element, illustrating that the immune system can effectively deal with evading microorganisms, such as viruses which down-regulate MHC class I.