Health promotion and environmental management: a partnership for the future

Health Promotion as a professional practice is facing its thirdmajor challenge this century. To the infectious diseases ofthe past and the lifestyle risks of the present have been addedthe global environmental hazards of the future. Each wave of health risk has three things in common. The firstis that ill-health results from a change in the relationshipbetween the environment and society. The second is that theill-health so caused falls predominantly on already disadvantagedgroups in the community. Third in each case there is a tunelag of two or more decades between recognition of the freshrisks to health and effective professional response. The challengetoday is to shorten the lead time for responding to the thirdphase, the degradation of the global environment. This willgive a radical reorientation to the field of health promotion,which has traditionally safe guarded the health of people fromenvironmental change, not vice versa. The reorientation of health promotion is discussed in termsof the contributions which health promotion can make to environmentalmanagement. The options for managing environmental change areidentified as protection, prevention, resilience and adaptation.These strategies are already in use in the different branchesof health promotion.     

Right Bundle Branch Block of Unknown Age in the Setting of Acute Anterior Myocardial Infarction: An Attempt to Define Who Should Be Paced Prophylactically

It is widely accepted that patients presenting with acute anterior myocardial infarction and acute onset of right bundle branch block should be prophylactically paced in contrast with those who have a chronic bundle branch block. The admitting physician is faced with the dilemma of how to act if the age of this conduction disturbance is unknown. This problem has further intensified in recent years, with the introduction of thrombolytic treatment, where insertion of a central vascular line is associated with increased morbidity. The objectives of this study were to define clinical or electrocardiographic parameters that may help the admitting physician to decide whether patients presenting with an anterior wall myocardial infarction and a right bundle branch block of unknown age should be prophylactically paced. We examined prospectively the in-hospital clinical course of 39 consecutive patients presenting with an acute myocardial infarction in whom the age of a right bundle branch block upon admission was unknown (group C, n = 39) and compared it with two similar groups of patients who presented with an acute right bundle branch block (group A, n = 38) and with a known chronic right bundle branch block (group B, n = 22). Thirty-three patients (33%) died, with cardiogenic shock being the leading cause of death in the entire population. Prophylactic pacing, which was carried out in 66% and 54% of patients in groups A and C, respectively, did not reduce mortality rates. No clinical or electrocardiographic variables on admission were predictive to support prophylactic pacing in group C. In 10 of 46 (22%) patients who were prophylactically paced with a transvenous electrode, the following complications attributed to the procedure were detected: (1) either rapid sustained ventricular tachycardia (during implantation) that was unresponsive to overdrive pacing, or ventricular fibrillation necessitating electrical defibrillation (4 patients); (2) recurrent episodes of rapid nonsustained ventricular tachycardia, which stopped only after the pacemaker was turned off (1 patient); (3) complete AV block (1 patient); (4) fever appearing on the third or fourth day after implantation (3 patients); and (4) a large hematoma in the groin in 1 patient who was treated with thrombolysis shortly before pacemaker electrode insertion. Thus, the complications of transvenous temporary pacing in the era of thrombolysis may outweigh any theoretical advantage. (PACE 1995; 18:1496-1508)     

Discrepancies in the catabolic pathways of human and rat high-density lipoprotein apolipoprotein A-I in the rat

The in vivo metabolism in the rat of radioiodinated human and rat high-density lipoprotein was compared with a double-label procedure using 125I and 131I. While rat high-density lipoprotein showed a biphasic serum decay, human high-density lipoprotein was characterized by a monoexponential serum decay. No differences were observed between the serum decay of human high-density lipoprotein-2 and -3 subfractions, isolated by rate zonal ultracentrifugation. The catabolic sites of human and rat high-density lipoprotein were analysed using the lysosomal cathepsin inhibitor leupeptin. Radioiodinated rat high-density lipoprotein was catabolized by the kidneys and by the liver. In contrast, radioiodinated human high-density lipoprotein was catabolized almost exclusively in the liver. No difference in the catabolic sites of human high-density lipoprotein-2 and -3 subfractions was observed. The catabolic sites of human high-density lipoprotein apolipoprotein A-I in the rat were further analysed using the O-(4-diazo-3-[125I]iodobenzoyl) sucrose label. Compared with rat high-density lipoprotein apolipoprotein A-I, the kidneys played a minor role in the catabolism of human high-density lipoprotein apolipoprotein A-I. It is concluded that in the rat the catabolic pathways of the apolipoprotein A-I moieties of rat and human high-density lipoproteins are different, indicating that homologous high-density lipoproteins should be used for the investigation of in vivo metabolism.     

CAR SAFETY BELTS: A STUDY OF TWO MODELS ADAPTED FOR PEOPLE WITH ARTHRITIS

People with arthritis find car seat belts difficult to use.Sixteen arthritic patients and 19 healthy volunteers completeda comparative study of one standard inertia-reel belt and twoadapted inertia-reel belts with reduced retraction forces. Thosewith arthritis were strong enough to use the standard belt butboth adapted belts had features making them easier to use. KEY WORDS: Arthritis, Seat belts, Accident prevention