Exploring the impacts of organisational structure,policy and practice on the health inequalities of marginalised communities: Illustrative cases from the UK healthcare system

This paper explores how organisational structure, policies and practices in healthcare can inadvertently disadvantage marginalised populations (e.g. individuals from ethnic minority backgrounds) and reinforce health inequalities. We draw upon three diverse UK healthcare settings (long term care institutions, high security hospitals and community pharmacies) to illustrate how systemic injustices negatively impact on access to care, treatment and health outcomes. The first case study considers the care of older people within nursing homes; specifically the disempowering effects of this service structure and impacts of choice reduction upon health and their access to health provision. The second case study explores the impact of security restrictions upon patients within high security hospitals, focusing particularly on the maintenance of relationships and support networks outside of the hospital. The third and final case study, draws upon a national community pharmacy medicine management service to illustrate ways in which policies and guidelines inadvertently obstruct patients' engagement with the service within a community setting. We draw upon these settings to highlight inequalities within different contexts and to illustrate the ways in which well intended services can inadvertently disadvantage marginalised communities in multiple ways.     

The spatial dimensions of medication management by home-dwelling older adults after hospital discharge

Ageing in place raises pressing questions about medication practices at home. Understanding how medication practices are integrated into older adults’ domestic settings requires an interest in where activities linked to medication take place and why. This study aimed to describe the medication practices and spatial dimensions of medication management for home-dwelling older adults after hospital discharge, using a qualitative research design. Semi-structured interviews were carried out with ten older adults aged 65 years old or more and discharged home from hospital, together with nine informal caregivers. Thematic content analysis identified two main themes dealing with the spatial dimensions of medication management in this specific context: the process of integrating medication changes into routines and familiar spaces, and the individual and collective management of medication changes linked to a renegotiation of the boundaries between public and private spaces.     

Codon usage patterns in chromosomal and retrotransposon genes of the mosquito Anopheles gambiae

Codon usage was compiled for fourteen chromosomal genes and four retrotransposons from the mosquito Anopheles gambiae. Variation exists among chromosomal genes in the degree of bias. The genes showing the highest bias are probably most highly expressed. In these genes, the base composition at the third codon position is much richer in G + C than is the overall coding sequence. Thus, codon usage is biased toward G- or C-ending codons. Codon usage in each retrotransposon is quite different, not only from chromosomal genes but also from the other retrotransposons. Codon usage comparisons among homologous genes from An. gambiae and two other Dipterans, the yellow fever mosquito Aedes aegypti and the fruitfly Drosophila melanogaster, show that while there are similarities, particularly between An. gambiae and D. melanogaster in the preference for G-and C-ending codons, each species has evolved a distinct pattern of codon usage.     

Kathon® CG reactivity in 1396 consecutively patch tested patients in the Copenhagen area

In 1396 consecutively patch tested patients 18 (1.3%) reacted to Kathon CG. Relevance was established in 4 of the 18 patients. The frequency of positive reactions to Kathon CG in eczema patients seems to have been stable in Denmark during the period 1983 to 1988.     

门诊抗菌药物使用调查

目的了解医院门诊抗菌药物应用情况，为临床合理应用抗菌药物提供依据。方法抽查2006年1月至11月份门诊处方18163张，统计抗菌药物使用情况，并评价其合理性。结果含抗菌药物处方5809张，占总处方数31．98％。头孢菌素类药物使用率最高，其次为喹诺酮类。给药途径主要为口服给药。结论抗菌药物应用基本合理，但使用中存在一些问题，应引起重视。     

上海社区老年人用药安全及影响因素分析

目的：了解上海社区老年人群的用药安全情况及其影响因素，方法：以整群抽样的方法抽取上海市黄浦区两个居民委员会2985名60岁以上的居民进行问卷调查，了解其疾病和用药情况，用药反应，对安全用药的知识，态度，行为，以及影响其用药行为的因素，结果：被调查中高血压、冠心病、消化系统疾病和呼吸系统疾病的患病率分别为35．93％、10．67％、5．70％和3．71％。抗高血压药，心脑血管病药，消化系统疾病和呼吸系统疾病的患病率分别为35．93％、10．67％、5．70％和3．71％，抗高血压药、心脑血管病药，消化系统药和抗生素的使用率分别为31．72％、16．20％、2．43％和2．11％，过去30天内，51．33％的被调查用过药物，用药不良反应发生率为2．06％，对用药安全的正确知识，态度，行为率分别为71．62％、69．39％及60．67％，影响药物选择的因素中医生占88．19％，结论：老年人的用药安全仍存在问题，有待改进，医生是影响老年人药选择的最主要因素。     

Population study of T cell receptor V beta gene usage in peripheral blood lymphocytes: differences in ethnic groups.

The T cell receptor (TCR) V beta repertoire in peripheral blood lymphocytes (PBL) of a large number of healthy individuals was analysed by quantifying V beta-specific mRNA using the method of anchored multiprimer DNA amplification and a reverse dot blot assay. Among 16 V beta gene families examined, particular V beta genes were noted to be unequally expressed in the PBL of 70 healthy donors. The frequently used genes belong to the V beta 4, 5, 6, 8 and 13 (12) families, while V beta 1, 9 and 15 were the least frequently used gene families. This bias in gene usage was observed in all individuals. Marked deviation from the mean percentage usage was noted for some V beta genes in individuals when their PBL were examined serially, but the common pattern of biased usage was not grossly distorted. When the TCR repertoire of different ethnic groups was examined, a lower mean frequency of V beta 3.2 was seen in the repertoire of 19 Caucasians compared with 25 age-matched Samoans (P < 0.003). Conversely, the expression of V beta 5.1 and V beta 5.3 was higher in Caucasians than in 51 age-matched Polynesians (Maoris and Samoans, P < 0.003). Considering the 20% co-efficient of variation in the estimate of V beta gene usage, our data from 70 unrelated individuals suggest that in PBL, individual variations in the TCR repertoire were superimposed upon a common biased usage of V beta genes in the general population.