Supplement on smoking cessation.
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Europe↗
Biomedical subjects
M McKee
Publications and source records attributed to M McKee.
Early entrance to the job market and its effect on adult health: evidence from Brazil.
OBJECTIVE: To determine the effect of employment in childhood on self-reported health in adulthood. METHOD: A cross-sectional household survey, with households selected through two-stage sampling, in urban and rural areas in the northeast and southeast of Brazil. A total of 4940 individuals, aged between 18 and 65 years, were included. The main outcome measure was self-reported health. RESULTS: There has been a marked reduction in the proportion of people starting work during childhood although, even in the youngest age group, nearly 20% of males began work when under 10. Early entrance into the labour market is strongly associated with low levels of both education and income, with income differentials remaining at later ages. Age starting work is also linked to current household income, with approximately 35% of those starting work when 15 or over currently in the top quartile of household income, compared with 12% of those starting work when under 10. Males, those living in rural areas, and non-whites are most likely to start work early. In univariate analyses, the younger a person started working, the greater the probability of reporting less than good health status as an adult. This persists through all ages, although the difference attenuates with increasing age. In multivariate analyses, adjustment for education or household income substantially reduces the effect but fails to eliminate it in several age bands up to the age of 48, indicating that age starting work has an independent effect on self-reported health in adulthood. CONCLUSIONS: The debate about the appropriate policy response to child labour is complex, requiring a balance between protecting the health of the child and safeguarding the income of the family. These findings indicate the need for more research on the long-term sequelae of beginning work at an early age.
Adolescent↗
Aquaporin 9 expression along the male reproductive tract.
Fluid movement across epithelia lining portions of the male reproductive tract is important for modulating the luminal environment in which sperm mature and reside, and for increasing sperm concentration. Some regions of the male reproductive tract express aquaporin (AQP) 1 and/or AQP2, but these transmembrane water channels are not detectable in the epididymis. Therefore, we used a specific antibody to map the cellular distribution of another AQP, AQP9 (which is permeable to water and to some solutes), in the male reproductive tract. AQP9 is enriched on the apical (but not basolateral) membrane of nonciliated cells in the efferent duct and principal cells of the epididymis (rat and human) and vas deferens, where it could play a role in fluid reabsorption. Western blotting revealed a strong 30-kDa band in brush-border membrane vesicles isolated from the epididymis. AQP9 is also expressed in epithelial cells of the prostate and coagulating gland where fluid transport across the epithelium is important for secretory activity. However, it was undetectable in the seminal vesicle, suggesting that an alternative fluid transport pathway may be present in this tissue. Intracellular vesicles in epithelial cells along the reproductive tract were generally poorly stained for AQP9. Furthermore, the apical membrane distribution of AQP9 was unaffected by microtubule disruption. These data suggest that AQP9 is a constitutively inserted apical membrane protein and that its cell-surface expression is not acutely regulated by vesicular trafficking. AQP9 was detectable in the epididymis and vas deferens of 1-wk postnatal rats, but its expression was comparable with adult rats only after 3--4 wk. AQP9 could provide a route via which apical fluid and solute transport occurs in several regions of the male reproductive tract. The heterogeneous and segment-specific expression of AQP9 and other aquaporins along the male reproductive tract shown in this and in our previous studies suggests that fluid reabsorption and secretion in these tissues could be locally modulated by physiological regulation of AQP expression and/or function.
Aging↗
Osteomalacia in hyp mice is associated with abnormal phex expression and with altered bone matrix protein expression and deposition.
To explore how the loss of Phex function contributes to the pathogenesis of osteomalacia, we examined the abnormalities of mineralization, Phex, and bone matrix protein expression occurring in Hyp mice in vivo and in ex vivo bone marrow cell cultures. The results in vivo show that mineralization was decreased significantly in Hyp mouse bone. Phex protein was identifiable in osteoblasts and osteocytes in wild-type mice, but not in Hyp mice. In Hyp mice, osteocalcin, bone sialoprotein, and vitronectin expression were down-regulated, whereas biglycan and fibrillin-1 expression were up-regulated in osteocytes and bone matrix relative to those in their wild-type counterparts. Parallel studies ex vivo demonstrated that cells derived from 18-day Hyp mouse bone marrow cell cultures had a 3'-Phex deletion, no Phex protein expression, decreased alkaline phosphatase activity, collagen deposition, and calcium accumulation, and reduced osteocalcin, bone sialoprotein, and vitronectin at both the protein and messenger RNA levels. Furthermore conditioned medium from Hyp mouse bone marrow cultures could induce analogous defects in bone marrow cell cultures of wild-type cells. These novel findings indicate that there is an intrinsic osteogenic cell differentiation defect in addition to the known hypomineralization of bone in Hyp mice, which may be inducible by an autocrine/paracrine secreted factor. These results suggest that alterations in the Phex gene may control bone matrix mineralization indirectly by regulating the synthesis and deposition of bone matrix proteins.
Animals↗
Involvement of actin filaments and integrins in the binding step in collagen phagocytosis by human fibroblasts.
In physiological conditions, collagen degradation by fibroblasts occurs primarily via phagocytosis, an intracellular pathway that is thought to require collagen receptors and actin assembly for fibril internalization and degradation. Currently it is unclear which specific steps of collagen phagocytosis in fibroblasts involve actin filament assembly. As studies of phagocytosis in fibroblasts are complicated by the relatively slow rate of particle internalization compared to professional phagocytes, we have examined the role of collagen receptors and actin only in the initial collagen binding step. Prior to the binding of collagen-coated fluorescent beads by human gingival fibroblasts, a cell type that is avidly phagocytic in vitro, cells were treated with cytochalasin D (actin filament barbed-end capping) or swinholide A (actin dimer sequestering and severing) or latrunculin B (actin monomer sequestering). Bead binding and immunostaining of (alpha)(2)(beta)(1) and (alpha)(3)(beta)(1) integrin collagen receptors were measured by flow cytometry. After 1-3 hours of coincubation with beads, cytochalasin D or swinholide A eliminated actin filaments stained by rhodamine-phalloidin and inhibited collagen bead binding (reductions of 25% and 50%, respectively), possibly because of cell rounding and restricted interactions with beads. In contrast, latrunculin enhanced binding dose-dependently over controls (twofold at 1 microM) and induced the formation of brightly staining aggregates of actin and the retention of long cytoplasmic extensions. Latrunculin also reduced surface (beta)(1), (alpha)(2) and (alpha)(3) integrin staining up to 40% in bead-free and bead-loaded cells, indicating that latrunculin enhanced collagen receptor internalization. As determined by fluorescence recovery after photobleaching, latrunculin increased the mobility of surface-bound (beta)(1) integrin. The stimulatory effect of latrunculin on collagen bead binding was reduced to control levels by treatment with a (beta)(1) integrin inactivating antibody while a (beta)(1) integrin blocking antibody abrogated both bead binding and the latrunculin-induced stimulation. Immunoblotting of bead-associated proteins showed that latrunculin completely eliminated binding of (beta)-actin to collagen beads but did not affect (beta)(1) integrin binding. These data indicate that latrunculin-induced sequestration of actin monomers facilitates the disengagement of actin from (beta)(1) integrin receptors, increases collagen bead binding and enhances collagen receptor mobility. We suggest that these alterations increase the probability of adhesive bead-to-cell interactions.
Actins↗
What is happening to the health of the Croatian population?
AIM: To describe the problems in the interpretation of Croatian mortality data and explore possible reasons for the recorded increase in mortality in the 1990-1999 period, particularly related to different methods of collection and estimation of data on deaths and population. METHODS: Numbers of recorded deaths and population estimates were first obtained from the Croatian Institute for Public Health and examined in detail. The Institute used population estimates supplied by the Croatian Statistics Bureau, which included de jure population data (including all Croatian citizens wherever they live) until 1996 and de facto population data (including only population living in Croatia at least for a year, irrespective of citizenship) since 1996. A different set of population estimates based on de facto estimates since 1992 was obtained from the Croatian Bureau of Statistics. We examined trends in age- and sex-specific death rates from major causes in 1990-1999 period, using the mortality data from the Croatian Institute for Public Health and both sets of population estimates. Lung cancer as a cause of death was examined in more detail, since it is relatively stable over short periods of time. Interviews were undertaken with key informants to identify the reasons for any discrepancies. RESULTS: In Croatia, relatively stable death rates from lung cancer in men ranged from 84/100,000 in 1990 to 79/ 100,000 in 1995. In 1996, a marked discontinuity appeared in the Croatian data, with a 14% increase compared to 1995 (from 79/100,000 to 91/100,000) and a further increase in 1999 (94/100,000), which is not credible on the basis of the natural history of lung cancer. Analysis of mortality rates with de facto population estimates showed more gradual increase from 1992-1996. Methods used to estimate population and mortality during the 1990s were inconsistent and misleading. At present, it is impossible to be certain about the true level of mortality in Croatia during 1990s, as the numerator (deaths) and denominator (population) were incompatible until 1998. CONCLUSION: Major problems in data collection would have been identified if the investigation of unexpected mortality trends in Croatia in the 1990s had been done. Systematic analysis of health patterns should be done as soon as data from the 2001 census become available. Capacities in public health should be strengthened to make this possible. This issue has received little recognition from the international donor organizations, particularly those that use health data.
Cause of Death↗
Ten years of German unification.
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Germany↗
Public health in Europe.
Any attempt to describe public health in Europe faces the twin problems of defining Europe and of dealing with the diversity of health and health systems it contains. Health status varies considerably between countries. In some, health is improving, with substantial decreases in heart disease in many western and central European countries. In others, especially in the former Soviet Union, there is concern about the rapid increase in tuberculosis and AIDS. A national analysis does, however, conceal a substantial variation within countries, between regions, and between social classes. The responses to these threats to health are also diverse. A few countries have developed effective mechanisms to design and implement appropriate policies but, in many countries, the public-health community is weak. In particular, public health has largely failed in its role as an advocate of the health of the population. There are, however, many encouraging signs that this may change in the future.
Acquired Immunodeficiency Syndrome↗
A new European health strategy.
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European Union↗
On target for health? Health targets may be valuable, but context is all important.
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Europe↗
Paying for the NHS. First decide how much we are willing to pay, then think about how to collect it.
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Financing, Government↗
Physical inactivity in the Baltic countries.
BACKGROUND: Physical inactivity is a known risk factor for heart disease and obesity, two major health problems in the Baltic Republics. This study examined patterns of physical activity level in these countries, and correlates of leisure-time sedentary behavior. METHODS: Data from three national surveys of adults conducted in Estonia, Latvia, and Lithuania in 1997 were used. Respondents who provided information on their activity level were included in this study (Estonia: n = 2,018; Latvia: n = 2,303; Lithuania: n = 2,140). RESULTS: One in three Estonians and one in five Latvians and Lithuanians had a low physical activity level at work. Half the respondents (Lithuania: 60%, Latvia: 52%, Estonia: 43%) participated only in sedentary activities during their leisure time. Leisure-time sedentarity was inversely related to education level in men and women and with income in men. It was also associated with smoking in men and with inadequate vegetable intake in men and women. CONCLUSIONS: Sedentary behavior during leisure time should be a public health issue in the Baltic Republics. Health promotion strategies aiming at increasing leisure-time physical activity level will need to target the general population, but particularly individuals from lower socioeconomic strata.
Adolescent↗
Patterns of body weight in the Baltic Republics.
OBJECTIVE: Previously recorded rates of obesity in the Baltic Republics have been among the highest in the world although little is known about how they vary within the population. This study investigates the distribution of body mass index (BMI) and obesity in these countries. DESIGN: Three cross-sectional surveys conducted in the summer of 1997. SETTING: Estonia, Latvia and Lithuania. SUBJECTS: Representative national samples of adults with measured weight and height (Estonia: n=1154; Latvia: n=2292; Lithuania: n=2096). RESULTS: Between-country differences are particularly large among women: women from Latvia and Lithuania are approximately three times as likely to be obese as those from Estonia (17.4%, 18.3%, 6.0% respectively); only about one-third of this difference is explained by the sociodemographic and behavioural factors studied. In men, the prevalence of obesity varied only slightly among countries (Estonia: 9.9%; Latvia: 9.5%; Lithuania: 11.4%). While the prevalence of obesity increases with age within each republic, particularly in women, it is not associated with nationality or urban/rural region, and no consistent association is observed with income. Obesity is inversely related to education in Latvia and in Lithuanian women. Latvian men and women and Lithuanian men who smoked had a lower prevalence of obesity than non-smokers. Leisure time physical activity was not associated with obesity. CONCLUSIONS: Obesity is a major health problem in the Baltic Republics, particularly among Latvian and Lithuanian women. The lack of association between obesity and most demographic, socioeconomic and behavioural factors suggests that the problem is generalized. Health promotion strategies aiming at preventing and controlling excess weight gain in the Baltic Republics will need to target the general population.
Adult↗
Understanding patients' views of a surgical outpatient clinic.
For many people, the outpatient clinic is the first point of contact with a hospital. As clinical management moves from the in-patient setting, it is taking on a much greater importance. Yet there are still many gaps in our knowledge about how those who interact with it, whether as staff or patients, view it. This study sought to describe patients' perceptions and to explore some of the socio-demographic characteristics associated with these differing perceptions. The study took place in a district general hospital in southern England. A questionnaire seeking the experiences and views of patients was developed. After piloting, it was administered to patients attending surgical outpatient clinics. The results were supplemented by those of a study of times that the same patients waited to be seen and the duration of their consultations. We found that 288 patients attended the clinics of four consultant general surgeons in a week chosen to be typical of those throughout the year and, of these, 188 (76%) returned questionnaires. As far as could be ascertained, responders did not differ from non-responders. New patients only were asked about the time they had waited for an appointment and 32% felt that this had been excessive. Young patients were more likely to feel that the wait had been too long. Patients were more likely to overestimate the time that they waited than to underestimate it and 27% thought the time spent with the doctor had been too short. The perception of inadequate time was greatest among those attending clinics where the actual time available was least. Of the patients, 30% had questions they would have liked to have asked but did not, 32% of patients would definitely have liked a leaflet explaining their treatment, 44% of patients were very satisfied with how they were treated by the doctor and 3% were dissatisfied. Non-white patients tended to be less satisfied with both the overall attendance and the length of consultation, although the actual times spent with doctors were the same for both groups. Seventy-eight per cent of patients had no preference for being seen by a male or female doctor. Those expressing a preference tended to prefer a doctor of their own sex. We found that while many patients are satisfied with the outpatient experience, there are several issues that require attention. Patient's perceptions are often as important as more objective measures in determining whether an attendance is considered satisfactory.
Ambulatory Surgical Procedures↗
Symptoms, disability and handicap in unilateral peripheral vestibular disorders. Effects of early presentation and initiation of balance exercises.
The aim of this study was to obtain a profile of disability and handicap in patients with unilateral peripheral vestibular disorders presenting to a specialist tertiary care unit. Two validated questionnaires were sent to patients who had a unilateral peripheral vestibular disorder as defined by strict criteria. Some patients still suffered moderate handicap and disability 5 years after the initial symptoms related to a unilateral vestibular disorder, although the duration of symptoms (onset to questionnaire completion) did not correlate with severity of disability and handicap, as judged by questionnaire scores. However, patients presenting to the unit within 6 months of onset of vertigo commenced balance exercises significantly earlier and had significantly lower disability scores than patients presenting later. A high proportion of non-compliance with, and delay in initiation of, vestibular rehabilitation exercises was noted in the total patient sample, while compliance with, and early initiation of, Cooksey Cawthorne exercises were significantly correlated with low disability and questionnaire scores. These findings suggest that early referral to a specialist balance unit for patients with persistent dizziness is associated with better outcome.
Adolescent↗
Public health in Russia: the view from the inside.
The health of the Russian population continues to lag far behind that in the west. A robust public health response to the high levels of communicable and non-communicable diseases is required. This challenge has attracted considerable attention from international donor agencies and others, but there are still many questions about how the health situation in Russia is understood by policy-makers within the country and what responses are being considered. This paper examines these questions by means of a review of literature published in Russia and interviews with key informants. It concludes that although many of the determinants of health in Russia have been identified, they are typically discussed in a general way. Research on the major determinants of disease in Russia, and published in the international literature, appears to have had little impact. The need for reform to enhance the public health response is recognized. Goals of reform have been described but are poorly defined and there is typically little relationship between a stated goal and the strategy proposed to achieve it. There is a lack of clarity about what is meant by public health, and key concepts, such as inter-sectoral and multi-disciplinary working, are either ignored or misunderstood. Evidence of capacity for managed change is weak. There is an urgent need to create a shared awareness of evidence on the nature of the health challenges facing Russia and the evidence base for both the content of potential responses and the strategies that might be adopted to implement them.
Attitude to Health↗
Health policy-making in central and eastern Europe: lessons from the inaction on injuries?
The burden of disease due to injuries has elicited virtually no public health response in the countries of central and eastern Europe, even though injuries have long been a much greater problem in the east of Europe than in the west, with children especially affected. This paper seeks to identify factors that have inhibited policy development on this topic and to draw lessons for health policy development in this region more generally. Several factors emerge. Deaths from injuries have had low visibility. Data have not been assembled in a way that would facilitate identification of the burden of disease that they constitute. Those organizations responsible for public health, whether within government or at local level, were typically very weak with little capacity either to identify the nature and scale of threats to the health of their populations or to develop strategies to address them. There was uncertainty about ownership, with fragmentation of responsibility but no tradition of intersectoral working. Non-governmental organizations, which have placed injuries on the health policy agenda in the west, are weak or non-existent. International donors, who could have had a role, have focused on issues such as health care reform. This analysis provides a potential framework for examining policy responses, or lack thereof, to other health challenges in this region. It highlights the need for a better understanding of the potential for using available data, which, in turn, requires a major strengthening of capacity. However, in many countries, there is a need for new ways of working, involving a broadening of the sense of ownership, with clearly designated responsibilities but designed in ways that encourage rather than inhibit intersectoral action. There is also a need to develop non-governmental organizations that have sufficient capacity to undertake their own analyses and to place issues on the agenda.
Child↗