Socioeconomic inequalities and the equity impact of population-level interventions for adolescent health: an overview of systematic reviews.

OBJECTIVES: Despite robust evidence on health inequalities in adulthood, less attention has been paid to inequalities in adolescence. The aim of this overview was to examine systematic review (SR) evidence on the equity impact of population-level interventions intended to improve health, happiness and wellbeing for adolescents. STUDY DESIGN: An overview (review of systematic reviews). METHODS: Eleven electronic databases were systematically searched to identify SRs of population-level interventions for adolescent health. A secondary data analysis of socioeconomic inequality was conducted to identify whether SRs reported on primary studies in terms of disadvantage, by measures of socioeconomic status (SES) and by differential effects. RESULTS: 35,310 review titles were screened; 566 full texts were retrieved and 140 SRs met the predefined selection criteria. Differential intervention effects were considered in 42/140 (30%) SRs, 18/140 (13%) reported primary studies using an SES measure and 16/140 (11%) explicitly reported differential effects. 15/140 SRs (11%) explicitly focused on socioeconomic inequalities; of these 4/15 reported differential intervention effects in more detail, 7/15 concluded there was insufficient primary evidence to identify the impact of interventions on socioeconomic inequalities and 4/15 planned to examine differential effects by SES, but this was not reported further. CONCLUSIONS: Our overview identifies that there is limited SR evidence on the equity impact of population-level interventions for adolescent health. Strengthening the evidence on whether interventions narrow or widen inequalities for adolescents must be a priority for public health research.

When might an operative complication be regarded as acceptable? Part 2: Judicial factors that influence the finding of fault during surgical litigation.

In cases where surgeons face litigation over operative misadventure, the result of a trial is uncertain. In order to identify factors in cases of surgical litigation that have influenced the final decision of the courts, we have previously reviewed reported cases where the outcome turned on actions taken by surgeons. We now turn our attention to judicial attitudes to evidence that play a role in the determination of the case.

When might an operative complication be regarded as acceptable? Part 1: Surgical factors that influence courts when finding fault during litigation.

In cases where surgeons face litigation over operative misadventure, the result of a trial is uncertain. In order to identify factors in cases of surgical litigation that have influenced the final decision of the courts, we have reviewed recent reported cases, noting both surgical and evidential influences on outcome. Taken together, these reveal that among other influential factors, the acceptability of more than one reasonable operative approach, the court's approach to inappropriate delegation and the uncertainties of expert evidence all play a role in the determination of the case.

Q fever outbreak among travelers to Germany associated with live cell therapy - United States and Canada, 2014: a co-publication.

WHAT IS ALREADY KNOWN ON THIS TOPIC?: Q fever is a zoonotic disease caused by Coxiella burnetii and is usually transmitted through inhalation of air contaminated with animal excreta. The disease is considered to be underdiagnosed because symptoms are nonspecific and can vary from patient to patient, making diagnosis difficult. WHAT IS ADDED BY THIS REPORT?: During September-October 2014, the New York State Department of Health identified Q fever in five patients with exposure to a treatment known as live cell therapy, an alternative medicine practice involving injections of fetal sheep cells, which is a type of xenotransplantation. Investigation revealed that a group of U.S. residents traveled to Germany twice a year to receive this treatment. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?: Clinicians should consider zoonotic diseases, such as Q fever, in patients whose history includes receipt of a treatment known as live cell therapy. International travel for xenotransplantation procedures can facilitate transmission of zoonotic disease.

Seeking responsibility for the lost swab? Search elsewhere.

This article explores the possibility that the surgeon's control over his or her environment is not complete and that, in certain circumstances, the final swab count can be distinguished from the 'normal course of events'. We readily accept that most swabs and instruments are left inside patients simply as a result of substandard care but we cannot accept that this is invariably the case, and lessons from the common law are cited to illustrate the reasons why. We hope to persuade defendant lawyers that it might be worthwhile to tease out from surgeons under scrutiny how these factors may have influenced their practice on the day that a swab was retained.

Disseminated Mycobacterium immunogenum infection presenting with septic shock and skin lesions in a renal transplant recipient.

Mycobacterium immunogenum is a relatively new species within the Mycobacterium chelonae-Mycobacterium abscessus group of rapidly growing mycobacteria (RGM). M. immunogenum was first characterized in 2001 and, similar to other RGM, is an ubiquitous environmental organism. This organism has most commonly been implicated in cutaneous infection in both healthy and immunosuppressed patients. To our knowledge, this is the first reported case of septic shock in the setting of disseminated M. immunogenum infection. Definitive identification of this organism requires gene sequencing at specialized centers, which may limit its detection. M. immunogenum is resistant to many anti-mycobacterial agents, and treatment can be especially challenging in transplant patients, given potential drug interactions and added toxicities. It is important to distinguish M. immunogenum from other RGM and determine the susceptibility profile to devise a successful treatment plan, particularly in the transplant population in which it can potentially cause severe, disseminated disease.

What do research ethics committees say about applications to conduct research involving children?

OBJECTIVE: To identify issues raised by research ethics committees (RECs) in letters about applications to conduct research involving children. METHODS: Analysis of 80 provisional and unfavourable opinion decision letters written by RECs in response to applications to conduct research involving child participants. RESULTS: RECs were most likely to be concerned about issues relating to consent, recruitment, care and protection of participants, scientific design and confidentiality. RECs focused on children's status as "vulnerable". They sought to ensure that children would be protected, that appropriate written language would be used to communicate with children and that an appropriate person would give consent for children to participate. IMPLICATIONS: Researchers should be attentive to issues of potential vulnerability when preparing applications. REC letters may be improved by giving clear and explicit reasons for their opinions.

Using remote sensing to predict outbreaks of Oestrus ovis in Namibia.

The Directorate of Veterinary Services of the Ministry of Agriculture, Water and Rural Development of Namibia issues warnings to farmers in the south of the country about the likelihood of infestation of small-stock by the nasal bot fly, Oestrus ovis. Farmers can then treat their stock at the most appropriate time. The O. ovis puparia develop at shallow depths in the soil and the timing of emergence is directly dependent on climate conditions, specifically the number of degree-days above a particular threshold soil temperature. Based on temperature measurements from only a few stations scattered throughout the country, the veterinary department warnings lack precision in space and time. This paper presents an attempt to support the programme of warnings with accumulated temperature information from Meteosat satellite images, in order to strengthen predictions of the time of emergence in specific places, and to improve the precision and reliability of warnings given to farmers.

A prediction model for strike in the sheep nasal fly, Oestrus ovis, in Namibia.

A model was developed for predicting outbreaks of Oestrus ovis throughout the main sheep farming areas of Namibia. Pupal developmental periods were studied, concomitant air and soil temperatures enabling degree-day calculations to be made for prediction of adult fly strike. Monitoring of larval infection established seasonal incidence of O. ovis infestation and acted as verification of predictions. The establishment of relevant isothermal maps for Namibia made possible extrapolation from the several study sites to the entire sheep farming area. Retrospective and actual predictions of the important first peak after winter were considered accurate enough to recommend timing of control measures. No evidence of overwintering of first stage instars was found, the strategy used instead being extended pupation. Adult fly energy reserves were determined.

Albumin standards and the measurement of serum albumin with bromcresol green. 1971.

A rapid and reliable method for measuring serum albumin employing bromcresol green is described. The addition of albumin to a solution of bromcresol green in a 0.075 M succinate buffer pH 4.20 results in an increase in absorbance at 628 nm. The absorbance-concentration relationship is linear for samples containing up to 6 g/dl albumin. Bilirubin, moderate lipemia, and salicylate do not interfere with the analysis. The use of nonionic surfactant (Brij-35) reduces the absorbance of the blank, prevents turbidity and provides linearity. The results by this method agree very well with those obtained by electrophoresis and salt fractionation. The method is simple, it has excellent precision and the reagents are stable. A protein standard is introduced which can be employed for both the total serum proteins and albumin determinations.

Euthanasia and death with dignity: still poised on the fulcrum of homicide.

This article questions whether the law of homicide is an appropriate mechanism to adjudicate the humanitarian issues involved in voluntary euthanasia; particularly where painful protracted dying appears inherently more harmful than euthanasia. The author suggests that even if euthanasia can provide death with dignity this will not be achieved while the law requires the undignified criminalisation of the practitioner.

Demarcation of potentially mineral-deficient areas in central and northern Namibia by means of natural classification systems.

Mineral deficiencies that lead to production losses often occur concurrently with climatic and management changes. To diagnose these deficiencies in time to prevent production losses, long-term monitoring of mineral status is advisable. Different classification systems were examined to determine whether areas of possible mineral deficiencies could be identified, so that those which were promising could then be selected for further monitoring purposes. The classification systems addressed differences in soil, vegetation and geology, and were used to define the cattle-ranching areas in the central and northern districts of Namibia. Copper (Cu), Iron (Fe), zinc (Zn), manganese (Mn) and cobalt (Co) concentrations were determined in cattle livers collected at abattoirs. Pooled faecal grab samples and milk samples were collected by farmers, and used to determine phosphorus (P) and calcium (Ca), and iodine (I) status, respectively. Areas of low P concentrations could be identified by all classification systems. The lowest P concentrations were recorded in samples from the Kalahari-sand area, whereas faecal samples collected from cattle on farms in the more arid areas, where the harder soils are mostly found, rarely showed low P concentrations. In the north of the country, low iodine levels were found in milk samples collected from cows grazing on farms in the northern Kalahari broad-leaved woodland. Areas supporting animals with marginal Cu status, could be effectively identified by the detailed soil-classification system of irrigation potential. Copper concentrations were lowest in areas of arid soils, but no indication of Co, Fe, Zn, or Mn deficiencies were found. For most minerals, the geological classification was the best single indicator of areas of lower concentrations. Significant monthly variation for all minerals could also be detected within the classification system. It is concluded that specific classification systems can be useful as indicators of areas with lower mineral concentrations or possible deficiencies.

The usefulness of faecal phosphorus and nitrogen in interpreting differences in live-mass gain and the response to P supplementation in grazing cattle in arid regions.

The average daily gains of heifers and oxen on commercial and experimental farms in Namibia were used to indicate production differences in several areas and at different rates of phosphorus and protein supplementation. Faecal concentrations of phosphorus and nitrogen were used to indicate concentrations of these nutrients in grazing. Areas with high concentrations of nitrogen in faeces proved to support high levels of average daily gain. Animals responded positively to phosphorus supplementation only when faecal nitrogen concentrations were above 12 g/kg DM. Nitrogen concentrations in faeces were directly related to average daily gain of heifers, but protein supplementation did not have a significantly positive effect on average daily gain.

Job-related tension, self-esteem and psychological distress in rehabilitation professionals.

We examined perceptions of job-related tension among a non-random sample of 52 New Zealand rehabilitation service providers. We considered the relations between job tension and psychological distress and the extent to which feelings of self-esteem moderated this relationship. Major findings are that (a) there is a consistent positive relationship between job tension and general psychological distress; (b) there is a consistent negative relationship between self-esteem and both job tension and general distress; (c) self-esteem moderates the effect of job tension on general distress in that high levels of job tension were associated with increases in psychological distress among respondents with low self-esteem while among respondents with high-self esteem, job-related tension had little negative impact on feelings of psychological distress. Despite a number of limitations, the findings have a number of important implications for professional functioning among rehabilitation service providers and highlight the need for appropriate staff development and training initiatives which focus specifically on service provider wellbeing.

A perspective on occupational concerns of rehabilitation service providers.

While the roles, functions and personality characteristics of rehabilitation service providers have been widely researched, much less is known about the correlates and consequences of occupational stress in these groups. In the present study measures of occupational stress, job tension, job satisfaction, life satisfaction, and affective well-being were completed by 52 rehabilitation service providers drawn from a range of agencies in New Zealand. Respondents also completed two open-ended questions assessing significant stresses in their work and strategies whereby stress could be reduced. There were consistently high negative correlations between job stress and job satisfaction. The correlations of job tension with overall life satisfaction and affect were generally significant. Surprisingly there was no significant relationship between job satisfaction and general life satisfaction. There were some significant associations between job satisfaction and ratings of affect, but the pattern of results was inconsistent. Open-ended stresses identified by subjects included time pressure/workload problems, interpersonal issues, agency-created problems, and problems keeping up with the implications, for rehabilitation, of rapidly changing Government policy. Strategies for stress reduction that were identified involved more resources, training and skills; intra-agency reorganization and more effective management and communication; more networking with other professionals; and more stable, realistic and caring Government policy. Limitations of the study and future research directions were identified.

Biting pattern and host-seeking behavior of Anopheles arabiensis (Diptera: Culicidae) in northeastern South Africa.

Biting rhythm as well as vertical and horizontal distribution of host-seeking Anopheles arabiensis Patton was studied at a remote warm-water spring in the Kruger National Park, South Africa, which usually is devoid of human presence. An. arabiensis seeking hosts were collected throughout the night with several peaks, often with greatest biting activity during the predawn period. Abundance did not decline linearly as a function of distance from the breeding area, but was related to vegetation patterns. Most bites occurred on the ankles or feet and decreased rapidly above that height. Wearing closed shoes or raising feet off the ground could reduce vector contact and therefore the risk of malaria infection.