Health response of two communities to military antennae in Cyprus.

OBJECTIVES: This study investigated concerns that have been raised about past and future health effects caused by high power transmissions of high frequency (7-30 MHz) radio waves from military antenna systems at Akrotiri, Cyprus. METHODS: A cross-sectional study of three villages (two exposed, one unexposed) collected longitudinal and short-term radiofrequency measurements. Health data were collected using questionnaires containing information on demographic factors, specific illnesses, general health (SF-36 well-being questionnaire), reproductive history, childhood illnesses, risk perception and mortality. Analysis was with SPSS v11.5 using cross tabulations of non-parametric data and tests for significance. Key health outcomes were subjected to logistic regression analysis. RESULTS: Field strengths within the two "exposed" villages were a maximum of 0.30 (Volts/Vm(-1) metre) from the 17.6 MHz military transmissions and up to 1.4 Vm(-1) from unspecified sources, mainly cell phone frequencies. The corresponding readings in the control village were <0.01 Vm(-1). Compared with the control village there were highly significant differences in the reporting of migraine (OR 2.7, p<0.001), headache (OR 3.7, p<0.001), and dizziness (OR 2.7, p<0.001). Residents of the exposed villages showed greater negative views of their health in all eight domains of the SF-36. There were also higher levels of perceived risk, particularly to noise and electromagnetic "pollution". All three villages reported higher values of risk perception than a UK population. There was no evidence of birth abnormalities or differences in gynaecological or obstetric history. Numbers of cancers were too small to show differences. CONCLUSION: It was clear that even this close (1-3 km) to powerful transmissions, the dominant sources of radiofrequency fields were cell phone and national broadcast systems. There was no excess of cancer, birth defects or obstetric problems. There was heightened risk perception and a considerable excess of migraine, headache and dizziness, which appears to share a gradient with radiofrequency exposure. The authors report this association but suggest this is unlikely to be an effect of radiofrequency and more likely to be antenna visibility or aircraft noise.

Molecular epidemiology of a large outbreak of hepatitis B linked to autohaemotherapy.

BACKGROUND: Unregulated skin-piercing procedures potentially facilitate the transmission of bloodborne pathogens. In February, 1998, a patient who had recently received autohaemotherapy at an alternative medicine clinic in the UK was diagnosed with acute hepatitis B. The autohaemotherapy procedure involved the drawing of 1 mL of the patient's blood, mixing with saline, and reinjection of the autologous blood mixture. We investigated the extent of hepatitis B virus (HBV) infection in patients and staff of the clinic. METHODS: Patients who had attended the clinic between January, 1997, and February, 1998, were tested for serological markers of HBV, and for HBV DNA by PCR. HBV DNA was sequenced to assess the relatedness of the virus identified in the cases. We analysed the number and dates of visits with regard to HBV status. FINDINGS: Serum samples were received from 352 patients and four staff members. Serological evidence of exposure to HBV was found in 57 (16%). Of the 33 patients and staff who were positive for hepatitis B surface antigen, 30 (91%) showed complete nucleotide identity in the DNA segments derived from the surface and core genes. Five patients with linked infection had markers of chronic hepatitis B, and one of these was regarded as the likely source of the outbreak. The attack rate was associated with the number of visits (p<0.0001) and the week of visit (p=0.011). Contaminated saline in a repeatedly used bottle was the probable vehicle of transmission. INTERPRETATION: We have described a large community-based outbreak of hepatitis B due to transmission by a single HBV variant. Our findings emphasise the continuing risk of transmission of bloodborne viruses in all health-care settings where skin-piercing procedures are used.

Diarrhoea and nitrogen oxides.

It is hypothesized that higher indoor nitrogen dioxide levels cause diarrhoea in infants and that this is the result of a direct action of oxides of nitrogen on the gut. This hypothesis is tested by reviewing the reported association between methaemoglobin and diarrhoea in children and two recent reports on indoor air and diarrhoea in infants. The collection of further empirical data is now needed. Studies which measure indoor levels of nitrogen dioxide could usefully collect data on infants symptoms that are not exclusively respiratory. Similarly, studies which are collecting diary information on children's health symptoms should consider collecting data on indoor air quality with respect to the oxides of nitrogen.

Improving infection control in general practice.

Infection control measures in the health care setting should protect patients and staff from cross-infection. The prevention of harm is an essential part of good medical practice and failure might result in professional misconduct proceedings by the General Medical Council (GMC) and prosecution under the Health and Safety at Work legislation, as well as civil liability. For a health authority, overall responsibility for public health includes arrangements for the control of communicable diseases and infection in hospital and the community (NHS Management Executive, 1993), a function usually led by the Consultant in Communicable Disease Control (CCDC). This paper describes one district's collaborative approach between public health and GPs to assess and improve local infection control standards.

The repeatability of self-reported exposure after miscarriage. ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.

BACKGROUND: The Avon Longitudinal Study of Pregnancy and Childhood is a prospective study of women who were resident in Avon and who were expected to deliver a baby between April 1991 and December 1992. METHODS: The study provided an opportunity to test the repeatability of responses from 220 women who experienced a miscarriage and who reported exposure to occupational substances and common household products and appliances in two questionnaires. The first questionnaire was completed in the early part of the pregnancy and the second after the miscarriage. Women were asked to score their frequency of exposure on a five-point scale from 'daily' to 'never'. Their responses were analysed to assess the degree of agreement between replies to identical questions in the two questionnaires using the kappa statistic. A new frequency variable was created which compared the replies for the two questionnaires; this was analysed for all exposures by cross-tabulation with possible explanatory variables (age of mother, social class, history of miscarriage and the time lag between questionnaires). RESULTS: In general there was good agreement in the reported exposures to 48 substances and products. The results showed a small and consistent pattern of reporting exposures less frequently in the second questionnaire, i.e. after miscarriage. This was not explained by the analysis of possible confounding variables. Given the literature, the authors had expected to find a shift in the opposite direction. CONCLUSION: The study reinforces the need to be cautious when using the results from single surveys of retrospective self-reported exposure.

The challenge of evaluating surgical procedures.

All new interventions and procedures must be properly assessed in comparison to the currently accepted method(s). It is unethical not to do so. The optimum method is by Randomised Controlled Trial (RCT). This is ideally suited to the testing of drugs because the trial can usually be double blind and placebo controlled. RCTs are less commonly used for the evaluation of new surgical techniques. There are valid and invalid reasons for this and these are discussed.

Audit of a psychosexual clinic: patterns of attendance and outcome.

A retrospective study of consecutive case notes examined patterns of referral, work and outcome to identify ways in which the psychosexual service at a community psychosexual clinic could be improved. The study identified the characteristics of patients, including their source of referral, the presenting symptom, the number of visits and outcomes. It also suggested the need to develop better prognostic factors and outcome measures. Case study is needed to identify when further improvement is unlikely so that treatment can be stopped at an appropriate time.

Audit of amniocentesis from a district general hospital: is it worth it?

OBJECTIVE: To audit all mid-trimester amniocenteses performed by obstetricians at a district general hospital to see whether experience improved the outcome. DESIGN: Retrospective review of medical records. SETTING: Royal Gwent Hospital, south Wales. SUBJECTS: All 469 amniocenteses carried out in 1985-7. OUTCOME MEASURES: Number of attempts at withdrawal of amniotic fluid; number with bloodstained liquor; and number of subsequent miscarriages, terminations, and congenital abnormalities. RESULTS: Of the 469 amniocenteses, 411 were performed by one obstetrician, and initial comparisons with those performed by the rest of the hospital team showed no significant differences in outcome of pregnancy. The main difference between the two groups was in the number of attempts at withdrawal of amniotic fluid and the number with bloodstained liquor. The single obstetrician failed to obtain amniotic fluid on 1% of occasions compared with 10% for the other operators by the end of the second attempt. The costs of carrying out the audit were considerable. The review of fewer than 500 case records cost the equivalent of 2000 pounds in staff time and took over 200 hours to complete, equivalent to 63 sessions of one person's time. CONCLUSIONS: The audit was useful in that it provided information on complication rates, which could be compared with published data, and comparisons between obstetricians who perform large and small numbers of procedures. IMPLICATIONS: For an individual's practice the monitoring of amniocentesis should not be continuously carried out and subsequent audits should tackle other common procedures. When an audit is attempted the health service should provide adequate support to clinicians for this purpose.

People's knowledge of health and disease.

A community survey based on the Cardiff electoral register was carried out in 1986. Seven hundred and ten adults were asked 10 open-ended questions about common serious illnesses in the United Kingdom and were given 18 statements about common diseases and asked to state whether they were true or false. This paper reports their responses. Amongst those gaining the highest scores there were more young people, more females, more from social classes I and II and more who had been educated to college or university level. We discuss the implications of the results for patient behaviour and for health education programmes.

Characteristics of self-reported hearing problems in a community survey.

The Cardiff Health Survey included a question asking whether the respondents had any difficulties with their hearing and, if so, to specify the biggest difficulty. This self-completed questionnaire was administered to 4,266 individuals randomly sampled from the electoral register of Cardiff in 1986. 14.7% of those responding indicated a hearing disability; and the main specific disabilities listed are described. The commonest complaints were of difficulties hearing the television and radio, and with general conversation. A number of other specific complaints were reported similar to those found in previous studies with the 'Problems Questionnaire'. Age, social class, general health, smoking and the individual's attitudes were found to influence the pattern of response.

Choosing who shall not be treated in the NHS.

In the face of severe resource constraints, health care systems are seeking both to control costs and to ensure maximum benefits for the resources consumed. The use of Quality Adjusted Life Years (QALYs) is becoming more widely advocated as a decision aid in the solution of resource allocation problems. The QALY combines two dimensions of health outcome--the quantity of life and its quality--in such a way that choices between different services with different purposes can be made using comparisons based on common units of measurement. The combination of these two dimensions allows comparisons between services with different objectives, such as curing and caring services. The QALY, however, lacks a third dimension which is vital to the decision-making process to which it is intended to contribute: the worth of a specific life relative to others. This paper presents results based on interviews of 719 residents of Cardiff drawn at random from the electoral register. The results suggest that further development of the novel methodology used to establish the relative value placed on various human lives is worthwhile. Evidence is given which indicates that the public consider lives to be of unequal worth. The results also show that these values are consistent for different types of choices phrased in different ways on a large number of control variables, implying the existence of a cultural stable value system which is a necessary prerequisite if consensus values of human life are to be used to assist decision-making in non-private health care systems.(ABSTRACT TRUNCATED AT 250 WORDS)

Disinfection methods in general practice and health authority clinics: a telephone survey.

Concern about the epidemic of the acquired immune deficiency syndrome led to discussions in one health district about the dangers of cross-infection from instruments in general practice and health authority clinics. In order to establish what current disinfection practices were in use a telephone survey was adopted as a quick and easy method of data collection. Information was collected on who was responsible for disinfection as well as details of how each instrument was disinfected. Results from 69 general practices and 21 health authority clinice in one health district are reported.Some form of sterilizer was used in 63 general practices. These included water boilers (49%), dry heat sterilizers (41%), autoclaves (5%) and pressure cookers (5%). Sixty one practices were using metal vaginal specula and of these 29 were disinfecting by boiling, three were using pressure cookers, 18 dry heat, seven chemical methods, three autoclaves and one the central sterile department of the local hospital. Of those who were boiling after simple washing, three practices boiled for five to 10 minutes and reused instruments during the same clinic. Of the 29 using simple boiling 20 (69%) were boiling for less than 20 minutes.The study highlights the fact that no formal advice has been given on disinfection practice by the DHSS, the health authorities or the family practitioner committees. The need to set up local guidelines and develop practical steps for their introduction are discussed.

A survey of the appropriateness of the public's responses to hypothetical medical problems.

In a community survey based on the Cardiff electoral register a sample of 737 adults were questioned about what they would do in certain illness situations. The 20 hypothetical situations varied in terms of the age of the patient and the severity and seriousness of the illness. People were asked to choose from 13 reactions of differing urgency from taking home remedies, going to bed or staying indoors to dialling 999 and calling an ambulance.The authors' perceptions of the appropriateness of the reactions often did not match that of the public. In some situations, notably those involving changed bowel habits, black motions and high temperature with stiff neck, the public were thought to under-react, while in other cases, for example those involving bleeding, there was a tendency to over-react. Women were more likely than men to make appropriate responses, as were those in social classes 1 and 2. Those whose education was limited only to elementary or secondary school were more likely to be defined as overreactors or changers. These same characteristics were observed in the over-65-year-olds.Although the methodology described in this paper needs further development, the study points to a number of conditions where the public seems more or less concerned than the medical profession. It also suggests that health education programmes could pay more attention to illness behaviour.

A community survey of alcohol consumption.

A survey by 150 trained medical students was carried out in 1986 on a random sample of adults from the electoral register of Cardiff. The survey explored attitudes, knowledge and behaviour over a wide range of health related topics. 4266 self-completed questionnaires were returned for analysis and this paper reports the answers to the question 'how much did you drink last week'. The total units of alcohol were calculated and the drinking characteristics of the respondents are presented by age, sex, marital status, social class, accommodation and occupation. The contribution that such community surveys play in the development of local alcohol policy is discussed.

The cost of saving a life through cervical cytology screening: implications for health policy.

Through a review of the published literature on routine cervical cytology screening, this paper seeks to establish a likely range for the cost of saving a life through this screening programme as presently organised in England and Wales. The current performance of the programme may be expressed in several ways: a cost of 270,000 pounds to 285,000 pounds per life saved, 40,000 smears and 200 excision biopsies per death averted, or 1000 to 1500 avoidable deaths annually in England and Wales alone. The policy problems are thus of two kinds. First, there is a substantial misallocation of the limited resources available to an insurance based system of health care. Further, the money which is spent on this service does not avoid the mortality and morbidity which could reasonably be expected if the system were performing adequately. It is suggested that substantial improvements in the performance of the programme may well be possible if managers are appointed. Nevertheless a deeper policy issue is raised: to be delivered efficiently, any service based on population rather than individual considerations will require some acceptance by the medical profession of a limit to their traditional view of clinical freedom. The unresolved clash between population and individual considerations which poses such a fundamental challenge for policy making in insurance based health services is particularly well illustrated by the dilemma of publicly funded cervical cytology screening.