Creative potential: mental well-being impact assessment of the Liverpool 2008 European capital of culture programme.

OBJECTIVES: Culture has a number of potential impacts upon health and well-being. This project was undertaken to assess the potential impacts of the Liverpool 2008 European Capital of Culture programme upon mental well-being, so that positive effects can be maximized and negative impacts reduced, in order that health and well-being are promoted and inequalities are reduced. STUDY DESIGN: A mental well-being impact assessment (MWIA) toolkit has been developed, and was piloted in this study. MWIA uses a sequence of procedures designed to systematically assess the effect of projects, programmes and policies upon people's mental well-being and health. METHODS: The MWIA toolkit was used to explore the potential positive and negative impacts on mental well-being of a sample of projects and policies from the European Capital of Culture programme. This was achieved by asking stakeholders to answer a series of questions, holding participative workshops, constructing a community profile and reviewing the research literature. Recommendations were developed which aim to enhance the impact of the programme on people's mental well-being. RESULTS: As expected, both positive and negative impacts of the European Capital of Culture programme on mental well-being were identified. Fourteen themes were identified as emerging from the workshops, screening and reviewing the research evidence. Based on these data, 33 recommendations were developed by the project steering group and have been presented to the Liverpool Culture Company. CONCLUSIONS: The process of conducting the assessment, particularly its participatory nature and its awareness-raising role, had impacts upon mental well-being. The findings demonstrate the potential for the Culture Company programme to have a profound impact upon mental well-being, and highlight areas which could be addressed to optimize the impact of the programme.

Gender, health inequalities and welfare state regimes: a cross-national study of 13 European countries.

BACKGROUND: This study is the first to examine the relationship between gender and self-assessed health (SAH), and the extent to which this varies by socioeconomic position in different European welfare state regimes (Liberal, Corporatist, Social Democratic, Southern). METHODS: The EUROTHINE harmonised data set (based on representative cross-sectional national health surveys conducted between 1998 and 2004) was used to analyse SAH differences by gender and socioeconomic position (educational rank) in different welfare states. The sample sizes ranged from 7124 (Germany) to 118 245 (Italy) and concerned the adult population (aged >or=16 years). RESULTS: Logistic regression analysis (adjusting for age) identified significant gender differences in SAH in nine European welfare states. In the UK (OR 0.88; 95% CI 0.78 to 0.99) and Finland (OR 0.85; 95% CI 0.77 to 0.95), men were significantly more likely to report "bad" or "very bad" health. In Denmark, Sweden, Norway, Holland, Italy, Spain and Portugal, a significantly higher proportion of women than men reported that their health was "bad" or "very bad". The increased risk of poor SAH experienced by women from these countries ranged from a 23% increase in Denmark (OR 1.23; 95% CI 1.08 to 1.39) to more than a twofold increase in Portugal (OR 2.01; 95% CI 1.87 to 2.15). For some countries (Italy, Portugal, Sweden), women's relatively worse SAH tended to be most prominent in the group with the highest level of education. DISCUSSION: Women in the Social Democratic and Southern welfare states were more likely to report worse SAH than men. In the Corporatist countries, there were no gender differences in SAH. There was no consistent welfare state regime patterning for gender differences in SAH by socioeconomic position. These findings constitute a challenge to regime theory and comparative social epidemiology to engage more with issues of gender.

Proteomic assessment of sympathetic ganglia from adult mice that possess null mutations of ExonIII or ExonIV in the p75 neurotrophin receptor gene.

Neurotrophins, such as nerve growth factor (NGF), are capable of binding to the transmembrane p75 neurotrophin receptor (p75NTR), which regulates a variety of cellular responses including apoptosis and axonal elongation. While the development of mutant mouse strains that lack functional p75NTR expression has provided further insight into the importance of this neurotrophin receptor, there remains a paucity of information concerning how the loss of p75NTR expression may alter neural phenotypes. To address this issue, we assessed the proteome of the cervical sympathetic ganglia from two mutant lines of mice, which were compared to the ganglionic proteome of age-matched wild type mice. The ganglionic proteome of mice possessing two mutant alleles of either exonIII or exonIV for the p75NTR gene displayed detectable alterations in levels of Lamin A, tyrosine hydroxylase, and Annexin V, as compared to ganglionic proteome of wild type mice. Decreased expression of the basic isoform of tyrosine hydroxylase may be linked to perturbed NGF signaling in the absence of p75NTR in mutant mice. Stereological measurement showed significant increases in the number of sympathetic neurons in both lines of p75NTR-deficient mice, relative to wild type mice. This enhanced survival of sympathetic neurons coincides with shifts toward the more basic isoforms of Annexin V in mutant mice. This study, in addition to providing the first comparative proteomic assessment of sympathetic ganglia, sheds new light onto the phenotypic changes that occur as a consequence of a loss of p75NTR expression in adult mice.

Engaging communities to tackle anti-social behaviour: a health impact assessment of a citizens' jury.

OBJECTIVES: To carry out a health impact assessment (HIA) of the Netherley Valley Citizens' Jury that was set up to develop recommendations for how anti-social behaviour should be addressed in their community. STUDY DESIGN: Concurrent HIA based on the Merseyside Guidelines for HIA and the European Policy HIA Guidelines. METHODS: Literature reviews, community profiling, and interviews and workshops with stakeholders and key informants were undertaken. RESULTS: A wide range of positive and negative impacts were identified, and 20 recommendations were developed to suggest ways of maximizing the potential positive impacts on health and wellbeing and minimizing the negative impacts. CONCLUSIONS: This HIA provided a unique opportunity to compare predicted and actual health impacts, which illustrates the importance of assessing the potential impacts of processes as well as intended outcomes. It also highlighted some of the potential risks involved in engaging with communities, and reinforced the value of assessing the potential impacts on health of policies, programmes and projects that may intuitively appear to be beneficial to all involved.

Developing public health nursing: barriers perceived by community nurses.

OBJECTIVES: To understand the key issues for field nursing in developing their public health role within five primary care trusts (PCTs) in Merseyside, in the North West of England. DESIGN: Qualitative study. METHODS: Fourteen school nurses and 30 health visitors participated in 11 focus groups consisting of others from their profession working within the same PCT, and 24 practitioners responded to a questionnaire. RESULTS: The findings suggest that there are a number of shared obstacles that need to be overcome before the public health approach can be fully developed within community nursing. These include: the need for facilitation to deal with organisational change, lack of clarity around the public health role, inadequate administrative support, general practitioner attachment problems, poor interprofessional partnerships, competing priorities and resistance to change. CONCLUSIONS: The development of public health nursing in England envisaged in current government policy will not occur in full unless the kind of issues identified in this study are adequately addressed. This will require participative, interprofessional approaches to redesigning services by all relevant public health practitioners.

Attitudes of community optometrists to smoking cessation: an untapped opportunity overlooked?

AIM: To assess community optometrists' attitudes and current behaviour regarding provision of smoking cessation advice in their practice. METHODS: A self-completion postal questionnaire was sent to community optometrists in north-west England identified from the General Optical Council's practice lists. RESULTS: Of 709 optometrists identified, 71.8% (509/709) returned the completed questionnaire. Few community optometrists routinely asked about smoking habits: only 6.2% (95% CI: 4.1-8.3) (n = 31) at new patient consultations, and 2.2% (95% CI: 0.9-3.5) (n=11) at follow-up visits. Reasons for optometrists not routinely providing smoking cessation advice included: not their role (35.4%, n=180), lack of time (22.0%, n=112) and forgetting to ask (21.4%, n=109). Overall 67.6% (95% CI: 63.5-71.7) (n=344) of community optometrists wanted to improve their knowledge of smoking and visual impairment with 56.2% (95% CI: 51.9-60.5) (n=286) requesting further training. CONCLUSION: Despite low levels of current involvement, many optometrists were keen to receive training on smoking cessation topics. We suggest that there are untapped opportunities to develop brief interventions to promote smoking cessation services in community optometry settings.

A politics of health glossary.

This glossary reflects a (re-)emerging awareness within public health of the political dimension of health and health inequalities, and it also attempts to define some of the key concepts from the political science literature in a way that will be of use in future public health analyses. Examples from different domains (healthcare and population health) are provided to highlight how political concepts pervade health.

Stereologic analysis of cell number and size during postnatal development in the rat substantia nigra.

Parkinson's disease is characterized by age-related atrophy and loss of dopaminergic neurons within the compact portion of the substantia nigra (SNpc) projecting to neostriatum. Despite numerous studies using rodent models to examine mechanisms underlying this disorder, the fundamental question of whether development- or age-related changes occur in the rodent SNpc remains unanswered. The present study used a three-level, optical fractionator approach to estimate the number and size of SNpc neurons immunoreactive for tyrosine hydroxylase (TH) in eight young (2-month) and eight older (7-month) Sprague-Dawley rats. Following standard protocols for animal care and tissue harvesting, every eighth 60-microm section from a gapless coronal series was treated immunohistochemically for TH along with a thionin counterstain. Neither the ventral tegmental area nor the lateral part of the SN was included in the analysis. The total bilateral number of SNpc TH+ neurons (approximately 8000) was equivalent between groups, whereas mean TH+ neuronal volume decreased significantly in the older group (approximately 18%). In contrast, volume of the SNpc increased with age by 17%, as did volume of the entire brain (24%). TH+ cells in the SNpc were also significantly larger on the left versus right side of the brain. These data are consistent with the hypothesis that age-related volumetric expansion of the SNpc is accounted for by an increase in the ratio between neuropil and average neuron somal size during intermediate postnatal development.

Is patriarchy the source of men's higher mortality?

OBJECTIVE: To examine the relation between levels of patriarchy and male health by comparing female homicide rates with male mortality within countries. HYPOTHESIS: High levels of patriarchy in a society are associated with increased mortality among men. DESIGN: Cross sectional ecological study design. SETTING: 51 countries from four continents were represented in the data-America, Europe, Australasia, and Asia. No data were available for Africa. RESULTS: A multivariate stepwise linear regression model was used. Main outcome measure was age standardised male mortality rates for 51 countries for the year 1995. Age standardised female homicide rates and GDP per capita ranking were the explanatory variables in the model. Results were also adjusted for the effects of general rates of homicide. Age standardised female homicide rates and ranking of GDP were strongly correlated with age standardised male mortality rates (Pearson's r=0.699 and Spearman's 0.744 respectively) and both correlations achieved significance (p<0.005). Both factors were subsequently included in the stepwise regression model. Female homicide rates explained 48.8% of the variance in male mortality, and GDP a further 13.6% showing that the higher the rate of female homicide, and hence the greater the indicator of patriarchy, the higher is the rate of mortality among men. CONCLUSION: These data suggest that oppression and exploitation harm the oppressors as well as those they oppress, and that men's higher mortality is a preventable social condition, which could be tackled through global social policy measures.

Assessment of fine motor skill in musicians and nonmusicians: differences in timing versus sequence accuracy in a bimanual fingering task.

While professional musicians are generally considered to possess better control of finger movements than nonmusicians, relatively few reports have experimentally addressed the nature of this discrepancy in fine motor skills. For example, it is unknown whether musicians perform with greater skill than control subjects in all aspects of different types of fine motor activities. More specifically, it is not known whether musicians perform better than control subjects on a fine motor task that is similar, but not identical, to the playing of their primary instrument. The purpose of this study was to examine the accuracy of finger placement and accuracy of timing in professional musicians and nonmusicians using a simple, rhythmical, bilateral fingering pattern and the technology that allowed separate assessment of these two parameters. Professional musicians (other than pianists) and nonmusicians were given identical, detailed and explicit instructions but not allowed physically to practice the finger pattern. After verbally repeating the correct pattern for the investigator, subjects performed the task on an electric keyboard with both hands simultaneously. Each subject's performance was then converted to a numerical score. While musicians clearly demonstrated better accuracy in timing, no significant difference was found between the groups in their finger placement scores. These findings were not correlated with subjects' age, sex, limb dominance, or primary instrument (for the professional musicians). This study indicates that professional musicians perform better in timing accuracy but not spatial accuracy while executing a simple, novel, bimanual motor sequence.

Effect of rotator cuff exercise on humeral rotation torque in healthy individuals.

Conservative management of rotator cuff pathology often involves certain therapeutic exercises. Although a major goal of these exercises is to increase strength of the rotator cuff, little empirical evidence supports this assertion. In this study, 34 nonpathologic young adults were pretested using a LIDO Multijoint II isokinetic device for average and peak torque generated during internal and external rotation. Subjects were arbitrarily assigned to a right-arm- or left-arm-trained group, exercised for 4 weeks, and then posttested for changes in humeral rotation torque. Moderate but significant increases in torque (8-10%) as well as in total work done were observed in both groups, only in the trained arm. Subjects who trained the nondominant (left) arm experienced gains similar to those who trained the right arm. Gains were significant in the case of both internal and external rotation (also average as well as peak torque), with men and women experiencing the same relative increases. These data, in addition to supporting the use of selected exercises to increase humeral rotation torque in a healthy population, offer a potential model for the rehabilitation of patients with rotator cuff injury.

A prospective health impact assessment of the Merseyside Integrated Transport Strategy (MerITS).

BACKGROUND: Prospective health impact assessment is a new approach to predicting potential health impacts of policies, programmes or projects. It has been widely recognized that public policies have important impacts on health. In 1997, the Liverpool Public Health Observatory was commissioned to carry out a health impact assessment of the Merseyside Integrated Transport Strategy (MerITS). A secondary aim was to pilot a method for health impact assessment at the strategic level. METHODS: The methods used drew on previous health impact assessments of projects, on strategic environmental assessment, and on policy research. They included policy analysis, semi-structured interviews with key informants and literature searches. RESULTS: Four priority impact areas of MerITS were identified: establishing road hierarchies, economic viability, air quality, and public transport. Potential health impacts in each of these areas were estimated, and recommendations were made to minimize the effects of negative impacts and to enhance positive ones. CONCLUSION: This health impact assessment prospectively identified the key health impacts of a strategy on a defined population and made recommendations to maximize potential positive and minimize potential negative health impacts. The methods employed are generally applicable to prospective health impact assessments of public policies and strategies.

Income inequality and mortality in England.

BACKGROUND: Despite the increasing evidence that income inequality causes reductions in life expectancy in developed countries, this relationship has not been explored in the United Kingdom, where local income data are not routinely available. We have surmounted this problem by employing an ecological design which applies national income data to local mortality and occupational data. METHODS: This ecological, cross-sectional study used 1991 mortality and Census data on the 366 English local government districts, and 1991 New Earnings Survey data for England, to determine the independent effect of income inequalities within English local authorities on the variation in all cause mortality between them. The subjects were all men and women recorded as economically active in the 1991 Census. We carried out linear regression analyses between all cause, all ages standardized mortality ratios, income inequality indexes and mean income levels of the local government districts. Results Both income inequality and mean income were independently associated with mortality. CONCLUSIONS: It is likely that income inequality makes an independent contribution to life expectancy in English local authorities. This finding adds further to the international evidence supporting the potentially positive health impact of increasing the scale of redistributive fiscal policies.