The relationship between mean birth weight and poverty using the Townsend deprivation score and the Super Profile classification system.

Super Profiles have been used as alternative methods of characterising the deprivation of an area. Some reports suggest that Super Profiles are as accurate as established indices such as the Townsend score (TS). This was a test of this assertion.A total of 138 696 live born singleton births to Birmingham residents born between 1986 and 1996 (inclusive) were allocated to enumeration districts (EDs) by linkage from the postcode. We allocated the TS of the individual's ED. We allocated a Lifestyle and Target Market (TM) from Super Profiles by linkage to the ED. We examined the gradient between mean birth weight and the 10 Super Profile Lifestyles and compared this to the gradient between 10 Townsend groups and mean birth weight. We repeated this approach using the 40 TMs and 40 Townsend groups. We used both the median income and a census-derived deprivation measure to rank Lifestyles and TMs. The gradient between mean birth weight and area deprivation was linear for Townsend groups but not linear using either Lifestyles or TMs whichever method of ranking Lifestyles or TMs was used. Where Lifestyles or TMs were out of line with their neighbours, the TS of that group mostly explained this. As Super Profiles are generated using nationally representative data, applying the affluence ranking to small areas can lead to inaccuracies, as shown in this data. We conclude that Super Profiles are probably unsuitable as measures of deprivation of small areas.

The cost effectiveness of including pencils and erasers with self-completion epidemiological questionnaires.

It is cheap to process epidemiological data from optical mark read (OMR) questionnaires. Respondents should use a pencil to complete OMR questionnaires, but many will not unless these are supplied. Sending pencils and erasers is expensive. Does sending pencils and erasers increase the response rate as cost-effectively as sending reminders, or does this decrease the error rate and offset data checking costs? We mailed 300 smokers and half were randomised to receive pencils and erasers. The relative risk (95% confidence intervals) for the response rate for the pencil group relative to the non-pencil group was 0.77 (0.46-1.29) and for the error rate was 1.31 (0.78-2.21). Sending pencils and erasers was not cost-effective in sensitivity analysis with any response rate or using the confidence intervals. Including pencils with mailed epidemiological questionnaires probably has no benefit and any plausible benefit does not offset the costs of sending pencils and erasers.

Does the multidimensional nature of Super Profiles help district health authorities understand the way social capital affects health?

BACKGROUND: Social capital describes the notion that the social processes in an area can lead to benefits in health. As Super Profiles describe the social character of an area and they are easy for health authorities to use, they could provide a simple method for local assessment of how social organization affects health. METHODS: We calculated the expected mean birthweight for the enumeration districts of Birmingham based upon marital status, registration details of the child, year of birth, the mother's country of birth, fetal sex and deprivation as judged by the Townsend score using data from 138,696 live-born singleton births for the years 1986-1996 inclusive. We classified enumeration districts into Target Markets, derived from Super Profiles. For each Target Market, we calculated the observed mean birthweight and the difference and 95 per cent confidence interval between the observed and expected birthweights. We used information in Super Profiles to speculate about the social processes that led to some Target Markets having mean birthweights that were significantly different from those expected. RESULTS: Fifteen of the 40 Target Markets had significant differences between predicted and observed mean birthweight, but these differences were less than 50 g. There were no common characteristics of Target Markets that were consistently advantageous for birthweight and none that were disadvantageous. CONCLUSION: The information in the Super Profiles does not illuminate the way that social processes affect health, and the variation in mean birthweight between areas explained by social processes as measured by Super Profiles is small.

Mongolia: a health system in transition.

PIP: 70% of the 2.2 million population of Mongolia are younger than 35 years old. More than 75% of the population live in urban areas, but many adopt the traditional nomadic lifestyle for at least a few weeks each year. 95% of the population is literate. Winters produce extremely cold temperatures and shortages. Mongolia has a well structured and staffed health care system. 3.9 physicians serve 1000 people. Women comprise more than 80% of physicians. Leading causes of mortality and morbidity are acute respiratory infections (ARIs) in the winter and diarrhea in the summer, particularly among children. Hypertension and ischemic heart disease are common. Mongolians are the greatest consumers of red meat in Asia and perhaps the world. The health system is in the process of switching from a centralized system of specialist clinics to a family doctor system. Family doctors usually are general physicians, pediatricians, and gynecologists who have undergone family doctor training. They have not received adequate training in treating ARIs, however. Family doctor clinics have 3-6 physicians, each physician with his/her own nurse. Each physician cares for 200-350 families (350-600 children younger than 16). Family doctors must visit each newborn every 2 weeks for the first 3 months and then once a month until age 1. They must also visit each elderly and homebound chronically ill patient at least once a month. Their nurses either come with them or visit patients alone to administer injections, change dressings, take infants' measurements, and encourage persons to come for vaccinations. The small district and county hospitals face shortages of drugs, raw materials, and functional equipment. The few national hospitals provide tertiary care. Treatment without medicine and traditional treatments of herbal remedies and Buddhist rituals and prayers are resurging in popularity. Harmful practices include swaddling babies, which contributes to rickets and pneumonia, and giving ill children their mother's early morning urine. Immunization coverage is high. Supplementary ration cards provide milk, flour, meat, rice, and sugar to pregnant women and mothers of children under 1 year old. Milk centers in major towns provide milk to children with a doctor's prescription. Even though malnutrition is rare, vitamin deficiencies are common.^ieng

Natural killer (NK) cell activity of first trimester human decidua.

The NK cell functional capacity of first trimester human decidua against K562 targets was assessed in a 3-hr CRA. Collagenase dispersal combined with plastic adherence, nylon wool passage, and density gradient centrifugation yielded NKH-1 (Leu 19) positive enriched decidual large granular lymphocyte fraction (mean 75% positive). Decidual effectors displayed reduced lytic activity compared with autologous PB effectors at every effector:target ratio but this difference in cytotoxicity was abolished by short-term culture before the CRA. Decidual effectors treated with 50 units rIL-2 showed increased lytic activity compared to untreated decidual cells. By FACS analysis the majority of NKH-1 positive decidual effectors were CD3 and CD16 negative which corresponds with a minority PB NK population. The implications of a population of functional NK cells in early pregnancy decidua for the materno-fetal relationship is discussed.