Recommendations for developing urban interventions to promote physical activity: interviews with key informants in Europe

Although there is growing evidence on what interventions can promote physical activity in urban environments, guidance on how to get these interventions implemented is lacking in a European context. To understand the process of developing urban interventions to promote physical activity, we conducted 13 key informant interviews with professionals working in urban development in five European countries, though some worked in more than one country. Participants described their experiences, challenges and recommendations across six European countries. The main challenges faced were political environments, unsupportive contexts, communication issues, working with other sectors, resource limitations and evaluations. We presented recommendations made by participants which can overcome these challenges when developing urban interventions to promote physical activity. Recommendations included obtaining cross-party political support for a project; working with local communities right from the beginning; involving all stakeholders and encouraging their commitment through identification of common goals; asking the market for solutions when faced with resource constraints, and using existing data to facilitate evaluations.

Barriers and facilitators to physical activity in second-generation British Indian women: A qualitative study

Aim

To understand the barriers to and motivations for physical activity among second-generation British Indian women.

Subject

Approximately 50% of British South Asians are UK-born, and this group is increasing as the second-generation also have children. Previous research into the barriers to and facilitators for physical activity has focused on migrant, first-generation populations. Qualitative research is needed to understand a) how we might further reduce the gap in physical activity levels between White British women and British Indian women and b) the different approaches that may be required for different generations.

Methods

Applying a socioecological model to take into account the wider social and physical contexts, we conducted semi-structured interviews with 28 Indian women living in Manchester, England. Interviews with first-generation British Indian women were also included to provide a comparator. Interviews were audio-recorded, transcribed, thematically coded and analysed using a grounded theory approach.

Results

Ways of socialising, concerns over appearance while being physically active, safety concerns and prioritising educational attainment in adolescence were all described as barriers to physical activity in second-generation British Indian women. Facilitators for physical activity included acknowledging the importance of taking time out for oneself; religious beliefs and religious groups promoting activity; being prompted by family illness; positive messages in both the media and while at school, and having local facilities to use.

Conclusions

Barriers to physical activity in second-generation Indian women were very similar to those already reported for White British women. Public health measures aimed at women in the general population may also positively affect second-generation Indian women. First-generation Indian women, second-generation children and Muslim women may respond better to culturally tailored interventions.

A study on patterns of use of mobile phone and nomophobia in medical undergraduate students during a COVID-19 pandemic lockdown

Introduction

The governments of various countries enforced a lockdown to contain the COVID -19 pandemic. As the colleges remain closed, the academic teachings for students was conducted online. The mobile phone remained the main source for academics and entertainment during this period.

Objectives

To assess patterns of use of mobile phone by Medical Undergraduate students prior to and during the COVID-19 lockdown. To assess Nomophobia among same participants.

Methods

This study was done by an online survey method after obtaining approval from the Institutional Ethics Committee. A validated questionnaire on patterns of mobile phone use and the Nomophobia Questionnaire(NMP-Q) was completed by the medical students (n=187) who consented to participate in the study

Results

Prior to the pandemic lockdown, 52.9% of the participants used the mobile phones for 2-4 hours per day with 78% of the usage in social media. During lockdown, 89.3% of the participants reported an increase in the usage of mobile phones. 35.65% reported an increase in use by 2-4 hours everyday. About 30.5 % used the mobile phone for 6-8 hours per day. 80.2 % reported a maximum usage for social media. 59.45% reported a maximum usage for online academics. 33.7% frequently checked their phones once in 15 minutes. About 60.43% of the participants were in the moderate and 21.4% in the severe category of nomophobia.

Conclusions

There is an increase in mobile phone usage during the lockdown with a significant proportion of students in the moderate and severe category of nomophobia.

Disclosure

No significant relationships.

Intervention development for exercise promotion at active charity events in the UK

This study used the Intervention Mapping protocol to design an evidence-based intervention package for organizers of active charity events to support their participants in remaining or becoming regular exercisers. A mixed-methods approach following the Intervention Mapping protocol was used to develop intervention components. A needs assessment was initially performed to identify the behavioural and environmental determinants of exercise for charity event participants (Step 1). Next, the intended intervention outcomes, and performance and change objectives were specified (Step 2). Theory-based change methods were selected and matched with practical strategies (Step 3). This resulted in the design of the first iteration of the intervention which underwent pre-testing with former event participants and feasibility testing at an active charity event (Step 4). The evidence-based interventions included components to implement at events (e.g. an activity and information zone, and exercise planner), along with elements pre- and post-event (e.g. social media). Pre-testing indicated high acceptability of the planned components, but feasibility testing suggested low engagement with the intervention. Despite developing the intervention package through the systematic process of Intervention Mapping, preliminary data suggest that further development and testing is needed to refine the intervention before implementation.

Peer social network processes and adolescent health behaviors: A systematic review

Research has highlighted the importance of peers for determining health behaviors in adolescents, yet these behaviors have typically been investigated in isolation. We need to understand common network processes operating across health behaviors collectively, in order to discern how social network processes impact health behaviors. Thus, this systematic review of studies investigated adolescent peer social networks and health behaviors. A search of six databases (CINAHL, Education Resources Information Centre, Embase, International Bibliography of the Social Sciences, Medline and PsycINFO) identified 55 eligible studies. The mean age of the participants was 15.1 years (range 13-18; 51.1% female). Study samples ranged from 143 to 20,745 participants. Studies investigated drinking (31%), smoking (22%), both drinking and smoking (13%) substance use (18%), physical activity (9%) and diet or weight management (7%). Study design was largely longitudinal (n = 41, 73%) and cross-sectional (n = 14, 25%). All studies were set in school and all but one study focused on school-based friendship networks. The Newcastle-Ottawa Scale was used to assess risk of bias: studies were assessed as good (51%), fair (16%) or poor (33%). The synthesis of results revolved around two network behavior patterns: 1) health behavior similarity within a social network, driven by homophilic social selection and/or social influence, and 2) popularity: health behavior engagement in relation to changes in social status; or network popularity predicting health behaviors. Adolescents in denser networks had statistically significant lower levels of harmful behavior (n = 2/2, 100%). Findings suggest that social network processes are important factors in adolescent health behaviors.

Brain pseudotumour secondary to Behçet's disease

Neuro-Behçet's disease (NBD) is a serious manifestation of Behçet's disease (BD) and can affect either the central or peripheral nervous systems, or both. It occurs in 10-50% of patients with BD. We report on a patient with an unusual intraparenchymal lesion, initially thought to be a brain tumour. Histological examination revealed vasculitis consistent with BD. Clinicians should include NBD as a differential diagnosis when considering an isolated inflammatory intracranial lesion.

Comparing trends in mortality from cardiovascular disease and cancer in the United Kingdom, 1983-2013: joinpoint regression analysis

BACKGROUND

We aimed to study the time trends underlying a change from cardiovascular disease (CVD) to cancer as the most common cause of age-standardized mortality in the UK between 1983 and 2013.

METHODS

A retrospective trend analysis of the World Health Organization mortality database for mortality from all cancers, all CVDs, and their three most common types, by sex and age. Age-standardized mortality rates were adjusted to the 2013 European Standard Population and analyzed using joinpoint regression analysis for annual percent changes.

RESULTS

The difference in mortality rate between total CVD and cancer narrowed over the study period as age-standardized mortality from CVD decreased more steeply than cancer in both sexes. We observed higher overall rates for both diseases in men compared to women, with high mortality rates from ischemic heart disease and lung cancer in men. Joinpoint regression analysis indicated that trends of decreasing rates of CVD have increased over time while decreasing trends in cancer mortality rates have slowed down since the 1990s. The lowest improvements in mortality rates were for cancer in those over 75 years of age and lung cancer in women.

CONCLUSIONS

In 2011, the age-standardized mortality rate for cancer exceeded that of CVD in both sexes in the UK. These changing trends in mortality may support evidence for changes in policy and resource allocation in the UK.

Trends in the epidemiology of cardiovascular disease in the UK

Cardiovascular disease (CVD) mortality in the UK is declining; however, CVD burden comes not only from deaths, but also from those living with the disease. This review uses national datasets with multiple years of data to present secular trends in mortality, morbidity, and treatment for all CVD and specific subtypes within the UK. We produced all-ages and premature age-standardised mortality rates by gender, standardised to the 2013 European Standard Population, using data from the national statistics agencies of the UK. We obtained data on hospital admissions from the National Health Service records, using the main diagnosis. Prevalence data come from the Quality and Outcome Framework and national surveys. Total CVD mortality declined by 68% between 1980 and 2013 in the UK. Similar decreases were seen for coronary heart disease and stroke. Coronary heart disease prevalence has remained constant at around 3% in England and 4% in Scotland, Wales, and Northern Ireland. Hospital admissions for all CVD increased by over 46 000 between 2010/2011 and 2013/2014, with more than 36 500 of these increased admissions for men. Hospital admission trends vary by country and CVD condition. CVD prescriptions and operations have increased over the last decade. CVD mortality has declined notably for both men and women while hospital admissions have increased. CVD prevalence shows little evidence of change. This review highlights that improvements in the burden of CVD have not occurred equally between the four constituent countries of the UK, or between men and women.

The physical activity profiles of South Asian ethnic groups in England

BACKGROUND

To identify what types of activity contribute to overall physical activity in South Asian ethnic groups and how these vary according to sex and age. We used the White British ethnic group as a comparison.

METHODS

Self-reported physical activity was measured in the Health Survey for England 1999 and 2004, a nationally representative, cross-sectional survey that boosted ethnic minority samples in these years. We merged the two survey years and analysed data from 19 476 adults. The proportions of total physical activity achieved through walking, housework, sports and DIY activity were calculated. We stratified by sex and age group and used analysis of variances to examine differences between ethnic groups, adjusted for the socioeconomic status.

RESULTS

There was a significant difference between ethnic groups for the contributions of all physical activity domains for those aged below 55 years, with the exception of walking. In women aged 16-34 years, there was no significant difference in the contribution of walking to total physical activity (p=0.38). In the 35-54 age group, Bangladeshi males have the highest proportion of total activity from walking (30%). In those aged over 55 years, the proportion of activity from sports was the lowest in all South Asian ethnic groups for both sexes.

CONCLUSIONS

UK South Asians are more active in some ways that differ, by age and sex, from White British, but are similarly active in other ways. These results can be used to develop targeted population level interventions for increasing physical activity levels in adult UK South Asian populations.

Effects of Microwave Absorption on Long and Short Single-Walled Carbon Nanotubes at 10-6 Torr

Carbon nanotubes have been observed to emit ultraviolet, visible and infrared radiation when exposed to microwaves. We have performed experiments in which both short (0.5 μm–2 μm) and long (5 μm–30 μm) single and double-walled carbon nanotubes were exposed to 2.46 GHz microwaves at a pressure of ~ 10-6 Torr. Structural modifications of the carbon nanotubes due to microwave absorption have been studied using the Raman spectroscopy G-band and D-band intensities, which suggest that microwave irradiation at relatively low pressure results in an increase in nanotube defects, especially in the case of the long nanotubes. Furthermore, a comparison of the spectra of the radiation emitted from the nanotubes suggests that the longer nanotubes emitted radiation of much greater intensity than the shorter nanotubes. Based on the results of the experiments and results described in previous reports, the ultraviolet, visible and infrared radiation emitted as the result of microwave absorption by carbon nanotubes seems to be primarily blackbody radiation emitted due to Joule heating. However, the presence of several broad photopeaks in the spectra of the emitted radiation (which do not seem to be related to gases absorbed by the nanotubes or the presence of catalyst particles) suggest that emissions are not the result of Joule heating alone.

Generational differences in the physical activity of UK South Asians: a systematic review

Background

South Asians are some of the least active people in the UK, but we know very little about how physical activity varies within and between different UK South Asian groups. There is much socio-economic and cultural heterogeneity among UK Indians, Pakistanis and Bangladeshis, and the same approaches to increasing physical activity may not be appropriate for all people of these ethnic groups. We report on the variation in physical activity behaviour prevalence in quantitative studies and the variations in attitudes, motivations and barriers to physical activity among South Asians in qualitative papers.

Methods

We performed systematic searches in MEDLINE, Embase and Psychinfo for papers written in English and published between 1990 and 2014. We also attempted to search literature not published in peer-review journals (the ‘grey’ literature). We reported data for the quantitative observational studies and synthesised themes from the qualitative literature according to age-group. We assessed the quality of studies using a National Institute of Health and Clinical Excellence tool.

Results

We included 29 quantitative papers and 17 qualitative papers. Thirteen papers reported on physical activity prevalence in South Asian children, with the majority comparing them to White British children. Four papers reported on adult second-generation South Asians and the rest reported on South Asian adults in general. Second-generation South Asians were more active than the first-generation but were still less active than the White British. There were no high quality qualitative studies on second-generation South Asian adults, but there were some studies on South Asian children. The adult studies indicated that the second-generation might have a more favourable attitude towards physical activity than the first-generation.

Conclusions

There is clear variation in physical activity levels among UK South Asians. Second-generation South Asians appear to be more physically active than the first-generation, but still less active than the White British. More qualitative research is needed to understand why, but there are indications that second-generation South Asians have a more positive attitude towards physical activity than the first-generation. Different strategies to increase physical activity may be needed for different generations of UK South Asians.

The epidemiology of cardiovascular disease in the UK 2014

Cardiovascular disease (CVD) presents a significant burden to the UK. This review presents data from nationally representative datasets to provide up-to-date statistics on mortality, prevalence, treatment and costs. Data focus on CVD as a whole, coronary heart disease (International Classification of Diseases (ICD):I20–25) and cerebrovascular disease (ICD:I60–69); however, where available, other cardiovascular conditions are also presented. In 2012, CVD was the most common cause of death in the UK for women (28% of all female deaths), but not for men, where cancer is now the most common cause of death (32% of all male deaths). Mortality from CVD varies widely throughout the UK, with the highest age-standardised CVD death rates in Scotland (347/100 000) and the North of England (320/100 000 in the North West). Prevalence of coronary heart disease is also highest in the North of England (4.5% in the North East) and Scotland (4.3%). Overall, around three times as many men have had a myocardial infarction compared with women. Treatment for CVD is increasing over time, with prescriptions and operations for CVD having substantially increased over the last two decades. The National Health Service in England spent around £6.8 billion on CVD in 2012/2013, the majority of which came from spending on secondary care. Despite significant declines in mortality in the UK, CVD remains a considerable burden, both in terms of health and costs. Both primary and secondary prevention measures are necessary to reduce both the burden of CVD and inequalities in CVD mortality and prevalence.

Monitoring hospital wastewaters for their probable genotoxicity and mutagenicity

Cancer is a leading cause of death worldwide. Excluding the genetic factors, environmental factors, mainly the pollutants, have been implicated in the causation of the majority of cancers. Wastewater originated from health-care sectors such as hospitals may carry vast amounts of carcinogenic and genotoxic chemicals to surface waters or any other source of drinking water, if discharged untreated. Humans get exposed to such contaminants through a variety of ways including drinking water. The aim of the present study was, thus, to monitor the genotoxic and mutagenic potential of wastewaters from three big hospitals located in Jaipur (Rajasthan), India. One of them was operating an effluent treatment plant (ETP) for treatment of its wastewater and therefore both the untreated and treated effluents from this hospital were studied for their genotoxicity. Two short-term bacterial bioassays namely the Salmonella fluctuation assay and the SOS chromotest were used for the purpose. Results of fluctuation assay revealed the highly genotoxic nature of all untreated effluent samples with mutagenicity ratios (MR) up to 23.13 ± 0.18 and 42.25 ± 0.35 as measured with Salmonella typhimurium strains TA98 and TA100, respectively. As determined with the chromotest, all untreated effluents produced significant induction factors (IF) ranging from 3.29 ± 1.11 to 13.35 ± 3.58 at higher concentrations. In contrast, treated effluent samples were found to be slightly genotoxic in fluctuation test only with an MR = 3.75 ± 0.35 for TA100 at 10 % concentration. Overall, the results indicated that proper treatment of hospital wastewaters may render the effluents safe for disposal contrary to the untreated ones, possessing high genotoxic potential.

Comparative oxidative stress, metallothionein induction and organ toxicity following chronic exposure to arsenic, lead and mercury in rats

Globally, arsenic, mercury and lead constitutes as the three most hazardous environmental toxicants perturbing imbalance in pro—oxidant and antioxidant homeostasis. Individual toxicity of these environmental toxicants is well known but there is lack of comparative data on variables indicative of oxidative stress. We thus investigated the effects of chronic exposure to sodium arsenite, mercuric chloride and lead acetate on blood and tissue oxidative stress, metal concentration and metallothionein (MT) contents. Male rats were exposed to sodium arsenite, mercuric chloride and lead acetate (0.05 mg/kg each, orally, once daily) for 6 months. Arsenic, mercury and lead exposure led to a significant inhibition of blood δ—aminolevulinic acid dehydratase (ALAD) activity and glutathione level supported by increased thiobarbituric acid reactive substance (TBARS). The level of inhibition was more pronounced in case of lead followed by mercury and arsenic. These metals/ metalloid significantly increased reactive oxygen species (ROS), thiobarbituric acid reactive substances (TBARS) and glutathione peroxidase (GPx) activity accompanied by a decreased superoxide dismutase (SOD), catalase and reduced and oxidized glutathione (GSH and GSSG) levels in blood and tissues. Mercury alone produced a significant induction of hepatic and renal MT concentrations. Serum transaminases, lactate dehydrogenase and alkaline phosphatase activities increased significantly on exposure to arsenic and mercury exposure suggesting liver injury which was less pronounced in case of lead exposure. These biochemical alterations were supported by increased arsenic, mercury and lead concentrations in blood and soft tissues. The present study suggests that exposure to sodium arsenite and mercuric chloride lead to more pronounced oxidative stress and hepatotoxicity while lead acetate caused significant alterations in haem synthesis pathway compared to two other thiol binding metal/metalloid.

Health care industries: potential generators of genotoxic waste

Health care waste includes all the waste generated by health care establishments, research facilities, and laboratories. This constitutes a variety of chemical substances, such as pharmaceuticals, radionuclides, solvents, and disinfectants. Recently, scientists and environmentalists have discovered that wastewater produced by hospitals possesses toxic properties due to various toxic chemicals and pharmaceuticals capable of causing environmental impacts and even lethal effects to organisms in aquatic ecosystems. Many of these compounds resist normal wastewater treatment and end up in surface waters. Besides aquatic organisms, humans can be exposed through drinking water produced from contaminated surface water. Indeed, some of the substances found in wastewaters are genotoxic and are suspected to be potential contributors to certain cancers. The aim of this study was to evaluate the genotoxic and cytotoxic potential of wastewaters from two hospitals and three clinical diagnostic centers located in Jaipur (Rajasthan State), India using the prokaryotic Salmonella mutagenicity assay (Ames assay) and the eukaryotic Saccharomyces cerevisiae respiration inhibition assay. In the Ames assay, untreated wastewaters from both of the health care sectors resulted in significantly increased numbers of revertant colonies up to 1,000-4,050 as measured by the Salmonella typhimurium TA98 and TA100 strains (with and without metabolic activation) after exposure to undiluted samples, which indicated the highly genotoxic nature of these wastewaters. Furthermore, both hospital and diagnostic samples were found to be highly cytotoxic. Effective concentrations at which 20 % (EC20) and 50 % (EC50) inhibition of the respiration rate of the cells occurred ranged between ~0.00 and 0.52 % and between 0.005 and 41.30 % (calculated with the help of the MS excel software XLSTAT 2012.1.01; Addinsoft), respectively, as determined by the S. cerevisiae assay. The results indicated that hospital wastewaters contain genotoxic and cytotoxic components. In addition, diagnostic centers also represent small but significant sources of genotoxic and cytotoxic wastes.

Evaluation of the sensitivity of scout radiographs on unenhanced helical CT in identifying ureteric calculi: a large UK tertiary referral centre experience

OBJECTIVE

Unenhanced helical CT for kidney, ureter and bladder (CT KUB) has become the standard investigation for renal colic. This study aims to determine the sensitivity of scout radiographs in detecting ureteric calculi using CT KUB as a standard reference.

METHODS

A retrospective review of consecutive patients who presented with acute flank pain and were investigated using CT KUB. 201 patients with positive ureteric calculi were included. Two radiologists independently reviewed the scout radiographs with access to CT KUB images. Each observer recorded the presence or absence of calculi, location, size and mean Hounsfield units of each calculus.

RESULTS

203 ureteric calculi were analysed from 201 patients. The overall sensitivity of scout radiographs for Observer A was 42.3% and for Observer B 52.2%, with an interobserver reliability κ-value of 0.78. The significance of mean Hounsfield units and size between two groups of patients with visible stones and those not visible were tested; the p-value for both variables was <0.0001, which is statistically significant. The study found that calculi in the upper ureter and larger than 4 mm are more likely to be seen on the scout radiograph.

CONCLUSIONS

Usage of CT scout radiography should be encouraged and reported routinely in conjunction with CT KUB as a baseline for treatment follow-up.

The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006-07 NHS costs

BACKGROUND

Estimates of the economic cost of risk factors for chronic disease to the NHS provide evidence for prioritization of resources for prevention and public health. Previous comparable estimates of the economic costs of poor diet, physical inactivity, smoking, alcohol and overweight/obesity were based on economic data from 1992-93.

METHODS

Diseases associated with poor diet, physical inactivity, smoking, alcohol and overweight/obesity were identified. Risk factor-specific population attributable fractions for these diseases were applied to disease-specific estimates of the economic cost to the NHS in the UK in 2006-07.

RESULTS

In 2006-07, poor diet-related ill health cost the NHS in the UK £5.8 billion. The cost of physical inactivity was £0.9 billion. Smoking cost was £3.3 billion, alcohol cost £3.3 billion, overweight and obesity cost £5.1 billion.

CONCLUSION

The estimates of the economic cost of risk factors for chronic disease presented here are based on recent financial data and are directly comparable. They suggest that poor diet is a behavioural risk factor that has the highest impact on the budget of the NHS, followed by alcohol consumption, smoking and physical inactivity.

Perinatal toxicity of cyfluthrin in mice: Developmental and behavioral effects

The present study was undertaken to evaluate the teratogenic and behavioral effects of perinatal exposure to cyfluthrin (Synthetic Pyrethroid) on mice offspring. Humans are exposed to this compound as it is widely used in various household insecticide formulations and in public health programmes. Pregnant females were exposed to 16 mg/kg (low dose) and 32 mg/kg (high dose) body weight cyfluthrin daily by oral intubation from gestation day 14 through parturition and lactation up to weaning. On 18th day of gestation, 50% females were euthanized for teratological studies and the remaining were allowed to deliver their pups normally. The fetuses were weighed and observed for gross external malformations and routine teratological examination was done. The neonates were observed for neuromotor reflexes (surface righting, tail hang reflex and pivoting) from day 1 up to day 7 after birth. Movement and exploratory behavior of weanlings were observed using ‘open-field’ and ‘hole-board.’ The fetuses did not show any external malformation. Skeletal aberrations observed included poor ossification of the skull and phalanges and short ribs. Surface righting and pivoting were significantly affected by the high dose. Both doses produced significant changes in the locomotion, exploration, and rearing frequencies in the open-field. The study indicates that cyfluthrin when administered at the above-mentioned doses did not elicit significant teratogenicity but both the doses caused significant difference in behavioral activities.

The incidence of all stroke and stroke subtype in the United Kingdom, 1985 to 2008: a systematic review

Background

There is considerable geographic variation in stroke mortality around the United Kingdom (UK). Whether this is due to geographical differences in incidence or case-fatality is unclear. We conducted a systematic review of high-quality studies documenting the incidence of any stroke and stroke subtypes, between 1985 and 2008 in the UK. We aimed to study geographic and temporal trends in relation to equivalent mortality trends.

Methods

MEDLINE and EMBASE were searched, reference lists inspected and authors of included papers were contacted. All rates were standardised to the European Standard Population for those over 45, and between 45 and 74 years. Stroke mortality rates for the included areas were then calculated to produce rate ratios of stroke mortality to incidence for each location.

Results

Five papers were included in this review. Geographic variation was narrow but incidence appeared to largely mirror mortality rates for all stroke. For men over 45, incidence (and confidence intervals) per 100,000 ranged from 124 (109-141) in South London, to 185 (164-208) in Scotland. For men, premature (45-74 years) stroke incidence per 100,000 ranged from 79 (67-94) in the North West, to 112 (95-132) in Scotland. Stroke subtype data was more geographically restricted, but did suggest there is no sizeable variation in incidence by subtype around the country. Only one paper, based in South London, had data on temporal trends. This showed that there has been a decline in stroke incidence since the mid 1990 s. This could not be compared to any other locations in this review.

Conclusions

Geographic variations in stroke incidence appear to mirror variations in mortality rates. This suggests policies to reduce inequalities in stroke mortality should be directed at risk factor profiles rather than treatment after a first incident event. More high quality stroke incidence data from around the UK are needed before this can be confirmed.

Chloroplast coupling factor 1: A species-specific receptor for tentoxin

Tentoxin, a cyclic tetrapeptide, induces chlorosis in certain plant species. It inactivated photophosphorylation and coupling factor 1 (CF(1)) ATPase in lettuce, a sensitive species. This effect was due to binding of tentoxin with CF(1) at a single site (affinity constant 1.3 to 20 x 10(7) M(-1)). Neither AMP nor adenyl-5'-yl imidodiphosphate appeared to bind to this site. In radish, an insensitive species, 20 times more tentoxin was required for 50% inhibition of photophosphorylation. In this species CF(1) ATPase was unaffected by tentoxin, and its CF(1) bound tentoxin only weakly (affinity constant less than 1 x 10(4) M(-1)). Sensitivity of photophosphorylation to tentoxin was correlated with chlorosis sensitivity in six other species examined.

Providing monovalent oral polio vaccine type 1 to newborns: findings from a pilot birth-dose project in Moradabad district, India

PROBLEM

Poliovirus transmission remained a public health challenge in western Uttar Pradesh, India in late 2005 and early 2006. In 2006, the India Expert Advisory Group for Polio Eradication concluded that, given the peak incidence of polio among children 6 to 12 months of age, a targeted birth dose of oral polio vaccine may be necessary to interrupt intense poliovirus transmission in high risk areas.

APPROACH

The Government of Uttar Pradesh, the National Polio Surveillance Project and the United Nations Children's Fund (UNICEF) implemented a pilot birth-dose project aimed at identifying and vaccinating all newborns with a dose of oral polio vaccine within 72 hours of birth in an effort to evaluate operational feasibility and potential impact on population immunity.

LOCAL SETTING

The project was piloted in Moradabad district: zone 7 in Moradabad City (urban setting), Kunderki block (rural setting) and in select birthing hospitals.

RELEVANT CHANGES

Between July 2006 and February 2007, 9740 newborns were identified, of which 6369 (65%) were vaccinated by project personnel within 72 hours of birth. Project coverage (for total newborns vaccinated) ranged from 39% (in zone 7) to 76% (in Kunderki block) of the estimated number of newborns vaccinated during previous supplemental immunization activities.

LESSONS LEARNED

Birth-dose coverage among newborns was lower than expected. Expansion costs were estimated to be high, with marginal impact. The project, however, provided opportunities to strengthen newborn tracking systems which have increased the number of newborns and young infants vaccinated during supplemental immunization activities and enrolled in routine programmes.

Genotoxicity evaluation of hospital wastewaters

In hospitals a large variety of substances are in use for medical purposes such as diagnostics and research. After application, diagnostic agents, disinfectants and excreted non-metabolized pharmaceuticals by patients reach the wastewater. Indeed, some of the substances found in wastewaters are genotoxic and are suspected to be a possible cause of the cancers observed in the last decades. Genotoxicity tests are an excellent means to study the toxicity and the risk associated with these releases. This paper points out the areas of concern for hospital wastewater disposal and reports the findings of genotoxicity tests for hospital effluents from 3 major hospitals in Delhi, namely All India Institute of Medical Sciences, Apollo and Escorts. Mutagenicity of hospital wastewaters from effluent treatment plants (before and after treatment) was studied. The results of this study show that the genotoxicity of hospital wastewaters is highly reduced after the treatment process. This study calls for establishment of advanced and effective effluent treatment plants in the hospitals, which are merely dumping the wastewaters in the municipal sewerage system. The results of this study call for further detailed study in this area.

Assessment of teratogenecity and embryotoxicity of sludge from textile industries at Pali (India) in Swiss albino mice exposed during organogenetic period

The present investigation was carried out to assess the teratological effects of in-utero exposure of sludge leachate from textile and dyeing industries located in Pali, Rajasthan. Sludge was collected at the combined effluent treatment plant (CETP). Two groups of 10 pregnant Swiss albino mice each, were given sludge leachate of 1/10 and 1/100 dilutions with water ad libitum from 6th day to 15th day of gestation covering the critical period of organogenesis. Cesarean sections were performed on day 18 of gestation and all foetuses were examined for reproductive and teratological tests. Sludge induced maternal toxicity was evidenced by significant increase in leachate consumption, reduction in body weight gain and reduction in fur of the body. Developmental toxicity was evidenced by a significant decrease in foetal weight per litter increase in the number of resorptions and an increase in total number of foetuses showing bone retardation and skeletal variations (specially of skull, sternebrae and vertebrae). The leachate of the sludge that is being dumped in the open areas of the town Pall seems to elicit teratogenic as well as embryotoxic potential as indicated by the findings of the present investigation.

Is the KUB radiograph redundant for investigating acute ureteric colic in the non-contrast enhanced computed tomography era?

AIM

To establish whether non-contrast enhanced computed tomography (NCCT) renders the kidneys-ureters-bladder (KUB) radiograph redundant as the initial imaging investigation for suspected acute ureteric colic.

MATERIALS AND METHODS

The imaging investigations for 120 patients consecutively admitted to an emergency department-led clinical decisions unit (CDU) with suspected acute ureteric colic were retrospectively reviewed. A multidisciplinary meeting reviewed the findings and recommended that KUB radiographs should not be routinely performed prior to NCCT. Prospective assessment of 116 consecutive patients admitted over a comparable period was then undertaken.

RESULTS

In the retrospective group, 61 (50.8%) patients had calculi to account for symptoms (positive NCCT) and 59 (49.2%) patients did not have stone disease (negative NCCT). Ninety (75%) patients had a KUB radiograph prior to NCCT. However, in 46 (38% of total) of these patients the NCCT was negative for stones, and therefore, they had been subjected to an unnecessary radiographic examination. These results prompted a change in practice. In the subsequent and prospectively studied group, preliminary KUB radiographs were performed in only 6% of the patients, with no significant change in the positive NCCT rate (50.8 versus 51.7%) or the total number of examinations performed (120 versus 116).

CONCLUSION

NCCT should be the initial imaging examination for acute ureteric colic. Up to 50% of patients with clinical suspicion do not have stone disease, and therefore, preliminary KUB radiographs with attendant radiation and cost implications are unjustified. Preliminary KUB radiographs can be omitted from the imaging pathway with no resultant indication creep or increase in demand for NCCT examinations.

Evidence-based practice in the utilization of knee radiographs--a survey of all members of the British Orthopaedic Association

There has been a debate amongst orthopaedic surgeons about which plain radiographs are required in common knee conditions and this is a 5-year review assessing the influence of recent publications on the use of radiographs. A postal survey of all members of the British Orthopaedic Association was performed. The response rate was 60% (990/1,650). There was a broad agreement on the use of anteroposterior and lateral radiographs. The use of the posteroanterior (PA) weight-bearing radiograph has increased from 82 to 86%. The use of skyline view for suspected arthritis and after knee replacement has increased from 23 to 41%. There is still disparity amongst orthopaedic surgeons regarding the knee flexion angle for skyline and weight-bearing views. After review of the literature we recommend that a single skyline view in 30 degrees flexion is adequate and should be a standard investigation in knee disorders. We also stress the importance of weight-bearing PA radiograph in 30 degrees knee flexion for adequate assessment in all patients with suspected arthritis.

Variation of a variation: case report of attenuated familial adenomatous polyposis

BACKGROUND

First described in 1988, attenuated familial adenomatous polyposis (AFAP) is a rare autosomal dominant precancerous condition of the gastrointestinal tract. Few reports have described adenocarcinomatous change in the gastroduodenal region thus far.

CASE OUTLINE

We report a case of AFAP presenting with extensive gastric polyposis and ampullary adenocarcinoma in absence of a positive family history of gastrointestinal cancer and a novel mutation.

Assessment of organochlorine pesticide residue levels in dairy milk and buffalo milk from Jaipur City, Rajasthan, India

The widespread application of pesticides in agriculture, public health, and industry and in and around the home can result in the accumulation of pesticides in the environment. Therefore, a survey has been conducted during 1993-1996 to investigate the magnitude of contamination of bovine milk with organochlorine pesticide (OCP) residues from Jaipur City, Rajasthan, India. Milk samples, i.e., dairy (toned and whole) and buffalo milk, were collected seasonally, and pesticide residues were assessed using a gas chromatograph (GC) with an electron capture detector (ECD). The results indicate that all the milk samples were contaminated with dichlorodiphenyltrichloroethane (DDT) and its metabolites (DDE and p,p'-dichlorodiphenyldichloroethane [DDD]), isomers of hexachlorocyclohexane (HCH; alpha, beta, and gamma), heptachlor and its epoxide, and aldrin. Seasonal variations of these pesticide residue levels were also observed in all the milk samples. Samples collected during winter season were found to contain higher residue levels as compared to other seasons.

Transgenic manipulation of the metabolism of polyamines in poplar cells

The metabolism of polyamines (putrescine, spermidine, and spermine) has become the target of genetic manipulation because of their significance in plant development and possibly stress tolerance. We studied the polyamine metabolism in non-transgenic (NT) and transgenic cells of poplar (Populus nigra x maximowiczii) expressing a mouse Orn decarboxylase (odc) cDNA. The transgenic cells showed elevated levels of mouse ODC enzyme activity, severalfold higher amounts of putrescine, a small increase in spermidine, and a small reduction in spermine as compared with NT cells. The conversion of labeled ornithine (Orn) into putrescine was significantly higher in the transgenic than the NT cells. Whereas exogenously supplied Orn caused an increase in cellular putrescine in both cell lines, arginine at high concentrations was inhibitory to putrescine accumulation. The addition of urea and glutamine had no effect on polyamines in either of the cell lines. Inhibition of glutamine synthetase by methionine sulfoximine led to a substantial reduction in putrescine and spermidine in both cell lines. The results show that: (a) Transgenic expression of a heterologous odc gene can be used to modulate putrescine metabolism in plant cells, (b) accumulation of putrescine in high amounts does not affect the native arginine decarboxylase activity, (c) Orn biosynthesis occurs primarily from glutamine/glutamate and not from catabolic breakdown of arginine, (d) Orn biosynthesis may become a limiting factor for putrescine production in the odc transgenic cells, and (e) assimilation of nitrogen into glutamine keeps pace with an increased demand for its use for putrescine production.

Inhibition of enriched stem cells in vivo and in vitro by the hemoregulatory peptide SK&F108636

Replacement of the labile sulfhydryl group (-SH) of the hemoregulatory peptide monomer pyroGluGluAspCysLys (HP5b) with an isosteric methylene group yields a chemically stable compound, SK&F108636. In this study, we describe the effects of SK&F108636 on highly enriched Lin-Sca1+ hematopoietic stem cells. SK&F108636 significantly reduced the fraction of cycling progenitor cells, granulocyte macrophage colony-forming cells (GM-CFC), in vitro and in vivo. There was no effect on GM-CFC or Mix-CFC colony formation. SK&F108636 significantly inhibited proliferation of high proliferative potential (HPP)-CFC in semisolid agar cultures stimulated by stem cell factor + interleukin 3 (IL-3) + IL-1, but had no effect in cultures stimulated with M-CSF + IL-3 + IL-1. SK&F108636 was shown to act directly on the stem cells since SK&F108636 inhibited proliferation of Lin-Sca1+ cells in single cell assays. Administration of SK&F108636 to lethally irradiated mice transplanted with 2000 Lin-Sca1+ cells significantly inhibited proliferation/differentiation of cells developing into colony forming units-spleen (CFU-S) (preCFU-S) and the reconstitution of HPP-CFC and GM-CFC. There was no effect of SK&F108636 on CFU-S colony formation or mature cell regeneration in bone marrow, spleen and blood. Hence, the hemoregulatory peptide monomer SK&F108636 is a potent primitive stem cell inhibitor in vivo and in vitro. Inhibition of stem cell proliferation by small specific inhibitors may protect hematopoiesis from myelotoxic side effects during chemotherapy treatment.

Zinc is a possible toxic contaminant of silicone oil in microdrop cultures of preimplantation mouse embryos

A batch of silicone oil (dimethylpolysiloxane) is described which had differential effects on the development of 1- and 2-cell preimplantation mouse embryos in vitro when used as a microdrop overlay over two culture media: CZB and KSOM. A high rate of development into blastocysts was observed when using CZB medium; in contrast, development was strongly inhibited when KSOM was used. Other batches of silicone oil or paraffin oil permitted development from the zygote to the blastocyst of an outbred strain of mouse without arrest at the 2-cell stage. Our results show that the higher concentrations of ethylenediaminetetraacetic acid (EDTA) and bovine serum albumin (BSA) in CZB medium, in comparison with KSOM, protect against the toxic component in the oil. Observations also gave circumstantial evidence that the toxic component in the oil is zinc. The beneficial effect of including EDTA in a medium is usually attributed to its chelating toxic metals introduced as impurities in other components of the medium. Our results now show that EDTA also protects against impurities in the oil overlay.

Interobserver agreement in the diagnosis of cervical smears

The present study was carried out to reveal the magnitude of individual variation in the diagnosis of Pap smears between two cytoscreeners and their compatability with cytopathologists and subsequent final diagnostic comparison with biopsy in 1,17411 cervical smears collected from different hospitals of Delhi during ten-year period. Smears diagnosed as dysplasia at initial level by any one of the cytoscreeners were screened by cytopathologists for confirmation of diagnosis. An overall agreement of 94.9 percent was observed between two screens. 79.5 percent was agreement between screeners and cytopathologists. An agreement between cytology and histology in the diagnosis of dysplasia and malignancy were found to be 61.9 percent and dysplasia and malignancy were found to be 61.9 percent and 40.1 percent respectively. From the above study, it was observed that consistency among the two screeners was fairly acceptable. Keeping this observation in view, we can possibly practice two tier screening in place of three.