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Background A person's health might influence their ability to attend and concentrate at school, obtain, maintain, and be productive in employment, and maintain wellbeing and an active social life. We aimed to better understand the causal effects of health on social and socioeconomic outcomes, to help establish the broader benefits of investing in effective health policy, thereby strengthening the case for cross-governmental action to improve health and its wider determinants at the population level. Methods We used a mendelian randomisation approach to analyse data from the UK Biobank to estimate the effect of eight health conditions (asthma, breast cancer, coronary heart disease, depression, diabetes, eczema, migraine, osteoarthritis) and five risk factors (alcohol intake, body-mass index [BMI], cholesterol, systolic blood pressure, smoking) with known genetic determinants on 19 socioeconomic outcomes in men and women of white British ancestry, aged between 39 and 72 years. The main outcome measures were annual household income, deprivation (measured using the Townsend deprivation index [TDI]), degree-level education, satisfaction with health, and self-reported happiness and loneliness. UK Biobank received ethical approval from the Research Ethics Committee (11/NW/0382). Findings Our cohort consisted of 337 009 men and women. Of the five risk factors, our results showed that higher BMI, smoking, and alcohol use affected socioeconomic outcomes. Smoking was estimated to reduce household income (mean difference –£24 394 [95% CI –£33 403 to –£15 384]), the chance of owning accommodation (absolute percentage change [APC] –21·5% [95% CI –29·3 to –13·6), being satisfied with health (APC –32·4% [–48·9 to –15·8), and of receiving a university degree (APC –73·8% [–90·7 to –56·9), and increased deprivation (mean difference in TDI 1·89 [1·13 to 2·64]). Of the eight health conditions, asthma decreased household income (mean difference –£13 519 [–£18 794 to –£8 243]), the chance of having a university degree (APC –17·0% [–25·3 to –8·7), and the chance of cohabiting (APC –11·0% [–18·0 to –4·0]), and migraine reduced the chance of having a weekly leisure or social activity (APC –43·7% [–66·0 to –21·3]), especially in men. No other associations were found. Interpretation Higher BMI, smoking, and alcohol use were all estimated to negatively affect multiple social and socioeconomic outcomes. Associations were not detected between health conditions and socioeconomic outcomes with the exceptions of depression, asthma, and migraine. Our findings might reflect true null associations, or be a result of selection bias (given the relative good health and older age of participants in UK Biobank compared with the eligible UK population), or a lack of power to detect effects. Funding The Health Foundation.

SummaryBackgroundVenous thromboembolism is a common, potentially avoidable cause of death and morbidity in patients in hospital, including those with stroke. In surgical patients, intermittent pneumatic compression (IPC) reduces the risk of deep vein thrombosis (DVT), but no reliable evidence exists about its effectiveness in patients who have had a stroke. We assessed the effectiveness of IPC to reduce the risk of DVT in patients who have had a stroke.MethodsThe CLOTS 3 trial is a multicentre parallel group randomised trial assessing IPC in immobile patients (ie, who cannot walk to the toilet without the help of another person) with acute stroke. We enrolled patients from day 0 to day 3 of admission and allocated them via a central randomisation system (ratio 1:1) to receive either IPC or no IPC. A technician who was masked to treatment allocation did a compression duplex ultrasound (CDU) of both legs at 7–10 days and, wherever practical, at 25–30 days after enrolment. Caregivers and patients were not masked to treatment assignment. Patients were followed up for 6 months to determine survival and later symptomatic venous thromboembolism. The primary outcome was a DVT in the proximal veins detected on a screening CDU or any symptomatic DVT in the proximal veins, confirmed on imaging, within 30 days of randomisation. Patients were analysed according to their treatment allocation. Trial registration: ISRCTN93529999.FindingsBetween Dec 8, 2008, and Sept 6, 2012, 2876 patients were enrolled in 94 centres in the UK. The included patients were broadly representative of immobile stroke patients admitted to hospital and had a median age of 76 years (IQR 67–84). The primary outcome occurred in 122 (8·5%) of 1438 patients allocated IPC and 174 (12·1%) of 1438 patients allocated no IPC; an absolute reduction in risk of 3·6% (95% CI 1·4–5·8). Excluding the 323 patients who died before any primary outcome and 41 without any screening CDU, the adjusted OR for the comparison of 122 of 1267 patients vs 174 of 1245 patients was 0·65 (95% CI 0·51–0·84; p=0·001). Deaths in the treatment period occurred in 156 (11%) patients allocated IPC and 189 (13%) patients allocated no IPC died within the 30 days of treatment period (p=0·057); skin breaks on the legs were reported in 44 (3%) patients allocated IPC and in 20 (1%) patients allocated no IPC (p=0·002); falls with injury were reported in 33 (2%) patients in the IPC group and in 24 (2%) patients in the no-IPC group (p=0·221).InterpretationIPC is an effective method of reducing the risk of DVT and possibly improving survival in a wide variety of patients who are immobile after stroke.FundingNational Institute of Health Research (NIHR) Health Technology Assessment (HTA) programme, UK; Chief Scientist Office of Scottish Government; Covidien (MA, USA).

Background Evaluation of community empowerment initiatives for their effects on health inequalities presents a paradox to researchers. By definition, such initiatives aim to empower people to influence decisions that affect their lives. However, once empowered, people might not necessarily take the decisions that the originators of the intervention desired. The inability to control the implementation of an intervention goes against all the basic principles of intervention trials. We studied a community empowerment initiative, using a systems approach, to see whether any ensuing diversity of implementation could be used as an advantage rather than be a problem for an evaluation design. Methods We conducted qualitative in-depth case studies in ten intervention neighbourhoods in England, including a total of 150 resident interviews and ethnographic observation, interviews with the national organisations involved, and a review of plans from 30 intervention sites. Data were coded in NVivo (version 10) in a pre-defined thematic framework. Narrative memos were developed and compared and contrasted across sites. Findings The initiative's overarching objective was to increase confidence and skills to enable residents to identify priorities and take action in their neighbourhoods. Our fieldwork found that the core objective was pursued in different ways: building connections across people living or working in the neighbourhood, promoting social participation, improving or so-called lifting an area's external reputation, achieving material improvements (eg, parks), and addressing debt or unemployment. Diversity in starting points of local area systems also contributed to divergence in the aspirations that residents identified, the actions being taken to achieve them, and the change in processes that ensued. Interpretation Understanding interventions as events in systems offers an approach that shifts the focus of assessment from what works to what happens when an intervention interacts with multiple local systems. This approach reveals how and why the intervention adapts over time as communities develop new capacities and learn from early implementation. The resulting diversity created across different sites can be exploited for evaluation purposes—for example, by creating internal comparators. This diversity offers potential for understanding how such interventions unfold over time and the differential health and social effects that might ensue. Funding This paper presents independent research funded by the National Institute for Health Research (NIHR) School for Public Health Research.

When a patient resuscitated from cardiac arrest remains unconscious the clinician would like to have a reliable early method for predicting the outcome. The objective of our study was to predict cerebral outcome after cardiac arrest by clinical neurological examination. The data were drawn from an international multicentre controlled clinical trial of thiopentone. Twelve hospitals in nine countries took part. 262 comatose cardiac arrest survivors were followed up for one year. These patients were given advanced life support (American Heart Association guidelines) followed by intensive care to a standardised protocol. Glasgow and Glasgow-Pittsburgh coma scores and their constituent signs were recorded at fixed times. Outcome was taken to be the best cerebral performance at any time during follow-up, and for that purpose we used cerebral performance categories (CPC 1-5) of the Glasgow outcome categories. A poor outcome (CPC 3-5) could be predicted immediately after reperfusion (at entry into the study) with an accuracy ranging from 52% to 84% for various signs and scores. On the third day it was possible to identify severely disabled or permanently comatose survivors without false predictions using both coma scores and several of their constituent variables. The best predictor was absence of motor response to pain. This modelling exercise now needs to be repeated on a new series of patients but the results do suggest that, after 3 days, stringent ethical criteria can be met and used in decision-making about termination of care in comatose cardiac arrest survivors.

The urgent need to contain the Ebola epidemic has led to clinical treatment trials being fast-tracked, including a trial of blood or plasma from Ebola survivors. However, the taking of blood samples is associated with fear and reticence throughout sub-Saharan Africa, including rumours of blood stealing. In the context of the convalescent blood trial (Ebola_Tx trial, to begin Jan 15–21, 2015), blood has an ambiguous meaning; although the blood of people who are ill should be avoided, the transfer of blood from Ebola survivors is a potential treatment. Anecdotal reports from the field that the blood from Ebola survivors is being traded informally, suggest it is already a valuable commodity. Meanwhile, rumours are circulating in some Guinean communities that patients with Ebola in treatment centres are being given infected blood to hasten death. Such perceptions should not be dismissed as superstitions or ignorance because they function as a means to understand the cause of misfortune and manifest as magico-religious beliefs, such as sorcery, the infl uence of ancestors, or the will of God. Furthermore, these perceptions refl ect a historically forged mistrust towards specifi c institutions, reinforced by social inequality, confl ict, and a conviction that some people are rich and infl uential at the cost of the poor. For example, the epicentre of the Ebola epidemic was also the location of epidemics of sleeping sickness that were fought in colonial times with measures including forced internment in treatment camps. The legacy of these campaigns should be recognised when regarding present suspicions about the Ebola response. Additionally, ongoing stigmatisation of Ebola survivors, who are expected to donate blood for the treatment of people with this disease, might be affected by the outcome of a trial. Positive results might foster the re-integration of survivors into their communities or, conversely, if convalescent blood treatment is shown to be ineffective, donors might be suspected of transmitting the disease. The post-trial follow-up of participants is therefore an ethical responsibility. Ebola trials must take into acocunt local perceptions of blood and other contextual factors. Unfortunately, despite anthropological insights, there has been insufficient opportunity for interdisciplinary research to investigate the eff ect of beliefs about blood on clinical trials. As a result, little evidence exists on which to base recommendations for Ebola trials. This approach is essential in the fi ght against Ebola and has broad applicability for other diseases.

Background The prevalence of overweight and obesity has increased rapidly in recent years. Consumption of an unhealthy diet is a key contributor to development of overweight and obesity. Several systematic reviews have concluded that food advertising has an effect on children's food preferences, purchasing requests, and consumption. There is also growing evidence that food marketing affects adults' food consumption. Because most food advertising focuses on less healthy products, advertising is likely to play an important part in the development and maintenance of overweight and obesity. In 2007, new scheduling restrictions on television food advertising to children were announced in the UK. The aim of the restrictions was to "reduce significantly the exposure of children under 16 to high fat, salt or sugar (HFSS) advertising". The UK was the first territory worldwide to introduce statutory scheduling restrictions of food advertisements to children. As such, the effects of such restrictions were unknown. Our aim was to assess the effect of the scheduling restrictions on relative exposure to HFSS food advertising among all viewers and among child television viewers, as well as adherence to the restrictions. Methods We undertook two cross-sectional studies of all advertisements broadcast in one region of the UK during 1-week periods—the first (week 1) 6 months before the restrictions were introduced, and the second (week 2) 6 months after. Data for what products were advertised were linked to data for how many people overall, and how many children aged 4–15 years, watched each advertisement. Both sets of data were provided by an audience research bureau and derived from national viewing figures. Nutritional content of foods advertised was added to the dataset and used to calculate HFSS status using the UK Food Standards Agency's nutrient profiling model. Relative exposure was calculated as the proportion of all advertising person-minute-views (PMV) that were for HFSS foods. Findings 1 672 417 advertising PMV were included in the analysis. 14·6% of advertising PMV were for food and 51·1% of these were for HFSS food. Relative exposure of all viewers to HFSS food advertising increased between study weeks 1 and 2 (odds ratio [OR] 1·54, 99% CI 1·51–1·57). Exposure of children to HFSS food advertising did not change between study weeks 1 and 2 (OR 1·05, 0·99–1·12). There was almost universal adherence to the restrictions. Interpretation Despite good adherence to the new scheduling restrictions, their introduction was not associated with a change in relative exposure of children to HFSS advertising. Their introduction was associated with an increase in relative exposure of all viewers to HFSS advertising. Stronger restrictions targeting a wider range of advertisements are necessary to reduce exposure of children to advertising of less healthy foods. Limitations include the repeat cross-sectional approach, which cannot establish causation; the short, 1-week, study periods, which might not be representative of all advertising; and the reliance on national viewing figures, which are calculated from fairly small, although demographically representative, panels. Funding National Prevention Research Initiative, with the support of the British Heart Foundation (BHF), Cancer Research UK; Department of Health, Diabetes UK, Economic and Social Research Council, Food Standards Agency, Medical Research Council (MRC), Health and Social Care Research and Development Office for Northern Ireland, Chief Scientist Office, Scottish Government Health Directorate, The Stroke Association, Welsh Assembly Government, and World Cancer Research Fund. The award was administered by the MRC (G0701873). JA, AJA, and MW receive salary support from Fuse–the Centre for Translational Research in Public Health, which is funded by the BHF, Cancer Research UK, Economic and Social Research Council, MRC, and the National Institute for Health Research (NIHR), under the auspices of the UK Clinical Research Collaboration. At the time of funding, AJA received salary support from an NIHR Public Health Career Scientist fellowship.

In a case-control study 27 (84%) of 32 patients with new daily persistent headaches (NDPH) and 8 (25%) of 32 controls had evidence of Epstein-Barr virus (EBV) "active" infection, as demonstrated by EBV excretion and/or early antigen titre above 1:32. 20 (62%) patients and 4 (12%) controls were excreting EBV in the oropharynx, as determined by a dot hybridisation assay. The mean titre of IgG antibodies to early antigen was significantly higher in patients than controls. EBV reactivation may be important in the pathogenesis of NDPH. Alternatively, patients with NDPH may be unusually prone to EBV reactivation.

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In-vitro studies showed several strains of influenza and rhinoviruses to be as sensitive to the antiviral action of human interferon as a known interferon-sensitive virus, provided that a yield-reduction assay was used. In volunteers, a single day of prophylaxis with intranasal interferon only slightly delayed the onset of an influenza-B infection, and did not prevent the illness or reduce its severity. However, by using a greater daily dosage of interferon and combining a day of prophylaxis with 3 days of treatment, a statistically significant prevention of clinical symptoms and virus-shedding was achieved after challenge of volunteers with rhinovirus 4.

A rabies vaccine, prepared in human diploid-cell culture, was given intradermally (i.d.) or intramuscularly (i.m.) to 35 volunteers who had not previously received prophylactic immunisation. Rabies neutralising antibody titres rose sharply after the first dose, and 4 weeks after the second dose all titres were above 1/80 (1·7 I.U. per ml.). Immunisation via the i.d. and i.m. routes was equally successful in terms of likely immune status, but the i.d. rate was associated with many more local side-effects.

The acceptability, reactivity, and antibody responses of recombinant WRL 105 strain, live, attenuated influenza virus vaccine administered intranasally were studied in seventeen normal adults, and in seventeen bronchitic and twenty-one geriatric volunteers. The effect on peak flow and 1-second forced expiratory volume (F.E.V.1) on the 3rd, 5th, and 7th days after vaccination was measured in the bronchitic and normal groups. Seroconversion occurred in 80% to tht homologous virus, in 40.6% to A/Victoria/3/75, and in 26.5% to A/England/864/75 in subjects with pre-vaccination haemagglutination inhibition titres of less than 1/40. A fourfold or greater increase in homologous anti-neuraminidase antibody was found in 48% of twenty-seven infected subjects when measured by a new elution inhibition technique. The frequency and nature of symptoms were similar in both infected and non-infected groups. No significant changes in F.E.V.1 occurred, but on days 5 and 7 there was a decrease in peak flow measurements in both infected and non-infected groups when assessed as the percentage change of the pre-vaccination value.

In human and in cow's milk an antiviral activity has been detected which does not seem to be related to antibodies or other known virus inhibitors. The antiviral activity lay in a relatively heat-stable macromolecule belonging to the non-fatty part of milk.

Four children, out of thirty presenting with recurrent respiratory infections, had deficient production of leucocyte interferon (interferon-α) from their lymphocytes stimulated with virus in vitro and from their nasopharyngeal secretions in response to rhinovirus infection in vivo. This defect was associated with recurrent upper and lower respiratory tract infections with wheeze.

Summary Serum-levels of rifampicin were investigated in patients receiving rifampicin alone or with other antituberculosis drugs. 2 g of probenecid given 30 min before 300 mg of rifampicin did not result in raising serum levels to more than half those achieved with the standard 600 mg dose of rifampicin. Hence probenecid should not be used to reduce rifampicin dosage in antituberculosis therapy.

The clinical and antibody responses of volunteers to three intradermal schedules of human diploid cell strain rabies vaccine (0.4 ml on day 0; 0-1 ml on days 0, 1, 2, 3; and 0-1 ml on days 0, 3, 7, and 14) are described. Vaccine was administered to 114 contacts of two rabid patients in order to evoke a rapid antibody response and the antibody titres of 30 of those who were vaccinated and bled were measured. High antibody titres were obtained in all subjects irrespective of their immunisation schedule; there were only minimal local reactions. All volunteers had titres greater than 1/78 (1.7 I.U./ml) by day 14, and 7 of 10 receiving 0.1 ml into each limb on day 0 had detectable antibody by day 7.

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98 volunteers were vaccinated with formalin-inactivated influenza-B virus intramuscularly or with living influenza-B virus intranasally. They, and a group of control volunteers, were subsequently challenged with live virus administered intranasally. 71% of those given killed vaccine developed an antibody response but 15% were infected on challenge. 51% of those who had received live virus had an antibody response and 2% were infected on challenge. Vaccination also reduced the frequency of clinical reactions. The living vaccine used in this trial produced too many reactions to be used on a large scale.

The integrated system of drug purchase and distribution described here starts in the hospital ward where stocks are replenished, not by orders written out by the ward sister, but by sending to the pharmacy a standard requisition card on which the ward's usual requirements are pretyped. Each requisition card is coded by colour and number and the work can be so distributed in the pharmacy that time is saved. With it is filed a drug-information card to help nursing staff and junior doctors. The pharmacy stores coloured coded record cards for each item, giving information on costs and hospital prescribing habits. The system should encourage more rational, more economical, and safer prescribing: it relieves nursing and pharmacy staff from unnecessary clerical work and simplifies the work of the hospital finance department.