Search

Data confirming the existence of social inequalities in health have continued to accumulate since the Black Report reported class inequalities across a broad range of causes of mortality, with an increasing emphasis on indicators of morbidity and current health status. Although evidence of continuing inequalities mounts, elucidation of underlying mechanisms generating and maintaining such inequalities has been more elusive, and much of the debate has oscillated from the very broad to the very specific. In this paper, the class patterning of a range of non-fatal indicators of health are modelled in an attempt to outline first the adequacy of models of linear relationships for this range of measures, and secondly, the extent to which these are generalizable across a series of age/sex subgroups and across different domains of health. Data are presented here for representative community samples of men and women in adolescence, early- and late-midlife. While orderly relationships between social class and health were seen for the majority of the measures considered; the detailed patterns show considerable diversity. Thus for some aspects of health, notably height (itself often heralded as a broad indicator of health and early life experience), common class gradients were observed for both sexes at each of the stages of the life course examined. For others (notably mental health and presence of chronic illness), gradients were evident in later life but not in adolescence. Others still showed sex but not age differences in class patterning (typically measures of body shape), or no clear patterns (notably blood pressure and consultations with general practitioners). The current analysis draws attention to the consistency of gradients in early- and late-midlife, which are apparent despite the marked increase in the burden of poorer health which manifests between these life stages for almost all indicators of health (an exception being mental health). The challenges which this presents for understanding the mechanisms and processes which have been candidate explanations for social inequalities in health are discussed.

A recent official report on the Scottish Diet reviews evidence for poor health and poor diets among the Scots, and makes extensive and specific recommendations about dietary change. This paper examines the extent to which reported consumption of fifteen of the food groups discussed in that report vary among four neighbourhoods in Glasgow City. Some foods appear to be typical of a wider Glaswegian (or Scottish) diet and show little variation among neighbourhoods (e.g. semi-skimmed milk, white fish, confectionery, cakes and pastries, savoury snacks). Other foods however show marked differences between neighbourhoods after controlling for sex, age and social class; these include fruit, vegetables, meat (particularly processed meat products), bread, spreading fats, sugar, natural fruit juice and alcohol. This suggests that such intraurban variations in food consumption cannot be explained simply by socio-demographic or socio-economic factors in individuals and that cultural and supply factors also need to be taken into account.

Although it is well known that their sex and socio-economic position profoundly influence people's mental and physical health, their use of health care, and their likely length of life, much research uses sex and social class as control variables rather than enquiring into the reasons for their association with health. Recent work on socio-economic differentials in health shows that these exist in all societies and are apparent throughout the social scale, suggesting that there is not simply a threshold of absolute deprivation below which people are sicker, but a linear relationship between socioeconomic circumstances and health even among the better-off. Other recent work indicates that cultural, social and economic conditions in the past may help to explain current variations in health. The observation that there are variations over the life course in the social patterning of health raises a number of interesting questions about the mechanisms involved; all the likely explanations have a social component. There is currently an exciting agenda for studying questions about interactions between material, psychosocial and biological factors in the production of health. Answers to such questions are important for decisions about how, when, and on whom public health medicine should intervene to promote the public health and to reach the targets set in the recent White Papers.

Dietary data from 15-year-old adolescents participating in the West of Scotland Twenty-07 study were examined in order to describe current eating patterns and food habits. Comparison of the data with a 'healthy eating' index showed that less than one-third of the sample were eating a diet similar to that promoted by local health education campaigns. Multivariate analysis showed that adolescents from non-manual and wealthier families, non-smokers, and females were more likely to be classified as 'healthy eaters'. Comparison of the data with that collected from a 35-year-old cohort in the same study showed that significantly fewer 15-year-olds were likely to consume diets associated with long-term health.

This paper describes heterosexual behaviour, and protection against pregnancy and sexually transmitted diseases, among 908 18-year-olds in the Glasgow area in 1990. The proportion who reported having experienced sexual intercourse was similar to, though slightly lower than, that reported in most recent studies elsewhere. There were marked sex differences, with males reporting being significantly younger at first intercourse and having had more sexual partners than females. The reported prevalence of unprotected sex (without any contraception) and of "unsafe" sex (without a condom) was high. Being male, of no religious affiliation, an early school leaver, and not in higher education were independently associated with sexual experience. Among the sexually experienced, lower education was also associated with "unsafe" sex, and Catholicism with unprotected sex. The overall pattern of findings, particularly in relation to sex differences, suggests that young people in the Glasgow area may be subject to more traditional influences than those elsewhere.

The recent White Paper, 'Scotland's Health: A Challenge To Us All', emphasises the importance of lifestyle factors, such as smoking, diet and exercise, in Scotland's poor health record. Targets are to be set for improvements in diet, and individuals will be encouraged to improve their eating habits. In this paper we suggest that attention should be given to the price and availability of healthy foods, particularly in socio-economically deprived areas. To illustrate the possible importance of this, we present findings from a small exploratory study of two socially contrasting and non-contiguous localities in Glasgow which indicates that price disincentives to eating healthy may be greater in poorer than in more affluent areas.

Concern is frequently expressed that young people are increasingly taking a 'grazing' approach to eating, rather than eating 'proper meals', and that this may have undesirable nutritional and social consequences. As part of a wide ranging study of health and well-being, 1,009 fifteen year olds in the Central Clydeside Conurbation were questioned in 1987 about their eating patterns. They reported an average of 5.5 eating occasions per day (2.7 main meals and 2.8 snacks), these eating occasions being concentrated towards the end of the day. Over 40% reported eating crisps, confectionery or biscuits at least once a day, a much higher proportion than among a cohort of 35 year olds in the same study. We discuss the implications for nutrition education and suggest that the picture is not as bad as is sometimes painted.

Parents' proxy reports of longstanding illness in their 15 year children are compared with the young people's own reports, both overall and between different reporting contexts; mother alone, father alone and both parents together. Parents over-report longstanding, but not limiting longstanding, illness in comparison to self report. There is no evidence of differential over-reporting by reporting context, but a number of differences are found in the likelihood of disagreement between these reporting contexts. The gender of the young person influences the relationship between proxy and self reports.

Objective: To ascertain what young people in western Scotland understand by the phrase 'safer sex', and the social correlates of this knowledge., Design: Face-to-face interviews with 18-year-olds participating in the third stage of a longitudinal study of the social patterning of health and illness., Setting: The Central Clydeside Conurbation in western Scotland., Participants: Eight hundred and seventy-nine 18-year-olds (416 men and 463 women)., Main Outcome Measures: Reported understanding of the term 'safer sex'., Results: Eighty-four per cent mentioned condoms, 68% some aspect of choice of partner, and only 2% abstaining from specific sexual activities. Those in more advantaged socio-economic circumstances and with higher levels of education were more likely to have 'better' knowledge (defined as mentioning condom use plus one or more other risk-reduction strategy)., Conclusions: Although knowledge of the routes of transmission of HIV may be reasonably good among the young, knowledge of what professionals mean by 'safer sex' appears less so, particularly among the more deprived sections of the community.

Higher rates of reported morbidity among women are sometimes attributed to lower thresholds among women for experiencing and reporting symptoms. Gender differences in the perception of signs and symptoms of minor illness were examined on data from the MRC Common Cold Unit. Volunteers assessed the presence and severity of colds at the end of their stay in the Unit, using the same two measures as a trained clinical observer (all ratings were double blind). Even after adjustment for other variables, men were significantly more likely to 'over-rate' their symptoms in comparison with the clinical observer than were women. These data, and recent analyses from elsewhere, suggest that rather than artefactually exaggerating gender differences in morbidity, differing thresholds for perceiving and reporting symptoms may produce underestimates of gender differences in morbidity.

In the last couple of decades there has been a considerable amount of research, mainly in the U.S.A., on the effects of family position on health. This paper reviews material on (a) the impact of family of origin on health and (b) adult family position and health. Parental divorce is shown to be related to a range of adverse outcomes in childhood, adolescence and adulthood. Marriage and parenthood are associated with longevity and good mental and physical health. This paper argues for more research in other cultural settings, for panel studies, for more direct measures of the roles and processes often inferred from structural variables, and for the use of measures of physical development and functioning.

The springtime stratospheric ozone (O3) layer over the Antarctic is thinning by as much as 50 percent, resulting in increased midultraviolet (UVB) radiation reaching the surface of the Southern Ocean. There is concern that phytoplankton communities confined to near-surface waters of the marginal ice zone will be harmed by increased UVB irradiance penetrating the ocean surface, thereby altering the dynamics of Antarctic marine ecosystems. Results from a 6-week cruise (Icecolors) in the marginal ice zone of the Bellingshausen Sea in austral spring of 1990 indicated that as the O3 layer thinned: (i) sea surface- and depth-dependent ratios of UVB irradiance (280 to 320 nanometers) to total irradiance (280 to 700 nanometers) increased and (ii) UVB inhibition of photosynthesis increased. These and other Icecolors findings suggest that O3-dependent shifts of in-water spectral irradiances alter the balance of spectrally dependent phytoplankton processes, including photoinhibition, photoreactivation, photoprotection, and photosynthesis. A minimum 6 to 12 percent reduction in primary production associated with O3 depletion was estimated for the duration of the cruise.

This paper examines the association between the smoking and drinking behaviours of parents and their adolescent children, and the effect of gender and social class upon this association. It is based on data collected from a cohort of young people and their parents, resident in the west of Scotland. Both social class and parental smoking behaviour were independently associated with young people's smoking, with young people from lower social class households or whose parents smoked being most likely to smoke. Social class and gender were independently associated with young people's drinking, with males and young people from non-manual households being most likely to drink. Parental drinking behaviour was associated positively with young people's drinking only in non-manual classes and among daughters. We conclude that it is important to take social class and gender into account since it may influence whether or not there is an association between the behaviour of young people and that of their parents, and it may influence young people's behaviour in addition to influences from parental behaviour.

The SecB protein of Escherichia coli is a cytosolic component of the export machinery which can prevent some precursors from prematurely folding into export-incompatible conformations by binding to the newly synthesised polypeptide. The feature(s) of target proteins recognised by SecB, however, are unclear and have been a matter of controversy. Also, it has not been asked if binding of SecB is specific for secretory proteins. We demonstrate here that a non-secretory polypeptide, a fragment of a tail fiber protein of phage T4, fused to the signal peptide of the outer membrane protein OmpA has a very strong SecB requirement for export and that the signal peptide itself cannot, at least not alone, be responsible for this action of SecB. The data reported, together with those of the literature, suggest that SecB recognizes the polypeptide backbone of the target protein.

We have previously shown, using a wide range of health measures, that there is little evidence of consistent class gradients in health in adolescence. This paper examines the possibility that those findings were an artefact of the measure of class used. Seven indicators of health, development and functioning are investigated using six different occupationally-based and five non-occupationally based measures of socio-economic status. The results do not alter the conclusion of the earlier paper, namely that in adolescence class gradients are not consistently apparent in most indicators of health.

Expression of mutant ompA genes, encoding the 325 residue Escherichia coli outer membrane protein OmpA, caused an inhibition of synthesis of the structurally unrelated outer membrane porins OmpC and OmpF and of wild-type OmpA, but not of the periplasmic beta-lactamase. There was no accumulation of precursors of the target proteins and the inhibitory mechanism operated at the level of translation. So far only alterations around residue 45 of OmpA have been found to affect this phenomenon. Linkers were inserted between the codons for residues 45 and 46. A correlation between size and sequence of the resulting proteins and presence or absence of the inhibitory effect was not found, indicating that the added residues acted indirectly by altering the conformation of other parts of the mutant OmpA. To be effective, the altered polypeptides had to be channelled into the export pathway. Internal deletions in effector proteins, preventing incorporation into the membrane, abolished effector activity. The results suggest the existence of a periplasmic component that binds to OmpA prior to membrane assembly; impaired release of this factor from mutant OmpA proteins may trigger inhibition of translation. The factor could be a See B-type protein, keeping outer membrane proteins in a form compatible with membrane assembly.

This short report examines the association between smoking behaviours of mothers and their 15 year old children, and whether there is a difference between families headed by a mother living alone or with a partner. It is based on data collected from a cohort of young people and their mothers (N = 967), resident in the West of Scotland. We found no evidence that children of lone mothers smoke more because their mothers do; the familial transmission of smoking behaviour, at 15, appeared to be less apparent in households headed by lone than cohabiting mothers.

Export of the outer membrane protein, OmpA, across the cytoplasmic membrane of Escherichia coli was severely inhibited by the presence of two, three, four or six additional basic residues at the N-terminus of the mature polypeptide, but not by three similarly positioned acidic residues. Because a few bacterial proteins do possess basic residues close to the leader peptidase cleavage site and because the type of inhibition described here could pose problems in the construction of hybrid secretory proteins, we also studied means of alleviating this form of export incompatibility. Inhibition was abolished when basic residues were preceded by acidic ones. Also, the processing rates of the mutants with two or six basic residues could be partially restored by increasing the length of the hydrophobic core of the signal peptide. Taking this as a precedent, it is suggested that the structure of the signal peptide is an important feature for maintenance of a reasonable rate of translocation of those exported proteins which possess basic residue(s) at the N-terminus of the mature polypeptide.

Because C-reactive protein (CRP) has been identified as a component of circulating immune complexes from patients with inflammatory diseases, we sought to evaluate a potentially clinically important interaction of this acute-phase protein with immunoglobulin or experimentally-prepared immune complexes in vitro. Highly purified human CRP was incubated with a variety of immunoglobulin substrates, including monomeric immunoglobulin G1 (IgG1), a polyclonal IgG, heat-aggregated IgG, and human serum albumin/anti-serum albumin complexes. We were unable to detect a significant binding interaction of radioiodinated CRP with any of these materials, using either polyethylene glycol (PEG) precipitation or sucrose density gradient ultracentrifugation. In contrast, binding of radioiodinated human C1q to both aggregated immunoglobulin and immune complexes was readily detected by these techniques. Incubation of radiolabeled CRP with serum samples from 22 patients with active inflammatory diseases and high levels of circulating immune complexes disclosed no difference in the amount of PEG-precipitable CRP when compared with serum samples from healthy individuals. However, a radiolabeled commercial preparation of CRP did result in some PEG-precipitable radioactivity after incubation with aggregated IgG. These findings provide no support for a biologically important binding interaction of CRP with immunoglobulin or immune complexes, and they suggest that highly purified preparations of CRP should be used in functional studies of this acute-phase protein.

The assumption that social class inequalities in health are a persistent feature of the life-course has been questioned in a recent issue of this journal. On the evidence of mortality and chronic illness, the pattern in youth in Britain appears to be characterised by the lack of class differentials, a striking contrast to early adulthood where the familiar picture of health inequalities is observed. The possibility that this finding of relative equality in youth is a consequence of the limited, and potentially inappropriate, health indicators used has now been tested on a cohort of 15-year-olds in the West of Scotland. On a range of indicators, from subjective assessments to objective physical measures, very little evidence of class variation in health is found. The possible transience of the youth pattern is, however, indicated by findings from a cohort of 35-year-olds in the same study, among whom marked class gradients in health are apparent. Possible explanations for the transformation of a pattern of relative class equality in youth into one of inequalities in adulthood are discussed.

Eight methods for estimating free serum T4 were compared for 26 patients with nonthyroidal illness (NTI) and 16 hypothyroid patients with comparable total T4 (TT4) concentrations. Free T4 values were determined by equilibrium dialysis, enzyme immunoassay (Abbott), antibody-coated tube (Clinical Assays), antibody-coated microfine silica (Corning Immunophase), microencapsulated antibody (Damon), and free T4 index using the T3 uptake ratio or thyroxine-binding globulin method. Equilibrium dialysis, Clinical Assays and Abbott methods usually provided free T4 estimates in the normal range in NTI patients with low TT4 values and differentiated them from hypothyroid patients with comparable TT4 levels. In contrast, the other methods gave decreased free T4 estimates in the low TT4-NTI groups and often did not distinguish them from hypothyroid patients. The normal free T4 estimates by equilibrium dialysis, Clinical Assays, and Abbott methods in the low TT4-NTI patients are consistent with the previous findings of normal T4 disposal rates in these patients. These three methods may assist the clinician in differentiating the low T4 state of NTI from overt thyroxine deficiency of hypothyroidism.

During a study of innovations in antenatal care it was found that overall levels of satisfaction with care were high. Pregnant women appeared to assume that whatever arrangements they had experienced were the best arrangements possible and to be negative about innovations until they had experienced them. This response, which may be due to conservatism or deference, is examined in relation to aspects of general practice and hospital care, and its implications for the evaluation of health care are discussed.

This paper reviews evidence about the social patterning and relationship to life chances of four measures of health, development or functioning; namely height, weight, blood pressure and respiratory function. It argues that these are useful supplements to more commonly used measures of 'health' such as mortality rates, morbidity rates, or self reports of health, and recommends the increased use of such direct physical measures in routine statistics and special health surveys.

The Bain circuit, a modified Mapleson D system, is a lightweight, simple circuit which has been used primarily for anesthesia. This report describes its use for long-term mechanical ventilation for infants and children. The use of this circuit improved warming of inspired gas reducing patient heat loss and, additionally, it was believed to have resulted in increased humidity of the inspired gas. There were no instances of accidental extubation nor were any of the endotracheal tubes blocked by inspissated secretions. Temperatures of the humidifiers had to be lower than conventionally recommended but this did not result in any nosocomial infections. This circuit is an effective and safe circuit to use for long-term mechanical ventilation of children.

The 325-residue OmpA protein is one of the major outer membrane proteins of Escherichia coli K-12. A model, in which this protein crosses the membrane eight times in an antiparallel beta-sheet conformation and in which regions around amino acids 25, 70, 110 and 154 are exposed at the cell surface, had been proposed. Linkers were inserted into the ompA gene with the result that OmpA proteins, carrying non-OmpA sequences between residues 153 and 154 or 160 and 162, were synthesized. Intact cells possessing these proteins were treated with proteases. Insertion of 15 residues between residues 153 and 154 made the protein sensitive to proteinase K and the sizes of the two cleavage products were those expected following proteolysis at the area of the insertion. Addition of at least 17 residues between residues 160 and 162 left the protein completely refractory to protease action. Thus, the former area is cell surface exposed while the latter area appears not to be. The insertions did not cause a decrease in the concentration of the hybrid proteins as compared to that of the OmpA protein, and in neither case was synthesis of the protein deleterious to cell growth. It is suggested that this method may serve to carry peptides of practical interest to the cell surface and that it can be used to probe surface-located regions of other membrane proteins.

LacY-ompA fusions, encoding the N-terminal 50, 71 or 143 residues of lactose permease, were constructed. The observed orientation of the OmpA part of each hybrid protein with respect to the plasma membrane supports current models of the N-terminus of Lac permease. Hybrids possessing the entire mature OmpA were very stable; those with only a part thereof were much less stable. Due to their in vivo stability and accessibility to antibody it is proposed that such hybrids may represent potential models to investigate the assembly pathway of lactose permease.

Complement activity in normal human serum was rapidly depleted by the addition of monosodium urate crystals (MSUC), while the same MSUC preparation had little effect on complement activity in 4 of 8 sera from patients with common variable immunodeficiency (CVID). The degree of complement depletion in the CVID sera correlated with their C-reactive protein (CRP) concentrations but not with their concentrations of IgG. MSUC-induced complement depletion in the 4 poorly reactive sera was partially restored by addition of CRP or by normalizing the IgG concentration, but not by addition of IgM or IgA. It is proposed that CRP, an acute phase protein, may play a role in the pathogenesis of gouty arthritis attacks occurring in some patients following surgery or acute physical illness.

We determined the plasma half-life of the acute phase protein C-reactive protein (CRP) both in normal rabbits and in rabbits that had received inflammatory stimuli. Rabbit CRP was purified from acute phase serum by Cx-polysaccharide affinity chromatography, radiolabeled, and rendered pyrogen-free. Six unstimulated rabbits were injected intravenously with (125)1-CRP prepared by the lactoperoxidase method and four were injected with CRP labeled by methylation using [(14)C]formaldehyde. Blood samples were obtained at 0.25 h and at intervals thereafter. Plasma half-life of CRP was calculated from the data generated during the first 12 h, by which time an average of 86% of labeled protein had disappeared from the blood stream. The mean half-life for CRP was 4.45+/-0.2 h, with no significant difference (0.40 < P < 0.45) between (125)1- and (14)C-labeled CRP. In six animals stimulated with either endotoxin or turpentine 24 h before injection of labeled CRP, a mean half-life of 5.8+/-0.6 h was found, not significantly different (0.30 < P < 0.35) from unstimulated rabbits. We equated fractional catabolic rate to fractional disappearance rate, since the rate constant for passage of CRP from vascular to extravascular compartment can be assumed to be relatively small compared to the observed fractional disappearance rate. Fractional catabolic rate was independent of serum CRP concentration; average fractional catabolic rate in all 16 animals was 14+/-0.8% h(-1) of the plasma pool. We were able to estimate rate of CRP synthesis, based on steady-state assumptions of pool sizes in those rabbits whose serum CRP levels did not change substantially during the period of study. Values as low as 6.7 mug/kg per h in the unstimulated animals and as high as 560 mug/kg per h in the stimulated animals were found.

We report two Caucasian families with systemic sclerosis and other connective tissue and immunological disorders, including rheumatoid arthritis, discoid lupus erythematosus, psoriasis, psoriatic arthritis, ankylosing spondylitis, ulcerative colitis, asthma, Sjögren's syndrome, Raynaud's phenomenon and thyroid disease. In one of these families, two sisters are affected with systemic sclerosis. Clinical, serological, and HLA haplotype results are reported, along with a review of the medical literature on familial occurrence of systemic sclerosis.

Aerolysin, the hemolytic toxin produced by Aeromonas hydrophila, has been purified by a combination of salt fractionation, gel filtration, and ion-exchange and hydroxyapatite chromatography. The resulting protein has a molecular weight of 51 500 and appears homogeneous by polyacrylamide gel electrophoresis in sodium dodecyl sulphate. It is free of detectable protease and phospholipase activities. The purified protein can be separated into two active components with pIs of 5.39 and 5.46 by isoelectric focusing. Both components are found in the original culture supernatant indicating that the multiplicity is not due to proteolysis during isolation. Purified aerolysin is unstable even at 25 degrees C and its hemolytic action is inhibited by certain reducing agents including ferrous iron and cysteine. It appears to be the only toxin hemolytic to human cells that is produced by A. hydrophila under the conditions described.

The hypotheses that self-reported symptoms are a valid proxy for physicians' ratings, and that people with different social characteristics may vary in their recognition and evaluation of symptoms, were tested on volunteers attending the MRC Common Cold Unit. Eleven-hundred volunteers assessed the presence and severity of colds at the end of their stay at the unit, using the same two measures as a trained clinical observer (all ratings were double blind). On both measures there was an extremely high correlation between self- and observer-assessments, a finding encouraging for those using self-reports in community surveys. Although this high level of agreement was found within all the age, sex, occupational class and marital status groups, men were significantly more likely than women to over-rate their symptoms in comparison with the clinical observer. No such differences in over-rating were found by age, class or marital status. This finding of a sex difference in the tendency to over-rate physical symptoms is of major significance to theories of illness behaviour, and is particularly convincing because it is based on a double-blind comparison between self-reports and assessments made by a doctor.

Turnover rates of 32 P-PO 4 and concentrations of orthophosphate as soluble reactive phosphorus (SRP) were measured in five East African waters. Rapid incorporation of 32 P-PO 4 by the seston and orthophosphate concentrations below the limit of detectibility were found in Lakes Elmenteita, Naivasha, and Naivasha Crater Lake. Turnover was slow and orthophosphate concentration high in both Lake Nakuru and the Crescent Island Crater basin of Lake Naivasha. Further experiments in Lake Nakuru indicated that colloidal binding of orthophosphate was limited and that particles retained by an 8.0 μ filter incorporated 66% as much tracer as particles retained by a 0.1 μ filter. These experiments strengthen our conclusion that a large quantity of orthophosphate is available for algal use in Lake Nakuru.

A patient had bilateral deep brachial vein thrombophlebitis in which Vibrio fetus was recovered from six blood cultures of the six drawn. Fever and phlebitis continued with treatment with intravenous doses of heparin and oxacillin but rapidly improved with treatment change of oxacillin to clindamycin. In vitro antibiotic disk susceptibility testing confirmed resistance to oxacillin and susceptibility to clindamycin. Vibrio fetus infection is associated with the vascular endothelium in this and previously reported cases

Associations are described between health (variously measured) and occupational class, gender, marital status, age, ethnicity and area of residence, using British data. It is argued that when exploring the social patterning of health, illness and death, it would be profitable for sociologists to consider several or all of these social positions, and to develop models of general vulnerability to ill-health rather than of specific etiology. Three main types of explanation, artefact, health selection and social causation, are reviewed, and six general points are made about how sociological research on social patterning in health should proceed.