THE JOURNAL OF THE INCREASINGLY RELEVANT

In this issue of our journal, which seems to the authors to contain increasingly relevant evidence about the way to secure meaningful health improvement at the population level, we carry contributions that range through inequalities, screening, play areas and child safety, disasters, aetiological aspects of multiple sclerosis, and tentative question marks over statin use.

The JECH Gallery asks whether the photographic evidence of schools in socially contrasting neighbourhoods provides clues as to health outcomes, and a view from the grave provides convincing evidence that inequalities persist into the afterlife. In Speaker’s Corner, Choi mines a creative vein in discussing traditional proverbs and suggesting some new ones. My own, recent favourite is “health is a journey, not a destination”, although an old, reassuring favourite is the Newtonian sounding “everyone has the same total amount of sin”. Meanwhile, Levi Tafari’s poem addresses the profligate way in which humans are consuming finite world resources (would a wise God trust humans with the custodianship of the planet earth?)
 See pages 1027, 1018, 1010, 996

In a timely Editorial, Joffe and Mindell explore some of the parameters of healthy public policy. Unless there is a serious political will to address the root causes, inequalities are like one of those long modelling balloons—squeeze it somewhere, and it bulges somewhere else.
 See page 966

In a linked Editorial to a paper by Marteau, McCaffery and Barratt raise questions about our approach to screening programmes and how we might do them better.
 See page 968

The Glossary this month provides a guide to navigating the field of social network analysis, an area of growing importance.
 See page 971

Several crunchy papers in Evidence Based Public Health Policy and Practice report:

• an increased number of public parks might reduce vehicle related pre-school deaths, in particular those involving pedestrians;

• a follow up of the Enschede firework disaster explores the use of such case studies for a variety of purposes—we are still not exploiting such disasters effectively as part of a cycle of audit and learning;

• further information from the SARS epidemic indicates that those travelling during the epidemic were a self selected group, using less preventive measures;

• support from Australia that a multi-level school based intervention can have a substantial impact on important health risk behaviours in adolescence;

• a cost effectiveness study of a community based exercise programme in over 65 year olds indicates that the programme was cost effective;


 See pages 976, 982, 988, 997, 1004

Research findings this month:

• unless attributable to chance or remaining, uncontrolled confounding, a slight exposure related increase in total cancer incidence has occurred in northern Sweden after the Chernobyl accident (this prompted me to wonder whether the destruction of home grown vegetables in this part of Sweden at the time may have been of benefit in reducing the impact);

• findings from the UK suggest that a large proportion of the ethnic minority population is concerned about being a victim of racism;

• work stress was found to be a robust predictor of cardiovascular mortality after controlling for socioeconomic circumstances in childhood and adulthood in Finland;

• heavy computer users with refractive errors seem to have an increased risk of visual field abnormalities, possibly related to glaucoma;

• in a study from Newcastle upon Tyne, a number of cross sectional and life course measures of socioeconomic position were associated with self reported, limiting longstanding illness at age 50 in men, but not in women;

• using an example from smoking and mortality, confounding by socioeconomic position remains after adjusting for neighbourhood deprivation;

• there is evidence of increasing comorbidity of psychiatric illness and substance misuse in primary care in England and Wales;

• self assessed health seems to predict having an aortic aneurysm independently of known risk factors;

• the use of both statins and fibrates was associated with the risk of peripheral neuropathy—the authors contend that this requires further investigation (let’s hope that the media don’t immediately jump to too many conclusions);

• a further paper from Newcastle upon Tyne found evidence of socioeconomic gradients in the completeness of detail, but not the ascertainment, of cancer registry data, which have implications for their interpretation.


 See pages 1011, 1017, 1019, 1021, 1028, 1030, 1036, 1042, 1047, 1052

Two Book Reviews to take note of this month are that of Archie Cochrane: Back to the Front, edited by F X Bosch and R Molas, in which they set Archie’s work in the context of his Spanish Civil War experience; and Global AIDS: Myths and Facts, which gives an overview of important AIDS related policy issues.
 See page 1055

A tit-bit from Hygieia: overall, smoking prevelance in Australia has dropped from 35% to 21%, with much of the decline being observed in blue collar workers—it can be done!
 See page 1056