Equity-focused health impact assessment: A tool to assist policy makers in addressing health inequalities

In Australasia (Australia and New Zealand) the use of health impact assessment (HIA) as a tool for improved policy development is comparatively new. The public health workforce do not routinely assess the potential health and equity impacts of proposed policies or programs. The Australasian Collaboration for Health Equity Impact Assessment was funded to develop a strategic framework for equity-focused HIA (EFHIA) with the intent of strengthening the ways in which equity is addressed in each step of HIA. The collaboration developed a draft framework for EFHIA that mirrored, but modified the commonly accepted steps of HIA; tested the draft framework in six different health service delivery settings; analysed the feedback about application of the draft EFHIA framework and modified it accordingly. The strategic framework shows promise in providing a systematic process for identifying potential differential health impacts and assessing the extent to which these are avoidable and unfair. This paper presents the EFHIA framework and discusses some of the issues that arose in the case study sites undertaking equity-focused HIA.     

Prenatal diagnosis and outcomes of five cases of mosaicism for an isochromosome of 20q

Five cases of mosaicism for an isochromosome of 20q have been detected from a total of 50 000 cases analysed for prenatal diagnosis by amniocentesis. Karyotypes were designated mos 46,X_/46,X_,i(20q). In all cases, the abnormal cell line was detected in more than one primary culture, thus fulfilling the criterion for true (level III) mosaicism. Indications for prenatal diagnosis were parental anxiety (two cases), low maternal serum alpha-fetoprotein (AFP) (two cases), and high maternal serum AFP (one case). Level II ultrasounds on all five fetuses were normal, and the abnormal cell line was never detected in fetal blood and/or cord blood. All five pregnancies were continued and had normal outcomes, with birth weights ranging from 2.4 to 3.8 kg. The development of all five children has been normal, with the oldest child in the study now 4 years of age. We suggest that the abnormal cell line in each case was of extrafetal origin, and that this may be one of the more common examples of this phenomenon, occurring in approximately 1/10000 prenatal diagnoses. Mosaicism i(20q) may have been missed in the past because of the higher resolution necessary to detect this subtle change.     

Prenatal diagnosis of a fetus with terminal deletion of chromosome 1 (q41)

Many authors have suggested that individuals affected by a terminal 1q deletion display a phenotypically definable and recognizable syndrome. In all of the 27 cases reported to date, the breakpoints were at band q42 or distally to it. To our knowledge, we report the first case of a terminal 1q41 deletion. Diagnosis was made prenatally by amniocentesis, following ultrasonographic diagnosis of omphalocele, cerebral ventriculomegaly, and increased nuchal fold thickness in a 19-week female fetus. Multiple facial and extremity features were consistent with the proposed distal 1q deletion syndrome; omphalocele, however, has not been reported previously. The absence of liver herniation into the omphalocele sac in this case supports the previously reported association of this finding with chromosomal anomalies.     

Reducing Fertilizer‐Nitrogen Losses from Rowcrop Landscapes: Insights and Implications from a Spatially Explicit Watershed Model

We present conceptual and quantitative models that predict changes in fertilizer‐derived nitrogen delivery from rowcrop landscapes caused by agricultural conservation efforts implemented to reduce nutrient inputs and transport and increase nutrient retention in the landscape. To evaluate the relative importance of changes in the sources, transport, and sinks of fertilizer‐derived nitrogen across a region, we use the spatially explicit SPAtially Referenced Regression On Watershed attributes watershed model to map the distribution, at the small watershed scale within the Upper Mississippi‐Ohio River Basin (UMORB), of: (1) fertilizer inputs; (2) nutrient attenuation during delivery of those inputs to the UMORB outlet; and (3) nitrogen export from the UMORB outlet. Comparing these spatial distributions suggests that the amount of fertilizer input and degree of nutrient attenuation are both important in determining the extent of nitrogen export. From a management perspective, this means that agricultural conservation efforts to reduce nitrogen export would benefit by: (1) expanding their focus to include activities that restore and enhance nutrient processing in these highly altered landscapes; and (2) targeting specific types of best management practices to watersheds where they will be most valuable. Doing so successfully may result in a shift in current approaches to conservation planning, outreach, and funding.     

Backwater Confluences of the Ohio River: Organic and Inorganic Fingerprints Explain Sediment Dynamics in Wetlands and Marinas

In the Ohio River (OR), backwater confluence sedimentation dynamics are understudied, however, these river features are expected to be influential on the system’s ecological and economic function when integrated along the river’s length. In the following paper, we test the efficacy of organic and inorganic tracers for sediment fingerprinting in backwater confluences; we use fingerprinting results to evidence sediment dynamics controlling deposition patterns in confluences used for wetland and marina functions; and we quantify the spatial extent of tributary drainages with wetland and marina features in OR confluences. Both organic and inorganic tracers statistically differentiate sediment from stream and river end‐members. Carbon and nitrogen stable isotopes produce greater uncertainty in fingerprinting results than inorganic elemental tracers. Uncertainty analysis of the nonconservative tracer term in the organic matter fingerprinting application estimates an apparent enrichment of the carbon stable isotopes during instream residence, and the nonconservativeness is quantified with a statistical approach unique to the fingerprinting literature. Wetland and marina features in OR confluences impact 42% and 11% of tributary drainage areas, respectively. Sediment dynamics show wetland and marina confluences experience deposition from river backwaters with longitudinally linear and nonlinear patterns, respectively, from sediment sources.     

Feather coloration in museum specimens is related to feather corticosterone

Colorful ornaments in birds are often sexually selected signals of quality, and variation in ornament expression may be mediated by physiological stress through the secretion of corticosterone. However, testing for links between ornamentation and corticosterone often requires sampling live animals, and such physiological measures may not be matched in the time span in which they were sampled (e.g., very dynamic plasma corticosterone vs. plumage coloration, which is relatively static). Here, we use museum specimens to test for a link between the color of a sexual ornament and feather corticosterone at the time of ornament formation. In red-winged blackbirds, Agelaius phoeniceus, carotenoid-based epaulets appear to be important in male–male social interactions, territory maintenance, and female choice. We measured reflectance spectra of adult male epaulets and plucked adjacent feathers for corticosterone analysis via radioimmunoassay. We controlled for differences in the number of mates, specimen age, and geography by selecting only males with one mate and only birds collected in Florida during a 3-year period. Epaulet hue and red chroma did not vary with feather corticosterone, but males whose epaulets scored high for mean brightness and red brightness had significantly lower corticosterone than males with low brightness scores. This correlation with brightness but not hue or chroma is consistent with an effect of corticosterone (CORT) on feather microstructure, with elevated CORT leading to lower reflectance of white light from the keratin matrix surrounding the carotenoid pigments.