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.     

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.     

Trisomy 5 mosaicism detected prenatally with an affected liveborn

This paper reports a case of chromosomal mosaicism for trisomy 5 recovered from amniotic fluid cells and from skin fibroblasts of a liveborn dysmorphic male. Routine amniocentesis was performed at 16 weeks' gestation because of parental concern. Trisomy 5 cells were measured from 25 per cent of amniocytes from two culture vessels. No further invasive testing was performed until 32 weeks' gestation, at which time ultrasound examination showed fetus with intrauterine growth retardation. Fetal blood sampling was then performed, with only karyotypically normal cells recovered. At birth, the child was found to have multiple dysmorphic features and congenital anomalies, including an eventration of the diaphragm and ventricular septal defect, both of which required surgical correction. Chromosomal analysis of cord blood lymphocytes indicated 46,XY; however, 20 per cent of the cultured fibroblasts obtained from the chest skin at the incision site for diaphragmatic repair had a 47,XY,+5 karyotype. Trisomy 5 mosaicism may be another example of tissue-limited mosaicism. Fetal blood sampling can then be falsely reassuring. Furthermore, because some cell lines rarely appear in lymphocyte populations, cytogenetic analysis of multiple tissues warranted as part of the evaluation of individuals with developmental delay and dysmorphic features.     

The safety policies and practices of community multi-purpose recreation facilities

This research investigated the under-explored area of safety in multi-purpose recreation facilities (MPRFs). Facility managers and other managerial staff (key informants) from four MPRFs in Victoria, Australia participated in semi-structured interviews. Safety was considered important from Occupational Health and Safety (OH&S), business viability and legal liability perspectives but not from a health promotion or public health point of view. Most implemented injury prevention measures required gymnasium and pool staff or users to change their behaviours. Awareness of safety standards was higher for some operational areas (e.g. aquatics, child-care) than others (e.g. gymnasium, group fitness activities). Key informants struggled to keep abreast of legislation changes and they relied on commercial, regulatory, and industry information sources rather than evidence of best practice. Reported factors influencing safety in MPRFs were classified into three types: internal (e.g. training, culture); external (e.g. weather, demographic change); and governance (e.g. insurance, industry standards). Comprehensive, relevant and accessible industry safety standards, which focus not only on OH&S but equally on health promotion principles and public health perspectives linked to injury prevention, are required. Training is needed to reflect these broader and equally important perspectives. Health/injury, fitness/recreation and insurance sector links should be improved to ensure a consistent, sustainable approach to safety.     

Achieving attainable outcomes from good science in an untidy world: case studies in land and air pollution

While scientific understanding of environmental issues develops through careful observation, experiment and modelling, the application of such advances in the day to day world is much less clean and tidy. Merseyside in northwest England has an industrial heritage from the earliest days of the industrial revolution. Indeed, the chemical industry was borne here. Land contamination issues are rife, as are problems with air quality. Through the examination of one case study for each topic, the practicalities of applied science are explored. An integrated, multidisciplinary response to pollution needs more than a scientific risk assessment. The needs of the various groups (from public to government) involved in the situations must be considered, as well as wider, relevant contexts (from history to European legislation), before a truly integrated response can be generated. However, no such situation exists in isolation and the introduction of environmental investigations and the exploration of suitable, integrated responses will alter the situation in unexpected ways, which must be considered carefully and incorporated in a rolling fashion to enable solutions to continue to be applicable and relevant to the problem being faced. This integrated approach has been tested over many years in Merseyside and found to be a robust approach to ever-changing problems that are well described by the management term, “wicked problems”.     

Planning routes around the world: International evidence for southern route preferences

Three studies test whether the southern route preference, which describes the tendency for route planners to disproportionately select south- rather than north-going routes, can be attributed to regional elevation patterns; specifically, we ask whether this effect replicates in three topographically disparate international regions, one of which is characterized by higher elevations to the north and lower to the south (Padua, Italy), and two characterized by higher elevations to the south and lower to the north (Enschede, Netherlands; Sofia, Bulgaria). In all cases, we found strong evidence that route planners disproportionately select south- rather than north-going routes at rates exceeding chance. We conclude that the southern route preference is driven by strong associations between canonical direction and perceived effort of route traversal; these effects are somewhat perplexing given that such associations are not founded in the reality of physical space.     

The automobile as a renewable resource

The present system which has led to a high rate of recovery of the ferrous and non-ferrous metals from the obsolete automobile processed by shredding is described. Projections of the potential resource recovery from the non-metallic components of the shredded automobile are presented along with a detailed account of the current research and development programme directed toward such recovery.