Perspectives in Public Health

Solar ultraviolet radiation (UVR) is a human carcinogen. The UK and the worldwide incidence of cutaneous (skin) melanoma are rising. It is now the second most common cancer in 15-34 year-olds in the UK, increasing by 49% in 1991—2000. The UK government prioritized skin cancer in 1992 in their public health strategy The Health of the Nation, and set the target for reducing the yearly rise in skin cancer incidence by 2005. In 1998 in the Saving Lives: Our Healthier Nation strategy, targets were set to reduce the death rate from cancer, including skin cancer, by 20% by 2010. As a consequence of these targets, since the mid-1990s public health campaigns to reduce sun exposure and skin cancer incidence in the UK have used specific interventions for at-risk groups and the mass media to reach the general population. Evidence indicates a shift in knowledge, with further work required to increase change in behaviour and attitudes.

An associate health problem is vitamin D deficiency, which is prevalent across certain UK population groups. The main childhood health problem associated with vitamin D deficiency is the development of rickets, with evidence indicating those at high risk are exclusively breastfed dark-skinned infants, the elderly, those with dark skin pigmentation, and certain cultural groups that cover their bodies in clothing. Adolescents are the group with the highest incidence of low vitamin D status in the UK, with children of Asian descent at higher risk than Caucasian children. Increasing the outdoor activity levels of children in winter and during the cooler hours in summer is one way of increasing safe sun exposure. It is imperative to educate the general public on the risk of vitamin D deficiency, and offer advice on safe sun exposure, dietary sources of vitamin D, and dietary supplements. More research is required on recommendations for daily vitamin D supplements to determine optimal vitamin D levels in different population groups. There also needs to be reliable and accessible evidence on the links between vitamin D deficiency and lack of sun exposure, with sun safe messages adjusted accordingly.

This paper surveys some recent developments in media criticism and recent developments in film and media representations of mental distress. Focusing on a representations drawn from various forms of media, the paper argues that media and film images of mental distress are in many cases `positive' and sympathetic, although they can also contain sexist, racist and other problematic elements that are not commonly identified by anti-stigma campaigners. It also suggests that while still valid in many ways, existing anti-stigma criticism tends to focus on a rather undifferentiated notion of `violence to others' as the sole criterion against which media images are judged. Finally, the paper proposes that critics and campaigners pay closer attention to how the particular form or genre of any media text influences its treatment of psychological distress.

The claim is made by many that we have reached a point where we are exposed to too much information. This potential phenomenon is particularly prominent in the health field where there is a suggestion that the volume of available information has increased significantly and more importantly that such volume has had detrimental effects on both the overall quality of such information and the ability of people to process and use it. This paper explores the nature and validity of these claims.

Within the context of the notion of an `information society', it outlines a range of concerns that have been expressed in relation to this increase, including the simple problem of overload, the potential for less robust information to enter the system and thus the overall quality of available information to decline. This excess of information is seen to act against the benefits that are sought — information can be invalid and people may not have time to reflect and act on excessive information loads. This can result in irrationality or disinformation.

The suggestion is made, however, that these concerns are largely unsupported by empirical evidence and are potentially the basis of a panic over the entry of alternative perspectives on health. The pessimistic perspectives are thus balanced by more constructive and optimistic views on this growth and opening up of information production and potential consumption. Seeing information creation as organic and pluralistic, it is suggested that increased information volume can actually be a constructive phenomenon.

The paper concludes with the contention that it is unrealistic to expect a return to former circumstances of controlled and limited information flows. Rather, a series of more pragmatic suggestions is offered within existing circumstances, including differentiating between information rich and poor health areas, addressing structural issues like information access and health literacy, and working towards organizing health information so that it is of a high quality, is physically accessible, relevant to the needs and literacy of groups, and in a usable form.

This article examines the nature and role of Web 2.0 resources and their impact on health information made available though the internet. The transition of the Web from version one to Web 2.0 is described and the main features of the new Web examined. Two characteristic Web 2.0 resources are explored and the implications for the public and practitioners examined. First, what are known as `user reviews' or `user testimonials', which allow people to comment on the health services delivered to them, are described. Second, new mapping applications that take advantage of the interactive potential of Web 2.0 and provide tools to visualize complex data are examined. Following a discussion of the potential of Web 2.0, it is concluded that it offers considerable opportunities for disseminating health information and creating new sources of data, as well as generating new questions and dilemmas.

Aims: Central obesity and insulin resistance are strongly implicated in the etiology of polycystic ovarian syndrome (PCOS) and their reduction is therefore a central treatment focus. Weight loss has been consistently successful in reducing insulin resistance and restoring ovulation and fertility in women with PCOS. The purpose of the current study is to investigate the general attitudes towards dieting and exercise in women with PCOS, together with the extent of implementation of the dietary and lifestyle advice that these women are given as part of their treatment. General knowledge of patients about their condition (PCOS) has also been assessed.

Methods: Fifty three pre-menopausal women, over the age of 18 years, with a confirmed diagnosis of PCOS, were recruited from the Endocrinology Department, Middlesex Hospital, London. Subjects were interviewed individually using an interview-guided questionnaire.

Results: Sixty four per cent of the subjects were overweight (BMI > 25 kg/m²) and 55% of those were obese (BMI > 30 kg/m²). All subjects identified the importance of weight control in the management of their condition. However, only nine out of the 35 overweight women had actually been referred to a dietician and only 22 reported taking moderate exercise at least once a week in order to improve their health. The main sources of information on weight management were the internet and their consultant endocrinologist, who they normally see only twice a year.

Conclusion: In spite of the fact that weight loss and weight maintenance are absolutely vital in the treatment of PCOS, our study has shown that the support given to PCOS patients to help reduce and control their weight is inadequate and needs to be improved.

The regulatory landscape of the health and adult social care system in England is constantly changing. The establishment of a new regulator, the Care Quality Commission (CQC), will help to integrate the regulation of the health and adult social care sector together and strengthen the safety and quality assurance for patients and service users. It will have the challenge of regulating a much bigger sector and wider variety of organizations than its predecessor bodies — i.e. Healthcare Commission, Commission for Social Care Inspection and Mental Health Act Commission. An effective and efficient regulatory approach is needed by the new regulator to achieve the objectives, without increasing the regulatory burden on the services. A risk-based regulatory approach may help to deal with those challenges by proactively identifying and assessing any key risks to the quality and safety of these services. There are a number of perceived benefits of adapting such a risk-based approach by the regulator, both in terms of effectiveness and efficiency, as experienced by many other regulators in the UK and abroad.

Over the last 25 years there have been considerable advances in the treatment and technologies used in the care of newborn infants. Most of these advances are related to the care of the premature infants and there have been few changes in the management of conditions commonly seen in term infants.

Neonatal jaundice is one of the commonest neonatal disorders and has been recognized since early history. Early neonatal jaundice is usually caused by the physiological destruction of red blood cells in the infant and its importance lies in the ability of the bilirubin pigment so produced to cross the blood brain barrier resulting in neurotoxicity. Prolonged neonatal jaundice (after 14 days of age) may be an indication of an underlying liver disorder. The approach to neonatal jaundice has remained largely unchanged over the last two to three decades. We continue to rely on visual inspection to assess the severity of early neonatal jaundice. We have technology that is effective in reducing the level of bilirubinaemia but in the UK there is no clear consensus as to the level at which jaundice should be treated. We do not have a standardized approach to the management of prolonged jaundice and there is potential for infants with significant liver problems to be diagnosed at a relatively late stage. Some countries (for example the US) have professional bodies who have introduced guidelines to ensure a standardized approach to the jaundice infant. We have little information about neonatal jaundice treatment in other parts of the developing world.