Minimum indoor temperature threshold recommendations for English homes in winter - A systematic review.

OBJECTIVES: To identify and assess the available evidence on the impacts of cold indoor temperature thresholds on human health and make evidence-based recommendations for English homes. STUDY DESIGN: Systematic literature review. METHODS: A systematic search of peer-reviewed published literature from the UK and countries with similar climates, and grading of the evidence using the National Institute of Health (NIH) framework was followed by a discussion with experts and formulation of recommendations. RESULTS: Twenty papers were included. Studies were included if they were conducted outside England but were from countries considered to have similar climates. Studies included two small randomised controlled trials, two cohort studies and one case control study; other studies were cross-sectional, largely laboratory-based studies. Health effects in the general population start to occur at around 18 °C. Effects in older people are more profound than in younger adults. Older people are less able to perceive low temperatures. DISCUSSION: Although evidence was limited, a strong argument for setting thresholds remains. The effects observed on the general population and the effects on those more vulnerable makes a case for a recommended minimum temperature for all. Health messages should be clear and simple, allowing informed choices to be made. A threshold of 18 °C was considered the evidence based and practical minimum temperature at which a home should be kept during winter in England. CONCLUSION: There is limited evidence available on minimum temperature thresholds for homes. However a recommendation of at least 18 °C for the whole population with nuancing of messages for those more vulnerable to the effects of cold can be made from the results of the retrieved studies. RECOMMENDATION: Heating homes to at least 18 °C (65 °F) in winter poses minimal risk to the health of a sedentary person, wearing suitable clothing.

Warm Homes, Healthy People Fund 2011/12: a mixed methods evaluation.

OBJECTIVES: To assess how the Warm Homes Healthy People Fund 2011/12 was used by English local authorities and their partners to tackle excess winter mortality. STUDY DESIGN: Mixed-methods evaluation. METHODS: Three sources of data were used: an online survey to local authority leads, document analysis of local evaluation reports and telephone interviews of local leads. These were analysed to provide numerical estimates, key themes and case studies. RESULTS: There was universal approval of the fund, with all survey respondents requesting the fund to continue. An estimated 130,000 to 200,000 people in England (62% of them elderly) received a wide range of interventions, including structural interventions (such as loft insulation), provision of warm goods and income maximization. Raising awareness was another component, with all survey respondents launching a local media campaign. Strong local partnerships helped to facilitate the implementation of projects. The speed of delivery may have resulted in less strategic targeting of the most vulnerable residents. CONCLUSIONS: The Fund was popular and achieved much in winter 2011/2012, although its impact on cold-related morbidity and mortality is unknown.

The Cold Weather Plan evaluation: an example of pragmatic evidence-based policy making?

OBJECTIVES: An evaluation of the Cold Weather Plan (CWP) for England 2011-2012 was undertaken in April 2012 to generate the basis for further revisions. It is widely considered good practice to formulate and revise policy on the basis of the best available evidence. This paper examines whether the evaluation is an example of pragmatic evidence-based policy-making. STUDY DESIGN: A process evaluation with a formative multimethods approach. METHODS: An electronic survey and national workshop were conducted alongside the production of a number of summary reports from the Health Protection Agency surveillance systems and Met Office meteorological data. The Department of Health and the Met Office were consulted on how the evaluation recommendations shaped the revised CWP and Met Office Cold Weather Alerting System respectively. RESULTS: The Cold Weather Plan survey had 442 responses, a majority from Local Authorities, and from all regions of England. Thematic analysis generated qualitative data, which along with feedback from the workshop were synthesized into six main recommendations. Reviewing the new CWP and the Met Office Cold Weather Alerting System revealed significant modifications on the basis of the evaluation. CONCLUSIONS: The evaluation sets the context for cold weather and health during the 2011-2012 winter. This study shows that the CWP 2012-2013 was revised on the basis of the national evaluation recommendations and is an example of pragmatic evidence-based policy-making.

Using an Emergency Department Syndromic Surveillance System to investigate the impact of extreme cold weather events.

This report describes the development of novel syndromic cold weather public health surveillance indicators for use in monitoring the impact of extreme cold weather on attendances at EDs, using data from the 2010-11 and 2011-12 winters. A number of new surveillance indicators were created specifically for the identification and monitoring of cold weather related ED attendances, using the diagnosis codes provided for each attendance in the Emergency Department Syndromic Surveillance System (EDSSS), the first national syndromic surveillance system of its kind in the UK. Using daily weather data for the local area, a time series analysis to test the sensitivity of each indicator to cold weather was undertaken. Diagnosis codes relating to a health outcome with a potential direct link to cold weather were identified and assigned to a number of 'cold weather surveillance indicators'. The time series analyses indicated strong correlations between low temperatures and cold indicators in nearly every case. The strongest fit with temperature was cold related fractures in females, and that of snowfall was cold related fractures in both sexes. Though currently limited to a small number of sentinel EDs, the EDSSS has the ability to give near real-time detail on the magnitude of the impact of weather events. EDSSS cold weather surveillance fits well with the aims of the Cold Weather Plan for England, providing information on those particularly vulnerable to cold related health outcomes severe enough to require emergency care. This timely information aids those responding to and managing the effects on human health, both within the EDs themselves and in the community as a whole.

Impaired sodium-evoked paraventricular nucleus neuronal activation and blood pressure regulation in conscious Sprague-Dawley rats lacking central Gαi2 proteins.

AIM: We determined the role of brain Gαi2 proteins in mediating the neural and humoral responses of conscious male Sprague-Dawley rats to acute peripheral sodium challenge. METHODS: Rats pre-treated (24-h) intracerebroventricularly with a targeted oligodeoxynucleotide (ODN) (25 µg per 5 µL) to downregulate brain Gαi2 protein expression or a scrambled (SCR) control ODN were challenged with an acute sodium load (intravenous bolus 3 m NaCl; 0.14 mL per 100 g), and cardiovascular parameters were monitored for 120 min. In additional groups, hypothalamic paraventricular nucleus (PVN) Fos immunoreactivity was examined at baseline, 40, and 100 min post-sodium challenge. RESULTS: In response to intravenous hypertonic saline (HS), no difference was observed in peak change in mean arterial pressure between groups. In SCR ODN pre-treated rats, arterial pressure returned to baseline by 100 min, while it remained elevated in Gαi2 ODN pre-treated rats (P < 0.05). No difference between groups was observed in sodium-evoked increases in Fos-positive magnocellular neurons or vasopressin release. V1a receptor antagonism failed to block the prolonged elevation of arterial pressure in Gαi2 ODN pre-treated rats. A significantly greater number of Fos-positive ventrolateral parvocellular, lateral parvocellular, and medial parvocellular neurons were observed in SCR vs. Gαi2 ODN pre-treated rats at 40 and 100 min post-HS challenge (P < 0.05). In SCR, but not Gαi2 ODN pre-treated rats, HS evoked suppression of plasma norepinephrine (P < 0.05). CONCLUSION: This highlights Gαi2 protein signal transduction as a novel central mechanism acting to differentially influence PVN parvocellular neuronal activation, sympathetic outflow, and arterial pressure in response to acute HS, independently of actions on magnocellular neurons and vasopressin release.

A cross-sectional examination of height, weight, and body mass index in adult twins.

A cross-sectional twin design was used to study the developmental nature of genetic and environmental influences on height, weight, and body mass index. The sample of same-sex adult male and female twins consisted of 586 monozygotic and 447 like-sex dizygotic twin pairs aged 18 to 81 years. Means and variances suggested normative age differences for all three physical variables. Biometrical model-fitting with maximum likelihood methods of parameter estimation indicated that the general best-fitting model across the age groups for height, weight, and body mass index was one in which the genetic effects were additive and the environmental effects were from nonshared, idiosyncratic experiences. The best-fitting cross-sectional biometrical model for height, weight, and body mass index indicated that additive genetic variance remained stable while nonshared environmental variance increased with age. This increase in environmental variance but stable genetic variance resulted in decreasing heritability with age for height (heritability ranging from 0.89 in the youngest group to 0.87 in the oldest), weight (heritability ranging from 0.86 in the youngest group to 0.70 in the oldest), and body mass index (heritability ranging from 0.82 in the youngest group to 0.63 in the oldest).

Dental health and the application of geographical methodology.

Reorganisation of dental services in Britain gives new opportunities for planning. Geographical methodology provides new techniques. An elementary spatial analysis of variations in dental health in Newcastle Area Health Authority (Teaching) shows that dental health varies with availability and access to treatment facilities. Opposite types of geographical distribution of community (School) and general dental services are illustrated showing location biases for each type of service. The evaluation of the spatial distribution of dental services is shown to be basic to planning and a key to improved dental health.

The use of an index of material deprivation to identify groups of children at risk to dental caries in County Durham.

An investigation of the potential for an index of material deprivation to indicate groups of young children at risk to dental caries and to assess caries experience in their age group at three levels of deprivation, measured by the Townsend Index, was undertaken in County Durham. Electoral wards were ranked on an index of material deprivation derived from 1991 Census data. Dental caries data for the upper quartile, inter-quartile range and lower quartile of material deprivation in the County were obtained from a dental survey of 6052 five-year-old children in 1991-92. The number of children in each group ranged from 1145 to 3058. Significant differences in dental caries experience between high, middle and low ranges of material deprivation existed. The index of material deprivation can indicate groups of children in the community at high and low risk of dental caries.

The relationship between caries, fluoridation and material deprivation in five-year-old children in Country Durham.

An investigation to assess the impact of fluoridation on the caries experience of young children at high and low levels of material deprivation measured by the Townsend Index was undertaken in County Durham. Electoral wards were ranked for deprivation from 1991 Census data. Dental caries data for 2,751 five-year-old children resident in electoral wards in the upper and lower quartiles of material deprivation in the County were obtained from a dental survey conducted in 1991-92. Wards were stratified for fluoridated and non-fluoridated water supply and the dental data for the resultant four populations, defined by high and low material deprivation and the presence or absence of fluoridation, were analysed. The mean dmft values in the four groups were 0.8 in the fluoridated low deprivation group, 1.2 in the non-fluoridated low deprivation group, 1.2 in the fluoridated high deprivation wards and 2.1 in the non-fluoridated high deprivation wards. Thus, with fluoridation the variation in caries between high and low deprivation groups was significantly reduced but not eliminated, leaving the level significantly lower in the least deprived group, to the continuing disadvantage of that deprived group.

Dental disease and current treatment needs in a group of physically handicapped children.

One hundred and twenty-nine physically handicapped children (89 males, 40 females) were dentally examined in a local authority residential special school taking pupils from a wide geographical area in the Northern Region, for caries, periodontal disease, malocclusions and treatment need using World Health Organization criteria. The children were aged between 3 and 17 years with a mean age of 10.7 years. Mean deciduous caries experience (dft) was 0.9 and the mean permanent caries experience (DMFT) was 2.0. The mean dfs/DMFS values were 2.5 and 3.4 respectively. A higher experience of deciduous caries was found in girls, dft = 1.3, than in boys who had a mean dft value of 0.8 and in the permanent dentition girls had a mean DMFT value of 2.8 compared with 1.6 for boys. Each component of the index was also higher for girls in both dentitions. The gender difference identified in caries experience extended to treatment need for the permanent dentition, where more girls were recorded as requiring treatment than boys. Of the 129 children, 126 were assessed for treatment co-operation. Only 18 (14.3 per cent) were assessed as being amenable to routine dental care, 66 (52.4 per cent) were thought likely to present some management problems and the remaining 42 (33.3 per cent) were thought to require all their treatment under a general anaesthetic.

Prevention and treatment of common HIV-associated opportunistic complications.

This article reviews the importance of preventing illness in HIV-infected patients. The indications and medication regimens for preventing several common opportunistic complications are discussed. Infections addressed include pneumocystis pneumonia, Mycobacterium avium complex, toxoplasmosis encephalitis, and tuberculosis, among others. Other preventive interventions such as routine immunizations are addressed briefly as well. Diagnosis and treatment of five of the most common HIV-associated opportunistic infections are reviewed.

A 10-year comparison of General Dental Service care in the Northern Region 1979-1989.

The 1979/1989 patterns of General Dental Service provision in the Northern Region and its nine FPC/FHSA areas have been examined in relation to intraregional variations and assessed against the national average and other regions. Attention is drawn to the Northern Region's failure to reach national averages in a number of key measures of dental care, owing to the low numbers of practitioners working within the Region. It is clear that redistribution of dental manpower will not be generated under the present system. Alternatives are required if dentistry is to continue to be an essential part of a comprehensive health service for all.

The relationship between fluoridation, social class and caries experience in 5-year-old children in Newcastle and Northumberland in 1987.

The dental health of 457 5-year-old children who have lived continuously in fluoridated (at 1.0 mg F/litre) Newcastle and 370 children of the same age in non-fluoridated (less than 0.1 mg F/litre) South Northumberland has been reported. This paper examines in detail the caries prevalence in social class groups I + II, III, IV + V, and the social class/fluoridation relationship in 1987. The prevalence of dental caries in the three social class groupings I + II, III, and IV + V (and the mean dmft), respectively, was 35% (1.1), 46% (1.7) and 67% (2.4) in the fluoridated area, and 59% (2.2), 67% (3.7) and 77% (5.0) in the non-fluoridated area. Fluoridation was effective in all social class groupings and, because caries levels were higher in social classes IV + V, fluoridation brought about greater savings for these children than for those in social classes I + II. Fluoridation reduces but does not eliminate social inequalities, leaving social disadvantage/social background/social class as the major factors in caries prevalence for this age group. Further research into the fluoridation/social class relationship is required, particularly since the understanding of occupational class, now considered an imperfect representation of social class, is being superseded by other criteria which have stronger associations with measures of poor health.

Traumatic stress reactivity promotes excessive alcohol drinking and alters the balance of prefrontal cortex-amygdala activity.

Post-traumatic stress disorder (PTSD) and alcoholism are highly comorbid in humans and have partially overlapping symptomatic profiles. The aim of these studies was to examine the effects of traumatic stress (and stress reactivity) on alcohol-related behaviors and neuronal activation patterns. Male Wistar rats were trained to respond for alcohol, were exposed to predator odor (bobcat urine) paired with context and were tested for short- and long-term avoidance of the predator odor-paired context, alcohol self-administration and compulsivity of alcohol responding. Rats were re-exposed to the odor-paired context for western blot analysis of ERK phosphorylation in subregions of the medial prefrontal cortex (mPFC) and the amygdala. Rats that avoided the predator-paired chamber (Avoiders) exhibited persistent avoidance up to 6 weeks post conditioning. Avoiders exhibited increases in operant alcohol responding over weeks, as well as more compulsive-like responding for alcohol adulterated with quinine. Following re-exposure to the predator odor-paired context, Avoiders and Non-Avoiders exhibited unique patterns of neuronal activation in subregions of the mPFC and the amygdala, which were correlated with changes in avoidance and alcohol drinking. Furthermore, activity of upstream regions was differentially predictive of downstream regional activity in the Avoiders versus Non-Avoiders. An animal model for assessing the effect of traumatic stress on alcohol drinking reveals individual differences in neuronal activation patterns associated with re-exposure to traumatic stress-related stimuli, and may provide insight into the neural mechanisms underlying excessive alcohol consumption in humans with PTSD.

Transgenic, inducible RNAi in megakaryocytes and platelets in mice.

BACKGROUND: RNA interference (RNAi) is a powerful tool for suppressing gene function. The tetracycline (tet)-regulated expression system has recently been adapted to allow inducible RNAi in mice, however its efficiency in a particular cell type in vivo depends on a transgenic tet transactivator expression pattern and is often highly variable. OBJECTIVE: We aimed to establish a transgenic strategy that allows efficient and inducible gene knockdown in particular hematopoietic lineages in mice. METHODS AND RESULTS: Using a tet-regulated reporter gene strategy, we found that transgenic mice expressing the rtTA (tet-on) transactivator under control of the cytomegalovirus (CMV) promoter (CMV-rtTA mice) display inducible reporter gene expression with unusual and near-complete efficiency in megakaryocytes and platelets. To test whether the CMV-rtTA transgene can drive inducible and efficient gene knockdown within this lineage, we generated a novel mouse strain harboring a tet-regulated short hairpin RNA (shRNA) targeting Bcl-x(L) , a pro-survival Bcl-2 family member known to be essential for maintaining platelet survival. Doxycycline treatment of adult mice carrying both transgenes induces shRNA expression, depletes Bcl-x(L) in megakaryocytes and triggers severe thrombocytopenia, whereas doxycycline withdrawal shuts off shRNA expression, normalizes Bcl-x(L) levels and restores platelet numbers. These effects are akin to those observed with drugs that target Bcl-x(L) , clearly demonstrating that this transgenic system allows efficient and inducible inhibition of genes in megakaryocytes and platelets. CONCLUSIONS: We have established a novel transgenic strategy for inducible gene knockdown in megakaryocytes and platelets that will be useful for characterizing genes involved in platelet production and function in adult mice.