Reducing the healthcare costs of urban air pollution: the South African experience.

Air pollutants often have adverse effects on human health. This paper investigates and ranks a set of policy and technological interventions intended to reduce such health costs in the high population density areas of South Africa. It initially uses a simple benefit-cost rule, later extended to capture sectoral employment impacts. Although the focus of state air quality legislation is on industrial pollutants, the most efficient interventions were found to be at household level. These included such low-cost interventions as training householders to place kindling above rather than below the coal in a fireplace and insulating roofs. The first non-household policies to emerge involved vehicle fuels and technologies. Most proposed industrial interventions failed a simple cost-benefit test. The paper's policy messages are that interventions should begin with households and that further industry controls are not yet justifiable in their present forms as these relate to the health care costs of such interventions.

Modelling the economics of gaming in South Africa.

This paper considers the application of two models for determining the optimal location and characteristics of a casino in a post-apartheid South Africa. The intention in developing the models was to allow provinces a facility for considering how to maximize the return to the stakeholders in the license award process, namely society at large, as represented by the provincial government, and the casino operator. The Allocation Model works on an estimate of total potential gambling spend and how that may be best distributed amongst a number of casinos. The Profitability model takes the estimated gaming spend from the allocation model and assesses the appropriate size and characteristics of the casino best suited to this level of gaming spend. It can then simulate levels of profitability for different proposed sizes and characteristics of proposed casinos. Together these models represent a powerful assessment mechanism for a country considering the introduction or radical changing of gaming legislation.

Does lithium reduce the mortality of recurrent mood disorders?

Numerous follow-up studies have shown that patients with mood disorders who do not receive prophylactic medication are at increased risk of death, particularly from suicide. After 11 years follow-up we compared the mortality of 103 patients attending a lithium clinic with that expected on the basis of age/sex/year-specific rates for England and Wales. Only 10 patients died during the study, although the expected number of deaths was 18.31 (P = 0.052, two-tailed) and no deaths from suicide were observed. After correcting for the prevalence of mood disorder in the general population, the relative risk was 0.60 (95% CI 0.29-1.12) which suggests that lithium reverses the excess mortality associated with recurrent mood disorders, including that from suicide.

Age, unemployment and parasuicide in Leeds.

The relationship between unemployment and parasuicide was examined amongst males and females in the City of Leeds between 1978 and 1982. The association between unemployment and parasuicide was found to be positive and significant in middle aged men. However, there was a negative and significant relationship between unemployment and parasuicide in older men aged between 55 and 59 years. For females between the ages of 20 and 25 years there was a significant negative relationship between unemployment and parasuicide. The findings which are discussed are considered to provide evidence for the hypothesis that unemployment may exert a differing vulnerability effect on proneness to parasuicide in different age groups and between the two sexes.

Ventricular size and CSF transmitter metabolite concentrations in severe endogenous depression.

The relationship between neurotransmitter metabolite concentrations and measurements of ventricular size on CAT scans and pneumoencephalographs was investigated in 15 patients with severe affective disorder. An association was identified between reduced levels of plasma free tryptophan and ventricular enlargement, and also between raised ventricular CSF levels of 5 HIAA and ventricular enlargement.

Ventricular size, the dexamethasone suppression test and outcome of severe endogenous depression following psychosurgery.

To assess the possible significance of cerebral ventricular size and the dexamethasone suppression test (DST) in the outcome of severe endogenous depression, 28 patients were followed up and reviewed 1 year after stereotactic subcaudate tractotomy. Neither ventricular size nor the dexamethasone suppression test predicted either a good or poor outcome. There was no relationship between ventricular size and the DST results.

The relationship of concurrent benzodiazepine administration to seizure duration in ECT.

The relationship of concurrent benzodiazepine administration to seizure duration in ECT was examined. Administration of a standard oral dose of 10 mg diazepam to a series of patients suffering from major depressive disorder produced a significant reduction in men seizure length during ECT compared to length of ECT-induced seizure in those patients when they were benzodiazepine free. This finding is discussed.

A randomized double blind group comparative study of sulpiride and amitriptyline in affective disorder.

A randomized double blind group comparison study of sulpiride and amitriptyline was carried out in 36 patients suffering from major depressive disorder (DSM III criteria). Sulpiride showed equivalent antidepressant activity to amitriptyline at 4, 6 and 12 weeks, using the Hamilton Rating Scale (HRS) and the Wakefield Self-Rating Scale for depression (WRS). However, at 24 weeks the antidepressant activity of amitriptyline was just statistically significantly better than that of sulpiride. Timing of onset of action was comparable in both drugs. The anxiolytic activity of sulpiride was equivalent to that of amitriptyline at 4, 6, 12 and 24 weeks using the Salkind Manifest Anxiety Inventory as a measure. There were no significant differences between the two groups, of variables measured by the Crown-Crisp Experiential Index, a life events scale and Paykel's Social Adjustment Scale.