Word cloud analysis of historical changes in the subject matter of public health practice in the United Kingdom.

OBJECTIVES: This study aimed to use the content of the journal Public Health to paint a picture of changing public health practice in the United Kingdom over the last 150 years. STUDY DESIGN: Word cloud analysis was used in this study. METHODS: Word clouds were generated for all issues in three separate years, 65 years apart, chosen to represent entirely different periods of public health practice - 1888, 1953 and 2018. RESULTS: The analysis has been successful in illustrating how the focus of public health practice has changed over the last 150 years in the United Kingdom. CONCLUSION: The majority of the analysis has corresponded with the four waves of public health improvement as set out by Hanlon et al. moving from the response to infectious disease caused by the problems of the Industrial Revolution to a focus on the determinants of health and well-being that lie behind chronic diseases, such as cancer. The most recent word cloud for 2018 has illustrated the holistic nature of modern public health practice, the multidisciplinary nature of its workforce and the fact that it is much more gender balanced than in the past.

The state of ethical-legal oaths in UK medical practice today: Is it time to look at standardising?

The taking of an ethical-legal oath is a "rite of passage" for many medical practitioners. A 1997 paper noted that half of medical schools in the UK administer an oath. I performed a survey of UK medical schools to see whether these are still used today. An electronic survey was sent to 31 UK medical schools, asking them whether the Hippocratic Oath (in any version) was taken by their medical students; non-respondents were followed up by telephone. Information was obtained from 21 UK medical schools, giving a response rate of 68% (21/31). A total of 18 (86%) institutions use an oath. Ethical-legal oaths are therefore taken in the vast majority of UK medical schools today. However, a great variety are used, and there are advantages in standardisation. My recommendation is that the Standard Medical Oath of the UK (SMOUK) is adopted by all medical schools, and that this is also taken regularly by doctors as part of revalidation.

Interventions to prevent dog fouling: a systematic review of the evidence.

OBJECTIVES: To undertake a systematic review of articles on the prevention of dog fouling. STUDY DESIGN: Systematic review. METHODS: Literature searches were conducted using six major electronic databases. Published and unpublished material was considered, with no restrictions on date or language. A total of 47 other databases and websites were interrogated. Articles were hand searched for references that had not been identified in the electronic search. Only controlled trials or observational studies assessing the impact of any intervention on the prevention of dog fouling were liable for inclusion in the systematic review. RESULTS: The search identified a total of 68 articles, none of which fulfilled the inclusion criteria. CONCLUSIONS: The review did not find any good-quality studies which have looked at interventions to prevent dog fouling. According to the Cochrane Collaboration, reviews that are unable to find any relevant studies are particularly useful because they highlight important gaps in our knowledge. It is recommended that research is commissioned to answer the important question of what interventions actually work to prevent dog fouling. Methods for performing this research are suggested.

The development of bacteriology, sanitation science and allied research in the British Army 1850-1918: equipping the RAMC for war.

The recent 90 year anniversary of the end of the First World War is an opportune time to reconsider the important role of the Royal Army Medical Corps in this conflict. One area which has been neglected is the role of the Royal Army Medical Corps in responding to infectious diseases and to understand this properly it is important to consider the development of bacteriology, sanitation science and allied research in the British Army up to the Great War. The context of the home front is also central, with the British population from 1880-1914 increasingly benefiting from improved public sanitation and the new science of bacteriology. Historians acknowledge that the British campaign in the Crimea in the 1850s was pursued with inadequate medical provision and as a result, the Army suffered severely from infectious diseases. Limited changes were introduced after the Crimean War, such as the establishment of the Army Medical School, with its high quality instruction in military hygiene and later bacteriology. Army medics also led the way in various branches of scientific research, through research in the colonies. As compared with the continental powers, however, the application of bacteriology and sanitation to field craft in the British Army was delayed. It took the experiences of the South African and Russo-Japanese Wars for the importance of these sciences to be recognised by the Army as a whole. These subjects began to form part of the education of army Medical Officers, but training was basic and few trainees had specialised in bacteriology by 1914. In spite of these limitations, the Royal Army Medical Corps responded well to the demands placed upon it by World War One, recruiting civilian bacteriologists to its ranks, developing technological innovations such as mobile bacteriological laboratories for them to work in, forming a sanitation service and fostering medical research.

Parents--why it is now legal to put your child's nappy in the dustbin.

BACKGROUND: Notifiable diseases in England and Wales include cholera, plague, relapsing fever, smallpox, typhus and food poisoning. S 26(1) of the Public Health (Control of Disease) Act 1984 Part II made it a criminal offence to place material which is known to have been exposed to infection from a notifiable disease or one of a number of additional diseases, and which has not been disinfected, in a dustbin. One such potential infection risk that is often placed in dustbins is the disposable nappy, particularly from children who are suffering from gastroenteritis. METHOD: A literature review was undertaken using PubMed on the relationship between nappies and the transmission of infectious disease. RESULTS: The literature review did not reveal any evidence of notifiable disease transmission through discarded nappies in dustbins. CONCLUSIONS: As a result of a recent review, Part II of the Public Health (Control of Disease) Act 1984 has now been replaced by Part IIA by virtue of the Health and Social Care Act 2008, and so s 26(1) no longer applies. This is both an evidence-based decision and more importantly, decriminalizes thousands of parents who decide to discard their baby's nappy in the dustbin.

Needle-stick injuries in primary care in Wales.

BACKGROUND: Accidental needle-stick injuries (NSIs) are a hazard for health-care workers and for the general public. OBJECTIVES: To estimate the presentation rate of NSIs to general medical practices, their relation to practice characteristics, and review practice policies for managing NSIs. METHOD: Descriptive study using logistic regression analysis. RESULTS: Annual rates of 2.73 (95% CI 2.08, 3.50) occupational NSIs per 100 clinical practice staff and 2.14 (95% CI 1.39, 3.13) non-occupational NSIs per 100,000 practice population were recorded. Stepwise logistic regressions showed that chance of a practice reporting at least one occupational NSI in previous five years was best predicted by being a single-handed practice (decreased odds). In contrast, the chance of a practice reporting at least one non-occupational NSI was best predicted by being a rural practice (increased odds). About one in five practices possessed no written policy on managing NSIs. Stepwise logistic regressions showed that the chance of a practice owning a NSI policy was best predicted by being located in an LHB area with a coastline (increased odds). CONCLUSION: NSIs are an important public health issue in Wales. We have tried to address the lack of guidance by developing new guidelines in Wales.

The response to the trench diseases in World War I: a triumph of public health science.

The recent 90-year anniversary of the Battle of the Somme presents an opportunity to examine the public health response to the trench diseases, new conditions which arose in the trenches of World War I. Throughout history, there have been two views of epidemic disease: the configurationist and contagionist perspectives. Most doctors responding to the trench diseases, 'contingent-contagionists', combined these two conceptions of disease. Because of the difficulty of finding a causative organism and the absence of effective treatment, the majority view became that these conditions were a product of the trench environment. Configurationism, with its emphasis on environmental and social determinants, seemed to provide the most obvious approaches for tackling the trench diseases. The diseases were effectively controlled using the tools of public health science: sanitary discipline and a battery of measures, such as improving trench construction, improving the diet, providing protective kit, regular bathing and treating lice infestation. The response demonstrates the triumph of public health science over new medical technologies. It also illustrates the importance of considering all the many determinants of health and of close surveillance, discipline and partnership working to counter ill-health. Although technology, training, doctrine and health beliefs change over time, the interaction between disease and environment remains the core challenge to public health practitioners.

The perils of public transport.

Section 33 of The Public Health (Control of Disease) Act 1984 makes it an offence for a person in England and Wales who is suffering from a notifiable disease, e.g. cholera, to use any bus, tram or train; or use a taxi without notifying the driver or owner of the vehicle, or their carer to allow them to do so. Section 34 of the same act prohibits the owner, driver or conductor of a bus, train or tram from carrying a person who he knows is suffering from one of these diseases However, a taxi can carry an affected person, provided this individual pays a sum in addition to the fare to cover the costs of disinfection. Assuming that the owner or driver did not know that a passenger was suffering from one of these diseases, he must inform the local authority, which is required to disinfect the taxi for free. A literature review using PubMed did not reveal any evidence that buses, trains, trams or taxis provide a significant vehicle for transmission of notifiable diseases. Is it therefore about time that a non-evidence-based and little-used law is removed from the British statute books?

The organisation of the RAMC during the Great War.

INTRODUCTION: At the 90 year anniversary of the Battle of the Somme, it is important to remember the members of the RAMC who served in the Great War, especially the more than one thousand Medical Officers who gave their lives. LEADERSHIP: The RAMC during the First World War was a Corps led by some able officers such as Sir Arthur Sloggett in France and Sir Alfred Keogh in London. Sir Douglas Haig was in overall command, his leadership style impacting on the RAMC. RECRUITMENT OF MOS: There were problems in filling the ranks of the Corps, both before the conflict, as well as well as during the War, and a significant number of civilian medical practitioners were recruited to the RAMC. Shortages were only really addressed when the Americans joined the conflict. TRAINING OF CIVILIAN MOS: The great need for MOs meant that there was little time for formal training of civilian MOs and many felt unsuited for war work. This was recognised by the authorities, who gradually set up centres of instruction. WORK OF RMOS: The workhorse of the organisation was the Regimental Medical Officer, who had an important role in disease prevention and the conservation of manpower, in a type of conflict (trench) that required a ready supply of personnel. Although an important role, some doctors found the job frustrating. CASUALTY EVACUATION: During the War, the RAMC managed to improvise an efficient system for handling casualties, the aim to give speedy treatment and to return the men to the front in the shortest possible time. CONCLUSIONS: The RAMC during the GreatWar was a highly structured and efficient organisation, geared towards maximising its available manpower, important in trench warfare.

The medical response to trench nephritis in World War One.

Around the 90-year anniversary of the Battle of the Somme, it is important to remember the international effort that went into responding to the new diseases, which appeared during the First World War, such as trench nephritis. This condition arose among soldiers in spring 1915, characterized by breathlessness, swelling of the face or legs, headache, sore throat, and the presence of albumin and renal casts in urine. It was speedily investigated by the military-medical authorities. There was debate over whether it was new condition or streptococcal nephritis, and the experts agreed that it was a new condition. The major etiologies proposed were infection, exposure, and diet (including poisons). Research pointed to the origin of the disease as being infective rather than toxic, but no definite cause was discovered. A number of labels were given to the disease, including war nephritis. However, trench nephritis was the one used most widely. Trench nephritis was a serious problem for the Allies, leading to 35 000 casualties in the British and 2000 in the American forces. There were also hundreds of deaths. The condition was treated in line with pre-war regimens designed for acute nephritis. No significant preventative methods were implemented for trench nephritis, as there was no consensus regarding causation. The medical response to trench nephritis was largely ineffective, with medical commentators recognizing that there had been a lack of medical progress.