Projects : Environment and Health : University of Sussex

The following list highlights some of the externally funded Environment and Health projects currently being undertaken by Sussex Faculty.

Global Flows, Human Rights, Sexual And Reproductive Health: Ethnographies of Institutional Change in the Global South

Dr Maya Unnithan, Wellcome Trust

The Wellcome Trust and Environment and Health Theme co-sponsored an international conference at the University in July 2011 entitled 'Global Flows, Human Rights, Sexual and Reproductive Health: Ethnographies of Institutional Change in the Global South'.

Focusing specifically on the globalising of facts around reproductive and sexual health, the conference brought together experts from across the social sciences to critically reflect on the way in which human rights ideas and conventions are shaping the development discourse and on-the-ground outcomes in sexual, maternal and reproductive health in the countries of Asia, Africa and Latin America. The conference also provided a space to debate broader issues in the gendered politics of rights such as whether rights are an appropriate means for achieving sexual & reproductive health of the poor and marginalised and to what extent a rights focus on the bodies of poor women forms part of a wider set of exclusionary discourses.

The conference was part of an ongoing research project funded by the Economic and Social Science Research Council entitled ‘Realising Global Rights to Health: An ethnographic analysis of rights-based organisations in promoting reproductive health in India’.

Bionetworking in Asia- International collaboration, exchange, and responsible innovation in the life sciences

Dr Margaret Sleeboom-Faulkner, Economic and Social Research Council

Bio-medical innovation makes a substantial contribution to Western societies and economies. But leading research organisations in the West are increasingly reliant on clinical research conducted beyond the West. Such initiatives are challenged by uncertainties about research quality and therapeutic practices in Asian countries. These only partly justified uncertainties are augmented by unfamiliar conditions. This study examines how to create responsible innovation in the life sciences by looking for ways to overcome existing obstacles to safe, just and ethical international science collaborations.

Building on observations of scientists, managers and patients and supported by Asian language expertise, biology background, and experience with science and technology policy-making, we examine the roles of regional differences and inequalities in the networks used for patient recruitment and international research agreements. Profit-motivated networks in the life sciences also occur underground and at an informal, unregulated level, which we call bionetworking. Bionetworking is a social entrepreneurial activity involving biomedical research, healthcare and patient networks that are maintained by taking advantage of regionally differences in levels of science and technology, healthcare, education and regulatory regimes.

Using novel social-science methods, the project studies two main themes. Theme 1 examines patient recruitment networks for experimental stem cell therapies and cooperation between research and health institutions involving exchanges of patients against other resources. Theme 2 maps and analyses exchanges of biomaterials of human derivation, and forms of ‘ownership’ rights, benefits and burdens associated with their donation, possession, maintenance, and application. Integral analysis of the project nodes incorporates an analysis of public health policy and patient preference in relation to Responsible innovation, Good governance and Global assemblages.

Sexual Antagonism and its Evolutionary Consequences

Dr Edward Morrow, Royal Society

Conflict is an inherent part of life. Evolutionary conflicts between the sexes potentially have an important role in speciation and the evolution of sexual dimorphism, and yet they remain poorly understood at a genetic level; not a single gene has so far been definitively identified as experiencing sexually antagonistic selection. This project explores the biology of sexual antagonism at a genetic, genomic and phenotypic level to reveal the true impact that sexual conflict has upon a sexual organism and its genome. This research project aims to identify the genetic basis of sex-specific fitness variation using genomic and phenotypic data from the widely used model organism Drosophila melanogaster. There is a wealth of genomic data already available for this species since its genome was first sequenced. By marrying this genomic data with behavioural data on sex-specific fitness variation I will be able to answer the question: what is the genetic basis of fitness and how important is sexual antagonism?

RCT of podoconiosis treatment in northern Ethiopia

Dr Gail Davey, Dr Fikre Enquosellasie Gashe; Dr Trudie Lang, Professor Andy McKay, Professor Melanie Newport

Medical Research Council/ Department for International Development/ Wellcome Trust

Podoconiosis is one of the forgotten types of leg swelling (elephantiasis) in the tropics. Although an estimated 4 million people are affected by podoconiosis across Africa, there is no government health service provision for patients in any endemic country. In Ethiopia, where 1 million people with podoconiosis live, non-government organizations (NGOs) have been responsible for the development of simple treatment methods using low-cost, locally accessible materials. Treatment takes the form of foot hygiene, skin care, bandaging, exercises to improve lymph drainage and use of socks and shoes. Although the NGOs consider the treatment to be effective, no formal test has yet been conducted.

Our main objective is to test whether the ‘standard’ treatment reduces the number of times a patient experiences ‘acute episodes’, when the leg become hot, painful and more swollen than usual. These episodes significantly compromise patients’ ability to work or carry out normal day-to-day tasks. We will measure the cost of the treatment and put this into context using information gathered on the economic impact of untreated disease.

The trial will be sited in northern Ethiopia, where 3% of the adult population is affected by podoconiosis. Prior to the trial, an economic context survey will be performed to supply background information on typical work hours and settings, labour and medical costs and productivity losses related to podoconiosis. The trial will also be preceded by rapid ethical assessment to identify optimal methods of conveying information about the trial and the approaches to obtaining informed consent preferred by the community.

We plan to randomly allocate 690 of these patients to one of two groups: either to ‘standard’ treatment, or to delayed treatment. Provision of care will be organised through the IOCC Podoconiosis Project, which already has excellent links with the community and local government. The randomisation process, data monitoring and statistical analysis will be overseen by experts at the Clinical Trials Facility in Kilifi, Kenya, who will make twice-yearly visits to the trial site. Data collection will be performed monthly by a team of 10 recruited specifically for the task, and independent of the community project assistants providing care. More detailed examination will be performed at 6 months and 1 year. Three Ethiopian doctoral students will benefit from training through involvement in the trial. The Clinical Trials Facility will ensure data quality, will monitor safety reports and will supervise data analysis, building capacity within Ethiopia for future clinical trials through frequent training and monitoring visits. Trial progress will be updated on the Research web page .

Opt-Out testing for HIV: Community Perspectives

Dr Carrie Llewellyn, Dr Simon Glew, Mr Alex Pollard, Ms Leila Hughes, British Academy

Background

The rate of new HIV infections in the UK continues to rise with approximately a quarter of people remaining undiagnosed. Opt-out is a method used to increase HIV testing uptake which has proved effective in antenatal care. Previous pilot studies of HIV opt-out testing at GP registration and acute medical admission to hospital have described service-level issues and the clinician’s perspective.

Aim

To further understand the public’s perspective on opt-out testing for HIV in England.

Design and Setting

Nine community-based focus groups containing fifty-four participants.

Method

Quota sampling based on sexual orientation, age, gender and testing experience was applied to high and low prevalence groups. Data was analysed using framework analysis.

Results

Opt-out testing for HIV was acceptable. Registration with a GP was regarded as a more appropriate setting than acute medical admission. Participants from higher prevalence groups felt HIV testing required consideration which may not be possible during acute hospital admission. There was concern that screening would still be targeted at higher prevalence communities based on clinicians’ judgement of patients’ behaviours, sexuality or ethnicity.

Conclusion

Opt-out testing for HIV is acceptable but must be offered to all eligible patients to prevent communities developing a sense of being targeted and increase test uptake. Any pressure to test exerted by clinicians is likely to be poorly received. Higher prevalence groups may resist testing in these non-traditional scenarios as they do not allow opportunity for consideration of the test and potential outcomes; resulting in the policy failing to reach the most at-risk groups. Primary care should become a driving force for HIV testing in future.

How this fits in

Pilot studies commissioned by the Department of Health identified that opt-out testing for HIV upon registration with a new GP or acute medical admission to hospital in areas of high HIV prevalence were acceptable to patients. This was inferred from percentage uptake of the test and written questionnaire response. This research is the first to specifically investigate acceptability of opt-out testing in depth using focus groups. It identifies a difference in the degree of acceptability felt towards the proposal according to background community prevalence. This could be minimized by ensuring that the offer to test is universally applied. It also found that participants felt opt-out testing was more acceptable when offered at new patient registration with a GP than upon acute medical admission to hospital. This suggests that there is a public desire for Primary Care to become more involved with HIV testing in future.

Young people's strategies for moderate alchohol consumption

Dr Richard de Visser, The European Foundation for Alchohol Research

There is a clear need to develop strategies to counter high and increasing levels of binge drinking among young people. This demands identifying the beliefs, motives, and skills that distinguish non-drinkers and moderate drinkers from binge drinkers.

Our aim is to identify skills and strategies that could be included in interventions to enhance young people's capacity to drink in moderation. The study is being conducted in parts of South-East England with high rates of youth drinking and alcohol-related problems. We used a large-scale survey of 1400 16-21 year olds to identify characteristics that distinguish lower- and higher-risk drinkers. We then interviewed non- and moderate-drinkers to discover how they resist alcohol, including specific skills and strategies used to resist pressure to drink.

We are using the results of the survey and interviews to develop video resources to teach to young people alcohol-refusal skills and strategies. These will be evaluated by school teachers and students. Planned future research will use the materials produced by this study in a structured trial to determine what effect they have on actual alcohol consumption.

The Ethics of HIV Testing and Transmission

Dr Kathleen Stock, Institute of Medical Ethics

A one-day conference on the Ethics of HIV Testing and Transmission was held on December 10^th at the Royal Sussex County Hospital, Brighton. It was organized by the Philosophy Department, University of Sussex, and co-sponsored by the Institute of Medical Ethics, Brighton and Sussex Medical School, and the Sussex University Centre for Global Health Ethics. The organizer was Dr Kathleen Stock. The event had 97 registrants, largely composed of HIV medics, other HIV healthworkers, and HIV community workers. Registrants also included a policy adviser to the All-Party Parliamentary Group on HIV and Aids; a policy adviser to the Tuke Institute; and the former Chief Executive of HIV Scotland. The event was CPD-accredited by the Royal College of Physicians.

Speakers at the event offered a diverse range of perspectives on the relevant issues, from a range of backgrounds and types of expertise. In ‘Should we offer everyone HIV testing? A conundrum’, Professor Jackie Cassell (BSMS) set out some of the main ethical questions about universalizing HIV testing in the context of epidemiology, and explored the consequences for health services and screening programmes.

In ‘HIV, sex and moralising’ Dr Francois Venter (Witswaterand) examined possible causes of the high incidence of HIV in sub-Saharan Africa, and cast doubt on the oft-held view that it is something to do with the high rate of concurrent partnerships there, arguing that moralizing about sexual behavior is not necessarily beneficial to HIV prevention.

In ‘Current guidelines on HIV testing’ Dr Martin Fisher (Royal Sussex County Hospital) described the background to the development of BHIVA guidelines on UK testing, which he had overseen as co-chair of the group.

In ‘The effects of criminalising HIV transmission’, Professor Matthew Weait (Law, Birkbeck) described the legal context surrounding HIV transmission, and in particular, numerous interventions of an increasingly radical nature against HIV-specific offences, despite UNAIDS International Guidelines on HIV/AIDS and Human Rights (1996/2006) which sought to protect infected individuals from prosecution.

In ‘Can we require people to know their HIV status?’ Dr Lucy Allais (Philosophy, Sussex) argued that mandatory knowledge of one’s HIV status could be regarded as an enforceable civic duty, such as paying taxes or having an ID book. She then defended this claim against the challenges of informed consent requirements.

In ‘Treating the reluctant mother: how persuasive should we be?’ Dr Kate Harding (St Thomas’ and Guy’s) stated that ensuring testing was not an issue with pregnant women, almost of whom are tested; instead she addressed why pregnant women should be treated for HIV. She examined why, since HIV transmission is virtually preventable with ART, some women still refuse treatment; and described multiple causes for this, and how to combat it.

In ‘Can we treat our way out of the epidemic: what are the challenges of ART as prevention?’ Dr Sarah Fidler (Imperial) discussed apparently conflicting ethical considerations surrounding HIV detection and treatment, including the right to know one’s own status, the right to privacy, and the right to protect others from infection, especially children. She also discussed the advantages of and problems raised by a Universal Test and Treat strategy: increasing voluntary HIV testing to universal levels, with immediate and lifelong ART for all HIV positive individuals.

There was also a roundtable discussion with Andrew Chitty (Lecturer in Philosophy, University of Sussex), Paul Ducle (patient representative, Chelsea and Westminster), Paul Clift (patient representative, Kings), and Jonathan Roberts (liaison health advisor in Brighton), in which they gave their response to the possibility of offering all individuals accessing medical care an HIV test, and responded to further questions.

The event was introduced by the Vice-Chancellor of Sussex University, Michael Farthing, who spoke about his early memories of seeing patients with what was then an inexplicable new syndrome, and confirmed that there were important ethical issues raised by the case of infectious diseases.

Feedback from registrants was taking on the day, and was overwhelmingly positive, in terms of the informativeness of particular talks, and their practical use and relevance to professional roles in HIV care.

Graphic Medicine: Ethics and Society

Professor Bobbie Farsides, Wellcome Trust

On 5^th -7^th July 2013 BSMS will be hosting the 4th International Conference on Comics and Medicine, an event that has previously taken place in London, Chicago and Toronto. The theme of the meeting is "Ethics Under Cover: Comics, Medicine and Society". Sponsored by the Wellcome Trust the event is a collaboration between BSMS, Brighton and Sussex University Hospital Trust and Graphic Medicine.

The conference organisers Professor Bobbie Farsides and Dr Sue Eckstein (BSMS) and Dr Muna Al-Jawad (BSUH) have worked with an international panel of scholars and practitioners to ensure that this meeting will appeal to a wide audience, including healthcare professionals, comics creators, students, academic scholars, comics enthusiasts, patient groups and charities. The meeting will consist of a mix of peer reviewed academic papers, lectures and workshops. There will also be an exhibition of presenters’ work and a marketplace where participants can sell their books and prints.

The call for papers has attracted an excellent response with people travelling from around the world to participate, and BSMS and BSUH staff and students will also be amongst the presenters. The keynote speakers are David B (France), Nicola Streeten (UK) and Paul Gravett (UK) all of whom are well known and highly respected within the graphic medicine community. David B has been hailed by The Comics Journal as one of Europe’s most important and innovative comics artists. His book, Epileptic, is a critically acclaimed autobiography about growing up with an epileptic brother. Nicola Streeten’s graphic memoir, Billy, Me & You, a retrospective reflection on the death of her infant son, has been described by The Guardian as “a remarkable book...it is searchingly honest, and desperately sad at times. At others, it is genuinely very funny.” Paul Gravett is a London-based journalist, curator, writer and broadcaster who has worked in comics publishing and promotion for over 20 years. He is the founder of Escape Magazine, and writes a monthly article on comics appearing in the UK magazine Comics International.

For further details and registration, visit the event webpage.

Visualisation of the Quality of Electronic Health Records for Clinical Research

Dr Anne Rosemary Tate, Dr Natalia Beloff, Technology Strategy Board

UK clinical databases provide a unique and valuable resource for research into the epidemiology of disease, and how patient diagnoses, referrals and treatment are handled within our healthcare system.

In April 2012 the government launched a “world-class e-health secure research service”, The Clinical Practice Research Datalink (CPRD) that will provide researchers with greater access to anonymised NHS patient data. The idea is to have a national and comprehensive “cradle to grave” database of health information which will be a fantastic resource for scientists, making Britain a more attractive and productive place to do research.

Rosemary Tate and Natalia Beloff in Informatics are working closely with the team a CPRD to achieve these aims: In the first project led by Dataline Software Brighton and funded by the Technology Strategy Board

“Visualisation of the Quality of Electronic Health Records for Clinical Research”

We have developed a end-to-end system, underpinned by an innovative search algorithm, which allows users to extract information from the CPRD databases in (near) real-time via an intuitive query interface and to explore this information using interactive visualisation tools. Our current application of the tool, TRIALVIZ, allows users to select patients suitable for clinical trials based on a specified set of criteria (see figure for an example). Typically protocols for RCT's are based on number of inclusion and exclusion criteria and the queries may be very complex. The flexible design means that it is can be easily adapted for many other applications.

Following from the success of this project CPRD has funded a Senior Research Fellowship for Rosemary Tate entitled

“Methods to characterise and monitor data quality in the Clinical Practice Research Datalink” –

With the massive expansion of CPRD datasets in order to facilitate health services research, it is now more important than ever that we have a mechanism for assessing data quality. Currently there is no widely recognised methodology for undertaking such data quality assessment.

Following our successful collaboration with CPRD for the TrialViz project, we are developing such a methodology, and shall assess data quality in both the original and new sources of data in a meaningful way applicable to research. Assessing and thereby improving data quality from disparate sources will deliver to CPRD’s mission both to maximise health gain through use of anonymised NHS data and increase UK wealth through increased funding for research projects.

Figure 1

TRIALVIZ’s stack and card interface showing the results of running a query to select diabetes patients who do NOT have type 1 diabetes, AND who have been prescribed either Metformin OR Sulfonylureas, AND who have a specified level of HbA1c, AND who have NOT been prescribed insulin and who are NOT pregnant. The counts are cumulative and represent how many patients are left within the search.

Figure 2

Visualisation of patient number on map for the above example.

Community innovation in sustainable energy

Dr Adrian Smith

Recent years have seen a surge in interest and activity in small-scale, sustainable energy projects led by local communities. Examples include solar water heating clubs and insulation clubs, which provide mutual support for system installation; energy awareness and behaviour networks, which provide guidance and reassurance to neighbours on energy matters relevant to them; and co-operatively owned small-scale renewable energy systems, such as micro-hydro and wind energy.

With colleagues at the University of East Anglia, this EPSRC-ECLEER funded research project studies the diffusion of community energy projects in the UK. It explores the extent of networking between projects, and whether this is assisting in the innovation of community energy. We also assess the performance of projects and provide independent advice to policy-makers and energy businesses about the merits and processes for supporting community energy. We draw upon the findings of our research to develop with practitioners a number of Foresight scenarios for community energy in the UK.

Related outputs:

Seyfang, G. and Smith, A. (2007) Grassroots innovations for sustainable development: towards a new research and policy agenda Environmental Politics, 16, 4: 584-603.

Smith, A. (2007) Translating sustainabilities between green niches and socio-technical regimes, Technology Analysis & Strategic Management, 19, 4: 427-450.

Smith, A. (2005) The alternative technology movement: an analysis of its framing and negotiation of technology development, Human Ecology Review 12, 2: 106-119.

For more information, refer to the project website or contact Dr Adrian Smith.

The politics of low carbon innovation

Dr Adrian Smith

Recent studies emphasise sustainable innovation processes developing within protective niches. Experimentation in these spaces accumulates experience and improvements, which carries technologies from demonstration and into commercial use.

This ESRC-NWO funded collaborative project with the Eindhoven Technical University analyses the politics of providing ‘protective space’ for three low carbon innovations in the UK and the Netherlands: photovoltaic cells, offshore wind, and carbon capture and storage. We study the strategies followed by advocates of these technologies for attracting public support, and how this political competition affects the innovation process. We analyse the arguments advanced by advocates of each technology, the audiences to whom these arguments are made, and how they are re-presented to different interests. The networks of actors contributing to the development of protective space will be explored; and how their activities generate different forms of protection, e.g. economic subsidies, public investments, institutional support, valued knowledge, political backing, attaining positive symbolic significance. We will study these protections influence the development of our case-study low carbon niches.

Relevant outputs:

Smith, A., Voβ, J.P. and Grin, J. (2010) Innovation studies and sustainability transitions: the allure of the multi-level perspective, and its challenges Research Policy 39: 435-448.

Smith, A. and Kern, K. (2009) The transitions storyline in Dutch environmental policy Environmental Politics, 18, 1: 78-98.

Raven, R.P.J.M., Van den Bosch, S. and Weterings, R. (2010) Transitions and strategic niche management: towards a competence kit for practitioners International Journal of Technology Management 51, 1: 57-74.

For more information, refer to the project website or contact Dr Adrian Smith.

Regulating Health Systems in Fragile States

Dr Alice Street

How are health systems being reshaped in places of political and social instability? What happens to new frameworks of global health governance, systems of regulation, standardisation and health management when they travel to unstable places? What kinds of state infrastructures are taken for granted by the technical interventions designed and funded by international agencies, organisations and NGOs?

This Nuffield Foundation research explores these questions in Papua New Guinea; a place where the state is often labelled as ‘fragile’ and where many people live in areas without transport infrastructure or access to basic health services. Through ethnographic fieldwork in Australia and Papua New Guinea, Dr. Street traced the programs and policy directives of international organisations such as AusAID and the Global Fund as they travelled through government departments in Papua New Guinea, NGOs, and frontline health services.

Her findings show how attempts to improve health governance in fragile states and technical solutions that bypass the state are generating new geographies of inequality and exclusion. Designing appropriate health systems, Dr. Street argues, involves understanding the complex histories and relationships that are built into health infrastructures. She proposes an approach that incorporates these histories and relationships into the material fabric of new logistical and managerial health interventions.

For further information, refer to Dr Street's profile.

Unlocking the Semantic Web

The Semantic Web is the future generation of WWW technology, aimed at dramatically improving the functionality and usability of search engines. Among the key goals behind this are to advance from searching on strings of words as we currently do with, say, Google, to searching on the very meaning of those words; and to allow machines to perform the tedious work currently carried out by users in finding, combining and acting upon the information that is available on the web.

During the last decade the Semantic Web community has established basic standards for representing data and ontologies. However, these formalisms have been designed for computer processing and data exchange rather than for easy comprehension by people; while they are transparent to computers they are pretty much gobbledegook to anyone other than 'semantic web techies'. Wide access to the Semantic Web therefore depends critically on the development of transparent editing and viewing tools that will allow less specialised users to create and edit content for the new generation of the web. This is particularly obvious in the field of biomedicine, where standardised medical terminology ontologies (eg SNOMED CT, Read and UMLS) that doctors are increasingly required to use can contain many hundreds of thousands fairly impenetrable class names.

Research in the Department of Informatics, led by Professor of Computational Linguistics, Donia Scott, is addressing this problem with three years of funding from the EPSRC and in collaboration with colleagues in Medical Informatics and Biomedicine at the University of Manchester.

For more information, refer to the project website.

Optimised investigation of radioactively contaminated land

Professor Mike Ramsey

Investigations of radioactively contaminated land and buildings raise a number of new issues. The hazardous nature of some radioactive materials combined with high costs of sampling, analysis, and remediation, together make the cost effectiveness of site invesigations a major concern. One feature of many radioactive elements that makes them so potentially hazardous is the emission of penetrating gamma radiation, but this characteristic can also come to our aid in locating and quantifying radionuclides in the environment.

Professor Mike Ramsey is undertaking a project to find the most cost-effective way of characterising radioactively contaminated sites, by knowing the uncertainty of the measurements, including that from the sampling process. Traditional sampling followed by ex situ lab analysis tend to be expensive and slow. In contrast, measurements made in situ cost less, and although they often have higher uncertainty, they can give a more accurate overall assessment of the contamination at the site by enabling higher number of measurements. Development and testing of these ideas is currently taking place at Dounreay in Northern Scotland, with funding from the EPSRC and Dounreay Site Restoration Ltd. Further details are available at the Ramsey Lab web pages.

Rapid ethical assessment of biomedical research projects in Ethiopia

Dr Adamu Addissue, Wellcome Trust

Dr Adamu Addissie holds a Wellcome Trust Biomedical Ethics Studentship to investigate the feasibility of introducing Rapid Ethical Assessment into normal research practice in Ethiopia.

The idea for the project came during earlier research on podoconiosis in a remote rural community in southern Ethiopia, where some of the assumptions underlying 'Northern' research ethics were found not to fit well with local principles and customs. Professor Bobbie Farsides suggested use of Rapid Ethical Assessment in this setting, with very successful results. She is now Dr Adamu's main supervisor as he works with researchers, ethics committees and lay people in Ethiopia to investigate the benefits and limitations of using this technique for a range of studies in a range of communities. This project is still in its first year, and brings ethicists and global health researchers at Brighton and Sussex Medical School together with clinicians, ethicists and public health experts in five research institutions in Ethiopia.

Impact of low doses of ionizing radiation and ELM-EMF exposure on embryonic neuronal development

Electromagnetic fields (EMFs) have been designated a potential carcinogen by the World Health Organization based on epidemiological data showing a possible (though not certain) relationship between EMF exposure and leukaemia in children.

Given the inherent limitations of epidemiological studies, it is imperative to provide evidence for a biological mechanism or indeed, evidence that EMFs exert an impact in cells. Studies to date have failed to show clear evidence of any cellular impact of EMF exposure but there are limitations with many studies. We have found in previous work, that the embryonic neuronal stem and early progenitor cells are extremely sensitive to radiation exposure. The end point examined is the induction of apoptosis in neuronal stem/progenitor cells after low-dose radiation exposure of embryos. In our study, we have assessed apoptosis at 6 h after doses of ionising radiation from 10 to 100 mGy . Strikingly, we observe a linear dose response relationship with an impact being observed even after 10 mGy. This represents a highly sensitive assay to monitor the impact of DNA damage. We are currently examining the response after exposure to EMFs. This work is funded by a grant to Penny Jeggo by the EMF Biological Research Trust.

Further work, including a study underlying this project is shown at the Jeggo laboratory.

DNA damage responses in mammalian cells and their contribution to human health disorders

Ionising radiation is increasingly being used for medical diagnostic procedures such as CT scanning and diagnostic X-rays. We are also exposed to X-rays from natural sources such as radon and from the increased frequency of flying. Radiation exposure can result in damage to our DNA and specifically to the induction of breaks in both strands of our DNA, a lesion called a DNA double strand break (DSB).

It is important that we understand how DSBs are repaired following exposure to both low and high doses of radiation and, particularly, to assess the fidelity with which the breaks are repaired. Misrepair of DSBs can lead to translocations of genomic material, which is an initiating event in carcinogenesis. Professor Penny Jeggo has a programme grant from the Medical Research Council to study the mechanism of DNA DSB repair and the responses activated by radiation induced DSB formation. A particular interest of the laboratory is to evaluate whether exposure to low doses of radiation is harmful, whether there are sensitive individuals in the population and how to assess risks from radiation exposure based on our current knowledge. Individuals with an impaired ability to repair DSBs have been identified in the human population. Such patients are extremely sensitive to radiation exposure. Interestingly, however, the pathway that functions to repair radiation induced DSBs also functions during the development of the immune response. Consequently, such patients are also immunodeficient. The Jeggo laboratory collaborates with the two major immunodeficiency clinics in the UK, Great Ormond Street in London and Newcastle General Hospital to help the diagnosis of such patients. This is important because such patients need to receive bone marrow transplantation. Ironically, they can also be sensitive to the conditioning treatments given during transplantation.

For further information, refer to the Jeggo Laboratory.

Rapid ethical assessment of biomedical research projects in Ethiopia

Dr Adamu Addissie holds a Wellcome Trust Biomedical Ethics Studentship to investigate the feasibility of introducing Rapid Ethical Assessment into normal research practice in Ethiopia.

Impact of low doses of ionizing radiation and ELM-EMF exposure on embryonic neuronal development

Further work, including a study underlying this project is shown at the Jeggo laboratory.

DNA damage responses in mammalian cells and their contribution to human health disorders

For further information, refer to the Jeggo Laboratory.

Access to Education and Child Health

The transmission of inequalities over the lifecourse is persistent. Inequalities in health during early years are likely to reproduce themselves over time, leading to educational inequalities during childhood as well as social and economic inequalities during adulthood. In order to break the transmission of inequalities between and across generations, the Commission on the Social Determinants of Health calls for early actions, universal and progressive, which help those most in need and deal with the unfair distribution of power and resources within societies.

Within this framework, this research aims to cover different aspects of the complex relationships between education and health across the lifecourse in four developing countries: Ethiopia, India, Peru and Vietnam. In particular, the research focuses on the transmission of health inequalities during infancy into educational inequalities prior to school enrolment and seeks evidence for interventions that could potentially reduce the transmission of these inequalities over time. Two of such interventions are access to preventative health care services and increasing maternal education. These are two different interventions that lie at the health of policy arenas in developing countries.

In addition, the research takes a step forward by looking into the relationship between educational inequalities and health inequalities later in childhood. Here, the aim is to demonstrate whether differential degrees of educational inclusion are associated with a health gradient, hence leading to health inequalities. The focus is on whether the transmission of educational inequalities to health inequalities are accounted for lack of opportunities, or to put it differently social constraints, or personal circumstances meaning individuals’ decisions.

The project uses data from the Young Lives Longitudinal Study which collected information on children born between 2000 and 2001 and between 1994 and 1995 and who were living in deprived areas of Ethiopia, the state of Andhra Pradesh in India, Peru and Vietnam (refer to http://www.younglives.org.uk for more information). The Young Lives study has followed these children over time, collecting relevant information in 2002 and also in 2007, five years after the first round of data collection. The study design has enabled us to make the connections between health and education at different stages of childhood and use information from different interventions to investigate the closing or widening of inequality gaps over time.

Using different statistical approaches, the project estimates the following specific dimensions:

The nature of the health disparities between children with differential access to education.
The effect of preventative actions, such as antenatal care, during pregnancy on reducing the negative effects of malnutrition on cognitive development.
The role of maternal education as a protective factor in the transmission of disadvantage across generations.

Results suggest:

A clear gradient in the nutritional status of children with different access to schooling - children with meaningful access show better level of nutritional status than their counterparts. A large proportion of the nutritional gap between children with differential access to education is explained by structural differences – which in our research are described by previous health status, household wealth status, parents’ education, previous access to school, and parental working condition. However, a proportion of the nutritional gap between children with differential access to education is explained by unobserved characteristics, which may be attributable to the protective effect of education on health outcomes.

Overall our results suggest the importance to improve access to education to reduce inequalities, the results especially underline the protective effect of schooling on child health.

Good access to antenatal care is positively associated with child’s cognitive development in Ethiopia, Peru, and Vietnam. More importantly, the effect of nutritional deficiencies in the first months of life on subsequent cognitive development can in part be weakened if the mother had access to antenatal care services during pregnancy and birth (Peru and Vietnam). Overall, our results suggest a key role for early life interventions on reducing the transmission of inequalities over the lifecourse.
Results confirm the protective role of maternal education on maternal mental health and child development. Women with more than six years of education are less likely to show a higher number of depressive symptoms, and have children with better outcomes on both nutritional and cognitive development status. Additionally the relationship between maternal mental illness and child growth and cognitive development was detected only in the group of less educated women

Overall our results suggest that maternal education plays a protective role not only on mothers’ and children’s general wellbeing but it is a key factor in reducing the transmission of disadvantage across generations.

The project was disseminated in three conferences and several organised meetings. In terms of conferences, results from this project were presented at the SLLS Developments and Challenges in Longitudinal Studies from Childhood on the 22nd to 24th September 2010 in Clare College, Cambridge, UK. We also presented at the International Conference for the British Psychological Society in November 2010, Never Too Early, Never Too Late: Learning For Life at Milton Keynes, UK. We also presented at the London School of Education during the Reproductive Morbidity and Poverty Workshop Announcement in November 2010. We attended organised meetings by the Young Lives team in Oxford and the Global Health group of the University of Sussex during 2011. Meetings at the London School of Economics and at the University of Sussex were attended by NGOs and policymakers.

This project is intended to provide further evidence on the research themes of the Commission on the Social Determinants of Health. Health inequalities arise because of the circumstances in which people live, work and age and the systems put in place to deal with these life events. Unless one deals with these issues, health inequalities will continue to persist across generations.

Towards global health security?: The medicalisation of security in the 21st Century

Professor Stefan Elbe.

A number of prominent health issues ranging from AIDS and SARS via anthrax terrorism scares through to avian and swine flu have recently raised the highest levels of political concern around the world but to what extent does the international spread of disease threaten global security?

This study consists of a comparative case study analysis of four different kinds of health security issues, pandemic threats (such as swine flu, bird flu, and SARS), bio-terrorism threats (such as anthrax and smallpox), endemic diseases that threaten human security (such as AIDS, malaria and tuberculosis) and wider public health threats (such as smoking, obesity and alcoholism).

Through a series of interviews carried out with key participants in health security debates the project shows how international politics is no longer characterised by its preoccupation with a single disease, but by a need to confront what is now an epidemic of epidemics.

The study argues that the recent rise of health security debates can be shown to mark the ‘medicalisation’ of security in at least three respects. These debates:

Partially redefine the problem of insecurity in world politics as a medical problem
Facilitate a greater role for medical professionals in the analysis and formulation of security policy
Push for strategies of securing populations that necessitate a range of medical interventions, as can be seen in the rise of new ‘medical countermeasures’.

Practising security increasingly demands that citizens become patients, that states resemble huge hospitals, and that security itself becomes a technology of medical control.

The Psychosocial Tools Project

Medical first responders have a range of specialisms and the expertise to deal with the spectrum of major accidents and mass emergencies. Alongside these formal skills, such first responders also have informal knowledge for dealing with stress in both the public and themselves. These ‘soft skills’ have been shown to contribute to recovery and therefore constitute a key contribution to psychosocial resilience. This project, funded by the Department of Health and Royal College of Psychiatrists, produced an evidence-base of professional first responders’ knowledge and needs for psychosocial resilience in order to develop tools for training, education and support. Focus groups and an online Delphi survey of over 100 ambulance paramedics identified consensus in a number of areas, including on sources of stress, the impacts of distress on their work, meeting their own emotional needs, needs for training in psychosocial skills for patients, and the professionals’ own needs for psychosocial training and support. These findings have been published in the Emergency Medicine Journal and have been translated into a toolbox to be used in training and support on psychosocial skills for medical first responders.

Drury, J., Kemp, V., Newman, J., Novelli, D., Doyle, C., Walter, D., & Williams, R. (2012). Psychosocial care for persons affected by emergencies and major incidents: A Delphi study to determine the needs of professional first responders for education, training and support. Emergency Medicine Journal. doi:10.1136/emermed-2012-201632. Available here

For further information visit the project website.