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admission. This proportion could already be greater in some parts of the country and may increase if referrals of cases of self-poisoning increase faster than the facilities for their assessment and management. The provision of social work and psychiatric expertise in casualty departments may be one means of preventing unnecessary medical admissions without risk to the patients. Dr Blake's and Dr Bramble's figures do not demonstrate, however, that any advantage would attach to medical teams taking over assessment from psychiatrists except that, by implication, assessments would be completed sooner by staff working on the ward full time. What the figures actually suggest is that if assessment of overdoses were left to house doctors there would be an increase in admissions to psychiatric units (by 19°U), outpatients (by 5O°'), and referrals to social services (by 140o). So for house doctors to assess overdoses would provide no economy for the psychiatric or social services. The study does not tell us what the consequences would have been for the six patients who the psychiatrists would have admitted but to whom the house doctors would have offered outpatient appointments. E J SALTER

Vitamin D deficiency.

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Part I: AN INTRODUCTION TO INQUIRY. 1. Human Inquiry and Science. 2. Paradigms, Theory, and Research. 3. The Ethics and Politics of Social Research. Part II: THE STRUCTURING OF INQUIRY: QUANTITATIVE AND QUALITATIVE. 4. Research Design. 5. Conceptualization, Operationalization, and Measurement. 6. Indexes, Scales, and Typologies. 7. The Logic of Sampling. Part III: MODES OF OBSERVATION: QUANTITATIVE AND QUALITATIVE. 8. Experiments. 9. Survey Research. 10. Qualitative Field Research. 11. Unobtrusive Research. 12. Evaluation Research. Part IV: ANALYSIS OF DATA:QUANTITATIVE AND QUALITATIVE . 13. Qualitative Data Analysis. 14. Quantitative Data Analysis. 15. Reading and Writing Social Research. Appendix A. Using the Library. Appendix B. Random Numbers. Appendix C. Distribution of Chi Square. Appendix D. Normal Curve Areas. Appendix E. Estimated Sampling Error.

社会研究方法基础 = The Basics of Social Research

List of Figures List of Tables Foreword Introduction Robin P. Fawcett, M.A.K. Halliday, Sydney M. Lamb and Adam Makkai 1 Language as Code and Language as Behaviour: A Systemic-Functional Interpretation of the Nature and Ontogenesis of Dialogue M.A.K. Halliday 2 Metaphors of Information John Regan 3 How Universal is a Localist Hypothesis? A Linguistic Contribution to the Study of 'Semantic Styles' of Language Yoshihiko Ikegami 4 Some Speculations on Language Contact in a Wider Setting Jeffrey Ellis 5 Ways of Saying: Ways of Meaning Ruqaiya Hasan Index

Language as social semiotic

Molecular biology and genomic research provide fascinating insights into the intricate functioning of human life at the cellular level (Parrington 2015). Promises abounded on how their achievements will improve population health. ‘‘We now have the possibility of achieving all we ever hoped for from medicine’’, stated the then UK Science Minister Lord Sainsbury in the year 2000 when the human genome had first been sequenced, in agreement with many of the scientists involved (BBC 2000). Fifteen years later the health impact of ‘‘omics’’ has been disappointing— equally so for ‘‘public health genomics’’ (Boccia et al. 2014), for ‘‘genomic medicine’’ (Hall et al. 2010), and for ‘‘personalised’’ or ‘‘precision medicine’’ (James 2014). This is no longer the view of only a minority—it is supported by recent pieces in the New England Journal of Medicine (NEJM) (Bayer and Galea 2015) and in The Journal of the American Medical Association (JAMA) (Joyner and Paneth 2015). And yet, inspite of the limited health impact so far, the current funding landscape is increasingly biased towards favouring omics research over other areas of health research (Bayer and Galea 2015). A case in point is the EU’s proposed new Horizon 2020 health work programme for 2016/17, which allocates about 70 % of the overall indicative budget of 934 million Euros to a call on personalised medicine (European Commission 2015). Does ‘‘omics’’ hold such unique promises that a special case can be made, temporarily exempting it from the need to demonstrate its impact? Researchers and politicians defend the budgetary needs with incessant claims of impending success in developing tools to improve population health. But this is not the only issue. Recently, it has been argued that public health has allegedly missed out on omic-based discoveries, thus hindering their implementation. In Germany, the ‘‘National Academy of Sciences Leopoldina’’ and two other distinguished academies published a joint statement on the future development of, and required structures for, public health in the country (Leopoldina 2015). Apart from many valid propositions (including the call for a solid evidence base for public health interventions), they again claim that ‘‘...genomics and other Omics on a population basis, the new science of molecular evolution of infectious diseases and, importantly, the genomic understanding of the evolution of man (‘‘evolutionary medicine’’) open up new vistas to understanding health and disease, public health and prevention...’’ (Leopoldina 2015). In view of the criticism in NEJM and JAMA that evidence is lacking, this appears over-enthusiastic and premature with regard to public health. Enthusiasm is an important driver of scientific progress. However, publicly funded research must also stand the scrutiny of process and outcome evaluation. Public health does have a lot to show, for example in the field of tobacco control in western countries. Smoking rates have declined in many population groups, followed by declines in cancer and cardiovascular disease rates. In the case of Germany, HIV/AIDS prevention campaigns involving a broad range of stakeholders have contributed to a decline both in new infections as well as in stigmatisation. With respect to improving public health outcomes, interventions to O. Razum (&) Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, P. O. Box 100131, 33501 Bielefeld, Germany e-mail: oliver.razum@uni-bielefeld.de

Molecular and genomic sciences in health: apply the established rules of evidence.


 Hintergrund Die gesundheitlichen Bedarfe Geflüchteter ergeben sich
 nicht nur aus Expositionen während Krieg und Flucht. Auch Determinanten
 aus dem Lebenslauf und etabliertes Gesundheitsverhalten spielen eine Rolle. Wir
 untersuchten daher die gesundheitliche Lage in der Ukraine vor der russischen
 Invasion 2022 und ihre Relevanz für die Versorgung ukrainischer
 Geflüchteter in Deutschland aus Sicht des Öffentlichen
 Gesundheitsdienstes (ÖGD).
 Methode Rapid Review in der Medline-Datenbank sowie Suche in
 einschlägigen ukrainischen und internationalen Gesundheitsdatenbanken.
 Narrative Synthese der Ergebnisse, gefolgt von einer Priorisierung der
 Gesundheitsprobleme und Maßnahmen durch zwei Mediziner mithilfe des
 Risikomatrix-Ansatzes.
 Ergebnisse Niedrige Impfquoten bestehen bei Covid-19 und führen zu
 Ausbrüchen in Unterkünften. Bei Masern und anderen
 Grundimmunisierungen bestehen Impflücken überwiegend bei
 älteren Kindern; 2–5-Jährige haben die zweite
 Masernimpfung noch nicht erhalten. HIV- und Tuberkulose-Therapien können
 durch die Flucht unterbrochen sein. Kommen zunehmend ältere
 Geflüchtete, so stehen aufgrund der Flucht unzureichend behandelte
 Herz-Kreislauferkrankungen und vorbestehende psychische Traumatisierung sowie
 ggf. akut therapiebedürftige Krebserkrankungen im Vordergrund. Bei
 ukrainischen Geflüchteten kann ein Misstrauen gegenüber mit dem
 Staat assoziierten Gesundheitsmaßnahmen bestehen, wie die
 Impflücken zeigen.
 Schlussfolgerung Der Zugang Geflüchteter zu kurativer und
 präventiver Gesundheitsversorgung sollte ohne bürokratische
 Hürden und Einschränkungen gewährleistet werden. Durch
 die Analyse von Gesundheitsstatistiken der Ukraine sowie wissenschaftlicher
 Publikationen können Angebote des ÖGD besser angepasst und ein
 Fehleinsatz von Ressourcen vermieden werden.

Gesundheitliche Lage in der Ukraine vor Kriegsbeginn und ihre
 Relevanz für die Versorgung ukrainischer Geflüchteter in
 Deutschland: Literaturdurchsicht, Risikoanalyse und
 Prioritätensetzung

Menschen mit Migrationshintergrund unterscheiden sich in gesundheitsrelevanten Aspekten von Menschen ohne Migrationshintergrund. Bestimmte chronische Erkrankungen treten bei Menschen mit Migrationshintergrund beispielsweise haufiger auf. Bisher begegnet diese Bevolkerungsgruppe zahlreichen Barrieren im Gesundheitssystem, die ihren Zugang zu Angeboten behindern und Versorgungsergebnisse nachteilig beeinflussen konnen. Diversity Management kann einen Beitrag leisten, diese Barrieren abzubauen und die Versorgung fur die gesamte Bevolkerung, einschlieslich Menschen mit Migrationshintergrund, nutzerorientierter zu gestalten.

Die Gesundheit von Menschen mit Migrationshintergrund aus sozialepidemiologischer Sicht

Breast cancer is the leading cause of cancer death and morbidity among women worldwide. In Germany an estimated 46,000 women are diagnosed with breast cancer every year, and 18,000 die of the disease. So far, limited information is available on possible epidemiological and clinical differences between women of German origin and other ethnic or national groups in Germany. Such differences between migrants and the general population could hint to underlying causes of disease and to differential access to medical care. In this paper we present epidemiological information on breast cancer among Turkish women in Germany and describe a future research agenda addressing these questions.

Oliver Razum

Papers

Molecular and genomic sciences in health: apply the established rules of evidence.

Gesundheitliche Lage in der Ukraine vor Kriegsbeginn und ihre Relevanz für die Versorgung ukrainischer Geflüchteter in Deutschland: Literaturdurchsicht, Risikoanalyse und Prioritätensetzung

Die Gesundheit von Menschen mit Migrationshintergrund aus sozialepidemiologischer Sicht

[Breast cancer among Turkish women in Germany - epidemiology and research agenda].

Pflege von Menschen mit Migrationshintergrund – Spezifische Bedürfnisse erkennen