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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

BACKGROUND Health disparities in children of immigrants are prevalent from birth and are hypothesized to - in part - emerge as a biological consequence of migration's unfavorable social and psychological sequelae. The aim of this study was to examine whether maternal migrant background is associated with inflammation during pregnancy - a key pathway by which maternal states and conditions during pregnancy may influence fetal development and subsequent pregnancy, birth, and child developmental and health outcomes. MATERIAL AND METHODS Data was available from 126 pregnant women who participated in a population based multi-site prospective birth cohort study in Bielefeld and Berlin, Germany. The study included two study visits in mid- and late pregnancy. At each visit, a composite maternal pro-inflammatory score was derived from circulating levels of plasma inflammatory markers (IL-6, CRP). Migrant background was defined by country of origin of participants and their parents' (Turkey or other) and generation status (1st or 2nd generation). We applied hierarchical linear models (HLM) in order to quantify the relationship between different migrant background variables and inflammation during pregnancy after adjustment for potential confounders (including socioeconomic status). RESULTS Migrant background was significantly associated with inflammation during pregnancy. When compared to women without migrant background, levels of inflammation were increased in 1) pregnant women with migrant background in general (B = 0.35, SE = 0.12, p < .01); 2) 1st (B = 0.28, SE = 0.15, p < .10) and 2nd generation (B = 0.40, SE = 0.15, p < .01); 3) women with a Turkish migrant background (B = 0.28, SE = 0.14, p < .10) and women with another migrant background (B = 0.42, SE = 0.15, p < .01); and 4) 2nd generation Turkish origin women (B = 0.38, SE = 0.20, p < .10), 1st generation women with other migrant background (B = 0.44, SE = 0.26, p < .10), and 2nd generation women with other migrant background (B = 0.43, SE = 0.17, p < .05). DISCUSSION Our findings support a role for maternal inflammation as a pathway of intergenerational transmission of migration-related health inequalities, suggest that the effect seems to persist in 2nd generation immigrants, and highlight the need for future research and targeted interventions in this context.

Association of maternal migrant background with inflammation during pregnancy - Results of a birth cohort study in Germany.

MigrantInnen haben gesundheitliche Vor- und Nachteile gegenuber der Mehrheitsbevolkerung. Der Zusammenhang zwischen Migration und Gesundheit ist mehrdimensional, weitere (soziale) Faktoren mussen bei der Interpretation beachtet werden Erklarungsmodelle bilden die Komplexitat des Zusammenhangs ab. Die zentralen Modelle haben eine Perspektive auf den gesamten Lebenslauf der Migranten (vor, wahrend und nach der Migration). Sie helfen der kommunalen Gesundheitspolitik, geeignete Daten zu erheben und wirksame Interventionen zu entwickeln.

Gesundheitliche Chancen und Risiken von MigrantInnen: Handlungsmöglichkeiten einer kommunalen Gesundheitspolitik

Paralytic poliomyelitis is quickly disappearing from the world. In June, the European Region of WHO was certified to be polio-free. This followed similar achievements in the Americas and the Western Pacific Region which had been certified polio-free in 1994 and 2000, respectively (WHO 2002a). Last year, less than 500 confirmed cases of polio were reported world-wide (WHO 2002b). Transmission of the polio wild virus has been restricted to 10 countries, among them India, Pakistan and Nigeria (Global Polio Eradication Initiative 2002). This is an enormous accomplishment. Not long ago, paralytic polio was a dreaded affliction of young people everywhere. For example, 50 years ago, in the summer and autumn of 1952, Germany was hit by the most severe polio outbreak the country ever experienced. Almost 10 000 cases were recorded in a single year, of whom 800 resulted in death (Pöhn & Rasch 1993). Over the following 10 years, polio outbreaks in industrialized countries ceased, thanks to successful mass immunization campaigns. In developing countries, childhood immunization coverage improved markedly through the Expanded Programme on Immunization. Notwithstanding, there were still 350 000 people affected by poliomyelitis in 1988. In that year, the World Health Assembly resolved to eradicate polio from the world. This goal is today being pursued by the Global Polio Eradication Initiative, an alliance of WHO, Rotary International, CDC, UNICEF and others. The WHO defines eradication as the achievement of a status whereby no further cases of a disease occur anywhere, and continued control measures are unnecessary (Last 1995). Technically, polio eradication appears to be feasible: an effective vaccine is available, and there exists no natural reservoir of polio virus outside humans. Recent developments, however, indicate that the eradication effort faces substantial problems. I shall discuss two of them in more detail. The first one relates to the attenuated live vaccine, the second one to the organization of immunization programmes.

https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1365-3156.2002.00958.x

Editorial: A farewell to polio vaccination? Not anytime soon

INTRODUCTION
Recent quantitative research in public health indicates that women across the globe report suboptimal treatment during institutional deliveries. The most common approaches used to comprehend this abuse, violence, or mistreatment have not fully achieved a balance between theoretical perspectives and empirical assessment. To contribute to a more accurate account of the cultural driving forces, institutional conditions, direct expressions, and individual perceptions that undermine or preserve what we define as “integrity at birth”, we develop a new theoretical approach and a multi-level model.


PURPOSE OF RESEARCH
We ground the terminology for integrity at birth upon theoretical foundations, referring to two theoretical discourses: medicalization and risk theory on the one hand, and embodiment and intersectionality theory on the other. We then contextualize this in a multi-level model in order to operationalize its potential for public health research.


RESULTS
The concept and model of “integrity at birth” recognize that women in labor suffer from a number of gender-specific violations, which can be expressed at all levels (macro to micro) as implicit, inherent, normalized and invisible, or explicit, intentional, visible and socially accepted. In distinguishing six separate domains, we propose a theoretical contribution for obstetric care practices.


CONCLUSION
Integrity at birth, as a multi-level and theoretically grounded approach, constitutes an important step towards raising awareness about this issue beyond the dimensions that have been studied to date in quantitative health research. Beyond available evidence of disrespectful and abusive practices constituting violations to integrity at birth, this study takes a step towards understanding gender-based violence and inequalities of health at childbirth.

Un regard théorique sur l’intégrité à la naissance : médicalisation, théories du risque, embodiment et intersectionnalité

Die Epidemiologie ist aus Sicht vieler Mediziner ein so genanntes „kleines“ Fach mit einer kurzen Geschichte, gemessen etwa an der Chirurgie oder der Inneren Medizin. Fur Public Health jedoch ist die Epidemiologie eine Kerndisziplin (Hurrelmann et al. 2006) mit differenzierten fachlichen Ausrichtungen. Wir zeigen in diesem Kapitel anhand von ausgewahlten Beispielen, wie sich die Epidemiologie in Deutschland seit den 1980er Jahren immer starker professionalisiert hat. Dadurch tragt sie einerseits wesentlich zum Erfolg von Public Health bei. Andererseits wird sie als klinische Epidemiologie von der Medizin zunehmend als gleichberechtigter Partner gesucht. Eine weitere Professionalisierung, besonders im Bereich solcher interdisziplinaren Zusammenarbeit, gehort zu den Herausforderungen, denen sich die deutsche Epidemiologie in den nachsten Jahren gegenubersieht.

Oliver Razum

Papers

Association of maternal migrant background with inflammation during pregnancy - Results of a birth cohort study in Germany.

Gesundheitliche Chancen und Risiken von MigrantInnen: Handlungsmöglichkeiten einer kommunalen Gesundheitspolitik

Editorial: A farewell to polio vaccination? Not anytime soon

Un regard théorique sur l’intégrité à la naissance : médicalisation, théories du risque, embodiment et intersectionnalité

Die Professionalisierung der Epidemiologie in Deutschland im Kontext von Public Health