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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

A ‘red herring’ is something that diverts attention from a topic or line of inquiry (Collins 2009). We believe that the main line of argument in the Viewpoint by Fisk et al. (2011) constitutes such a red herring. By enthusiastically promoting investment in Research & Development (R&D) for new drugs and diagnostic techniques, the authors divert attention from the top priorities in maternal and perinatal health in lowand middle-income countries. These priorities are (as Fisk et al. state in their paper): providing access to comprehensive reproductive health services, to skilled care during and immediately after childbirth, and to emergency care when life-threatening complications develop (International Women’s Health Program 2009). Fisk et al. do not challenge that health services in lowand middle-income countries need to be improved. But they anticipate new pharmaceutical products and diagnostic techniques which they imply will make independent contributions towards improving maternal and perinatal health – provided that there will be increased investment in R&D. We are not told what exactly these products will be like. They are so far entirely hypothetical, but will supposedly offer effective technical solutions to longstanding social and health problems. One can see Fisk et al. Viewpoint as visionary – or as peddling ‘silver bullets’, magically simple solutions to longstanding, complex problems. With their message, Fisk et al. risk diverting not only attention but also scarce resources – in the worst case, away from the health care services in need of improvement.

Of silver bullets and red herrings: invited commentary to Fisk et al.

Die Weltgesundheitsorganisation initiierte im Jahre 1988 ein Programm zur globalen Eradikation der Poliomyelitis. Mithilfe von Routine- und Massenimpfungen insbesondere von Vorschulkindern konnte die Erkrankung zuletzt auf 3 endemische Lander (Afghanistan, Pakistan und Nigeria) zuruckgedrangt werden. Allerdings kommt es – begunstigt durch Reisebewegungen, Konflikte und unterentwickelte Gesundheitssysteme – seit dem Beginn des 21. Jahrhunderts immer wieder zu Sekundarepidemien in zahlreichen Landern. Hinzu kommen technische (z. B. Ruckmutationen des oralen Impfvirus zu Quasi-Wildviren) sowie sozio-politische (z. B. Ablehnung der Impfung von muslimischen Bevolkerungsgruppen in Nigeria und Pakistan) Probleme mit dem Impfstoff in den verbliebenen Endemielandern. Es erscheint daher fraglich, ob das Ziel einer globalen Eradikation dieser Erkrankung im Rahmen des aktuellen Ausrottungsprogramms in absehbarer Zeit erreichbar ist.

[Poliomyelitis--Challenges for the Last Mile of the Eradication Programme].

Reforming public and global health research in Germany

An outbreak of meningitis with 85 secondary cases and an unusually high attack rate of 16% occurred in a rural village in southern Tanzania. We investigated risk factors for clinical illness in a community-based case-control study. Attending a commercial mobile video show carried an age- and sex-adjusted odds ratio of 8.0 (95% confidence interval: 3.8-16.8). The videos had been shown in a windowless and overcrowded storeroom and had been attended by the primary case, a visitor from neighbouring Mozambique who died from meningitis on the following day. We conclude that mobile video shows, which have become popular in many developing countries, constitute a potential health hazard in areas prone to meningitis epidemics.

Meningitis propagation in southern Tanzania: the role of a village video show.

Mit insgesamt fast 16 Millionen Menschen hat ein groser Teil der Bevolkerung in Deutschland einen Migrationshintergrund Die Gruppe der Menschen mit Migrationshintergrund umfasst Personen auslandischer Staatsangehorigkeit und deutsche Staatsangehorige, die selbst oder deren Eltern nach Deutschland zugewandert sind Die beiden grosten Bevolkerungsgruppen mit Migrationhintergrund sind (Spat-)Aussiedlerinnen und (Spat-)Aussiedler sowie Menschen turkischer Herkunft Zusammen machen sie knapp die Halfte der Bevolkerung mit Migrationshintergrund aus (vgl Statistisches Bundesamt 2012) Menschen mit Migrationshintergrund unterscheiden sich in gesundheitsrelevanten Faktoren von der Mehrheitsbevolkerung – beispielsweise hinsichtlich der Haufigkeit und des Verlaufs von Erkrankungen, aber auch im Hinblick auf die Nutzung von Versorgungsangeboten Bestimmte chronische Erkrankungen wie Diabetes mellitus und psychische Erkrankungen kommen bei Menschen mit Migrationshintergrund haufiger vor und treten im Vergleich zur nicht migrierten Bevolkerung in einem jungeren Alter auf (vgl Razum et al 2008) Als Grunde fur diese Unterschiede werden lebenslaufbedingte Einflussfaktoren vermutet, die sich zwischen Menschen mit und Menschen ohne Migrationshintergrund unterscheiden Diese umfassen zum einen Faktoren, denen Menschen, die selbst zugewandert sind, in ihrem Herkunftsland ausgesetzt waren Zum anderen handelt es sich um negative Faktoren, denen sie in Deutschland ausgesetzt sind (vgl Spallek et al 2011) Zu letzteren zahlen ein im Durchschnitt ungunstigerer sozialer Status sowie damit einhergehende geringere gesellschaft liche Teilhabechancen (vgl Statistisches Bundesamt 2012; Razum et al 2008) Aber auch schwierigere Arbeitsbedingungen, die vor allem fur die sogenannten „Gastarbeiter“ vorherrschten und die fur einen grosen Teil von Menschen mit Migra tionshintergrund auch Medizinische Rehabilitation und Leistungen zur Teilhabe am Arbeitsleben bei Menschen mit Migrationshintergrund

Medizinische Rehabilitation und Leistungen zur Teilhabe am Arbeitsleben bei Menschen mit Migrationshintergrund Eine Bestandsaufnahme zur Zugänglichkeit und Qualität der Versorgung

Oliver Razum

Papers

Of silver bullets and red herrings: invited commentary to Fisk et al.

[Poliomyelitis--Challenges for the Last Mile of the Eradication Programme].

Reforming public and global health research in Germany

Meningitis propagation in southern Tanzania: the role of a village video show.

Medizinische Rehabilitation und Leistungen zur Teilhabe am Arbeitsleben bei Menschen mit Migrationshintergrund Eine Bestandsaufnahme zur Zugänglichkeit und Qualität der Versorgung