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reviews 212 book sciousness of the influence of health factors cepted it is a comprehensive and at times inpregnancy the medicalisation ofchildbirth captivating review ofawhole field ofresearch notices the rise ...

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                                                                                                                                                                                  reviews
                        212                                                                                                                                                Book
                                                                               sciousness of the influence of health factors           cepted, it is a comprehensive and at times
                                                                               inpregnancy, the medicalisation ofchildbirth,           captivating review ofawhole field ofresearch.
                                   NOTICES                                     the rise offeminist sociology, and the voices of                                       MARKABELLIS
                                                                               anarticulate mass ofpregnantandparturating                        Senior Lecturer in Public Health Medicine,
                                                                               women, have made it a noisy arean. Ob-                                              University ofLiverpool.
                                      Public Health Association                stetricians and gynaecologists are divided be-
                        European              Pamplona, Spain, 20-22           tween defending their hospital citadels and
                        Annual Meeting,                  the 9th Health        yielding to the siren voices outside; patients
                        November 1997 (including           and the Span-       want both the security of good medical care             Diet and Cancer: Markers, Prevention
                        Services Research Conference Management                 and the comforts ofhome; militant midwives             and Treatment (Advances in Experimental
                        ish Public Health and Health                            and health visitors strive to preserve and ex-         Medicine and Biology Volume 354). Edited
                        meetings). For further information contact:            pand their hard-won roles. Caught between               by Maryce MJacobs. (Pp 256; $79.50). New
                        Idoia Gaminde, Facultad de Economicas,                  all these pressures, the GPs, in this brief            YorkandLondon: PlenumPress, 1994. ISBN
                        Universidad Publica de Navarra, Campus de               paper, fight their corner. They want obstetric         0 306 447 231
                        Arrosadia 31006 Pamplona, Spain. Tel: +34               training to move from its hospital base out
                        48 169420. Fax: +34 48 169404. Email:                   into the community, emphasising the relative           This volume is the proceedings of a con-
                        EUPHA-SESPAS@upna.es. Forupdated in-                    "normality" of most pregnancies; closer col-           ference on nutrition and cancer held in 1992.
                        formation abouttheprogramme, visittheweb                laboration with midwives and greater at-               It is heavily biochemical, but a smattering
                        page: http://animal.upna.es/economia/eupha.             tention to the quality of care. They are quiet         of epidemiological research is included. It
                                                                                over pay (one possible reason why GP-mid-              provides details of possible mechanisms for
                        Cornerstones for Mental Health: The                     wife units are declining), and differences             nutrients causing or preventing cancer. Of
                        1997 World Congress ofthe World Fed-                    within their own ranks. Do they really speak           particular interest to epidemiologists would
                        erationfor MentalHealth, 6-11 July 1997,                with one voice?                                        be chapters 4-6, which describe possibilities
                        Lahti and Helsinki, Finland. For more in-                                                                      for the development of biological markers
                        formation, contact: KaKo Congress Services,                                      BERNARD INEICHEN              for cancer risk. Chapter 4 also contains an
                        "Cornerstones", PO Box 762, FIN-00101                                             Lecturer in Public Health,   interesting discussion of the difficulties in
                        Helsinki, Finland. Fax: +358 9 492 810.                                    Department ofPublic Health and      addressing racial/ethnic differences in diet
                        Email:_kako ar@cc.helsinki.fi.                                                               Primary Care,     and cancer. Chapters 8 and 9 describe the
                                                                                                     Charing Cmss and Westminster                                                  garlic
                                                                                                                   Medical School.     possible protective effects ofconsuming         as
                                                                                                                                       and green tea, mainly using rat studies
                                                                                                                                       examples. Chapter 10 covers the possibility
                                                                                                                                       ofsoybean containing foods reducing the risk
                          BOOKREVIEWS                                                                                                  of breast and prostate cancer due to their
                                                                                                                                       isoflavone content. Chapter 11 is an excellent
                                                                                                                                       example of a "molecular epidemiological"
                                                                practical       Human energetics in biological an-                     approach,     it  integrates    exposure    meas-
                        Epidemiological         studies:    a       £14.95      thropology. Stanley J Ulijaszek. (Pp235;               urements with epidemiological studies. The
                        guide. By Alan J Silman. (Pp 175;                       £35.00; US$54.95). Cambridge: Cambridge                chapter uses aflotoxin excretion in the urine
                        pbk;    £40.00 hbk). Cambridge: Cambridge               University     Press,   1995.    ISBN 0-521-           as a marker for human liver cancer. The last
                        Unversity Press, 1995. ISBN 0-521-43979-5               43295-2.                                               four chapters consider nutritional problems
                         (pbk), 0-521-43371-1 (hbk).                                                                                    and support in the treatment of cancer.
                                                        written originally      The fundamentals of life involve the con-                 This is not a book to browse through at
                         This introductory text was                             version of food into body, energy, and ul-             bedtime, but it could be a useful reference
                         for trainee public health physicians as a guide        timately children. This book explores the               for researchers working in the field of nu-
                         to the undertaking of simple epidemiological           anatomical     and physiological       limitations      trition and cancer.
                         (largely field) studies. It is admirable for this      placedonthisprocessbythehumancondition
                         purpose and has strong sections on study               and the development of diversity in human                                                  JANET CADE
                         design,    questionnaire     design,    and    de-     energetics in order to adapt to the varying                            Lecturer in Nutritional Epidemiology,
                         velopment, data analysis and interpretation,           ecologies occupied by different populations.                                       University ofManchester.
                         ethical issues, and project costings. There are           Ulijaszek's studyofthis process is thorough,
                         many worked examples and the section on                withcomprehensivecoverage oftheliterature,
                         the validity of information and the re-                making the text a useful reference tool for the
                         producibility    of measurements are par-               specialist student and academic. The more              Tobacco and Health. Karen Slama (Ed).
                         ticularly useful to anyone setting up a survey.         casual reader may wish to skip through the             (Pp 1039; $US175.00). New York: Plenum
                         This text therefore will be useful to a wide            first half of the book which deals in extensive        Press, 1995. ISBN 0-306-45111-5.
                         range of individuals including hospital spe-            detail with basics of adaptation, evolution,
                         cialists and general practitioners.                     andmethodologyinmeasuringandmodelling                  "Theworldover, tobacco manufacturers andmer-
                           The book more than adequately fulfils its             energy flow through human populations.                 chants put their ownfinancial interests before the
                         title and contains a wealth ofimportant prac-           However, those who persevere with this first           health andlives ofthe thousandmillion consumers
                         tical hints on designing and running surveys.           half will be rewarded with an excellent sum-           to whom they sell their products."
                         As a stand-alone text for epidemiology and              mary of the human adaptive process but                                                                ad-
                         public health, however, there are some gaps             firmly returned to earth with the detailed             So said Hiroshi Nakajima in his openingTo-
                            notably on the analysis of routine data,             practicalities of the scientific methods in-           dress to the 9th World Conference on
                         health services research, screening, and clin-          volved in researching this field.                      bacco and Health in Paris in 1994. It was a
                         ical trials. The book is presently unreferenced           In the second half, the pace accelerates as          recurringtheme, togetherwiththreeworrying
                         but this may be rectified in future editions.           the author unravels the relationship between           trends: the persistent excessive consumption
                                                                                 the availability ofenergy and the development          by young people; the growth in women's
                                                    JOHNWGYARNELL                ofthe reproductive process, the physical stat-         smoking; and the spread of smoking to de-
                                             Department ofEpidemiology and       ure of different populations, and even the             veloping countries and central and eastern
                                                               Public Health,               of societies. Here, covering aspects        Europe.
                                            The Queen's University ofBelfast.    structure                              countries,         This book is the conference proceedings
                                                                                 of developing and developed                            and consists of over 200 individual con-
                                                                                 Ulijaszek explores concepts useful to an-              tributions documenting the current position
                         Therole ofgeneral practice in maternity                 thropologist,    ecologist,   and health pro-          in the battle against the tobacco barons. Con-
                         care. Report of Royal College of General                fessional.                                      in-     tributions range from analysis of the dev-
                          Practitioners     Maternity      Care     Group.          The author provides all the necessary                astating health effects, through prevalence
                          (Occasional Paper 72) (Pp 14; C11.00).                 formation to conclude with a discussion of              surveys to describing and evaluatingthe grow-
                          London: Royal College of General Prac-                 what such an anthropological approach has               ing repertoire of interventions to reduce up-
                          titioners, 1995. ISBN 0-85084-218-2.                   achieved and where such research may pro-               take and promote cessation. It is a large and
                                                                                 gress. Unfortunately, however, the book fin-            expensive book andwill probably appeal most
                          Maternitycarehas,inrecentdecades,become                ishes abruptly instead, leaving the reader                 librarians and specialists. It will certainly
                          something of a cockpit. A growing con-                 without any real sense of direction. This ex-           to
             Book reviews                                                                                                                                                             213
             prove useful for students, researchers, and                 tone includes repeated reminders that work-                sheneedstorefertoitveryoftenforadditional
             activists.                                                  ing with black carers is the best way to ensure            information.
                Inevitably, some contributions are rather                success.                                                      Given that primary health care pro-
             mundane, repetitious, or poorly presented;                     So the second section (chapter 5: "Di-                  fessionals usually receive scant training on
             though there are plenty of gems to com-                     lemmas in developing support for Black ca-                 nutrition, this book can help to fill the gap as
             pensate.    I   particularly    enjoyed the con-            rers")   sits  oddly. The separate/integrated              it provides much interesting information in a
             tributions of Alan Blum and Eric Solberg.                   issue seems covered by previous advice to                  format that facilitates its use as a guide in
             There are many fascinating examples of in-                  be specific rather than specialist. Describing             daily practice.
             novative practice from around the world. An                 black carers as not seeking help because, "...                                                 JESUS
             example is the Goethe Chalenge Trophy. A                    they are looking after someone, usually a                                                               VIOQUE
             44 pound silver bust of the poetic genius is                family member" clashes with repeated warn-                                          Department ofPublic Health,
             awarded each year to the German medical                     ings against the myth of, "they look after their                                           University ofAlicante,
             school with the lowest rate ofsmoking among                 own". Challenging racism, ensuring in-                                                                     Spain.
             its students and faculty staff. The UK equi-                dividually tailored services, and involving the
             valent might be the Roy Castle Cup, though                  voluntary sector are all important but would
             it doesn't have quite the same cultural res-                fit better in the final chapter (third section).           Community Health Indicators: Defin-
             onance.                                                     This looks to the future, where services for               itions and Interpretations. Working Group
                The metaphor of a global battle with the                 black carers must be a mainstream mul-                     on Community Health Information Systems
             tobacco industry is used by many con-                       tiagency business.                                         and S Chevalier, R Choiniere, M Ferland, M
             tributors. Its aptness is demonstrated by the                  If services develop nationally in the way               Pageau, and Y Sauvageau. (Pp 224; no price
             chilling descriptions by Connolly, Mackay,                  they should, one would hope the author will                stated).    Ottawa:     Canadian Institute         for
             Gorecka and others ofthe tobacco industry's                 soon replace this affordable book with more                Health Information, 1995. ISBN 1 896104
             unscrupulous tactics in exporting its product               examples of widespread and permanent ser-                  08 8.
             to developing countries and eastern Europe.                 vices for black carers. I look forward to that.
                The book mixes optimism and pessimism.                                                                              This book, published by the Canadian In-
             Those of the "glass is half full" view will                                           JO WALSWORTH-BELL                stitute for Health Information (CIHI), is the
             be encouraged by the evidence of tobacco                                   Consultant in Public Health Medicine,       last of several revisions dealing with com-
             control activityfrom over40 countries around                                South Staffordshire Health Authority.      munity health indicators. To make their ad-
             the globe. "Half empty" types will be im-                                                                              option consistent across potential users, the
             pressed byathoughtprovokingpiecebyBlum                                                                                 book provides for each indicator a synoptic
             and Solberg entitled Revisionism, magical                                                                              table    with   definitions,    methods of cal-
             thinking, andhokey-pokey objectives in the anti-                                                                       culations, limitations, sources, interpretation,
             smoking movement. This dissects the weak-                   Nutrition in General Practice: 2 Pro-                      observed values, and suggested categories.
             nesses of the tobacco control movement -                    moting Health and Preventing Disease.                      The indicators are further classified in three
             particularly a tendency to mistake advocacy,               Judith Buttriss (Ed). (Pp 162; 16.50) Lon-                  main groups: indicators of determinants of
             policy, and legislation with real action - in               don: Royal College of General Practitioners,               health, indicators of consequences of health
             theface ofdynamic, versatile, and determined                1995. ISBN 0 85084 214 X.                                  problems (including utilisation ofhealth ser-
             transnational tobacco companies. Others des-                                                                           vices), and indicators of health status.
             cribe the ability of the tobacco industry to                This book makes a useful contribution to the                  As claimed in the first of the two sections,
             subvert control measures such as advertising                few publications on nutrition addressed at                 covering conceptual issues, the 60 indicators
             bans and the failure of governments to take                 primary health care professionals. It provides             will   allow readers to "reach rapid con-
             effective action.                                           them with nutrition guidelines and targets                 clusions",    "make sweeping observations",
                Peto, Lopez, and Boreham have stated that                to be used with their patients and with the                and provide the necessary information for the
             the evolving pandemic oftobacco related dis-                community as a whole, in accordance with                   decision making process.
             ease leaves Asia "sitting on a time bomb".                  current scientific knowledge. It considers                    The indicators have been chosen to "re-
             This book shows that it is a worldwide phe-                 common problems and prevalent situations                   flect" and "represent", in the most coherent
             nomenon. Unfortunately, it seems that de-                  in the UK that are also applicable to other                 possible way, phenomena which cannot be
             spite our best efforts we are still tackling the            developed countries.                                       measured directly. Infant mortality rate, for
             problem with fire extinguishers rather than a                 This volume is the second part of a three                instance, would allow reliable and valid in-
             bomb disposal team.                                        part manual; the first is Basic Principles of               ferences on a number of phenomena related
                                         RICHARD EDWARDS                Nutrition and the third Nutrition in the Man-               to the level of preventive care, as well as to
                       Lecturer in Epidemiology and Public Health,      agementofDisease. It consists ofthree sections              the very magnitude of infant mortality. The
                   Department ofEpidemiology and Public Health,         divided into chapters with a very clear teach-              comparable and recognisable information on
                              Newcastle University Medical School.      ing structure. In the first section, the nu-                health and social managers will, therefore,
                                                                        tritional needs of different age groups are                 find exhaustive representations, instrumental
                                                                        considered, with special attention to pre-                  to the process of planning, assessing, moni-
                                                                        conception, pregnancy, and lactation; infant                toring and forecasting services and care. Will
             Improving Support for Black Carers: A                      feeding and weaning; preschool and school                   they?
             source-book of information, ideas and                      children; and elderly people. In the second                    The complexity of the phenomena to be
             service initiatives.            Yee.                       section, the social aspects of nutrition are                represented, not always coherent and homo-
             London:                  Lydia        (Pp 29; 6.99)        examined as they concern specific groups in                 geneous, makes "macro-indicators" difficult
                        King's Fund, 1995. ISBN 1 85717                 the UK such as vegetarians and people from                  to use for a critical analysis of the needs in
             076 8.                                                     different religions, whose diet may be re-                  the health and social sector. Infant mortality,
             The needs ofcarers are on the NHS                          stricted. Low income level and sports are                   for instance, may say a great deal about the
             (see HSG             Carers                   agenda       also considered as these too may influence                  level of perinatal and neonatal care, but very
                     Act (97)8            (Recognition and Ser-         people's diet. In the third part, devoted to                little about the level ofmaternal care, precisely
             vices)        1995. London: NHS Executive,                 the prevention of ill health, coronary heart                because the correlation between level and
             1996), with special consideration for black                disease and weight management are ex-                       type of maternal care and infant mortality is
             carers. This slim paperback fills a need for               tensively    considered in addition to os-                  not yet fully recognised and needs, at least,
             practical ideas in this context. It uses "black"           teoporosis, dental health, and food hygiene.                to be circumstantiated.
             as shorthand for "people who share a com-                     Ideas to improve understanding, including                  There is a substantial drawback in pro-
             mon experience ofracism".                                  ideas and tips for addressing many common                   moting single and/or macro-indicators. The
                The six chapters fall into three parts. First           problems in primary health care, are given                  possibility ofsweeping and rapid conclusions,
             are four chapters dealing respectively with                together with very useful tables and relevant               which they are actually intended to achieve,
             knowing who black carers are, the issues                   information (eg recommendations for in-                     may bring about superficial views among
             affecting them; getting started on services,               troducing a mixed diet, food source for spe-                users. Summary indicators may produce an-
             and the processes of service development.                  cific nutrients or types ofdiets, lipid lowering            aesthetic effects on public and professional
             Theirlanguage is clear, sections are supported             diet, etc). Updated references are given in                 opinions. Indeed, decision makers and po-
             and reinforced by lists of key action points,              every chapter, including further reading in                 liticians may be tempted to hijack them for
             and there are illustrations from work in pro-              the field. However, the reader does need to                 slogans or self complacent declarations. Ex-
             gress at the time of writing. The practical                have the first part of the manual since he or               amples of misuse can be found in any coun-
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...Reviews book sciousness of the influence health factors cepted it is a comprehensive and at times inpregnancy medicalisation ofchildbirth captivating review ofawhole field ofresearch notices rise offeminist sociology voices markabellis anarticulate mass ofpregnantandparturating senior lecturer in public medicine women have made noisy arean ob university ofliverpool association stetricians gynaecologists are divided be european pamplona spain tween defending their hospital citadels annual meeting th yielding to siren outside patients november including span want both security good medical care diet cancer markers prevention services research conference management comforts ofhome militant midwives treatment advances experimental ish visitors strive preserve ex biology volume edited meetings for further information contact pand hard won roles caught between by maryce mjacobs pp new idoia gaminde facultad de economicas all these pressures gps this brief yorkandlondon plenumpress isbn unive...

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