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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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