Science,opinions and politics

Valerie Marett, IMMIGRANTS SETTLING IN THE CITY, Leicester University Press, 1989, 207 pp., £30.00.

Ruth Glass, CLICHES OF URBAN DOOM, Oxford: Basil Blackwell, 1988, 266 pp., £25.00.

Stanley Lieberson and Mary C. Waters, FROM MANY STRANDS: ETHNIC AND RACIAL GROUPS IN CONTEMPORARY AMERICA, New York: Russell Sage Foundation, 1988, 304 pp., $29.95.

Susan J. Smith, THE POLITICS OF ‘RACE’ AND RESIDENCE: CITIZENSHIP, SEGREGATION AND WHITE SUPREMACY IN BRITAIN, Cambridge: Polity Press, 1989, 228 pp., £29.95 and £9.95 (paper).     

Influenza vaccination for immunocompromised patients: systematic review and meta-analysis from a public health policy perspective

Background

Immunocompromised patients are vulnerable to severe or complicated influenza infection. Vaccination is widely recommended for this group. This systematic review and meta-analysis assesses influenza vaccination for immunocompromised patients in terms of preventing influenza-like illness and laboratory confirmed influenza, serological response and adverse events.

Methodology/Principal Findings

Electronic databases and grey literature were searched and records were screened against eligibility criteria. Data extraction and risk of bias assessments were performed in duplicate. Results were synthesised narratively and meta-analyses were conducted where feasible. Heterogeneity was assessed using I² and publication bias was assessed using Begg''s funnel plot and Egger''s regression test. Many of the 209 eligible studies included an unclear or high risk of bias. Meta-analyses showed a significant effect of preventing influenza-like illness (odds ratio [OR] = 0.23; 95% confidence interval [CI] = 0.16–0.34; p<0.001) and laboratory confirmed influenza infection (OR = 0.15; 95% CI = 0.03–0.63; p = 0.01) through vaccinating immunocompromised patie nts compared to placebo or unvaccinated controls. We found no difference in the odds of influenza-like illness compared to vaccinated immunocompetent controls. The pooled odds of seroconversion were lower in vaccinated patients compared to immunocompetent controls for seasonal influenza A(H1N1), A(H3N2) and B. A similar trend was identified for seroprotection. Meta-analyses of seroconversion showed higher odds in vaccinated patients compared to placebo or unvaccinated controls, although this reached significance for influenza B only. Publication bias was not detected and narrative synthesis supported our findings. No consistent evidence of safety concerns was identified.

Conclusions/Significance

Infection prevention and control strategies should recommend vaccinating immunocompromised patients. Potential for bias and confounding and the presence of heterogeneity mean the evidence reviewed is generally weak, although the directions of effects are consistent. Areas for further research are identified.     

Molecular tools and triatomine systematics: a public health perspective.

Triatomines, or kissing bugs, are vectors of Chagas disease to humans. This disease is a substantial public health problem affecting up to 12 million people throughout the Americas, and its control relies mainly on the insecticide treatment of triatomine-infested houses within villages. In this article, Fernando Monteiro, Ananias Escalante and Ben Beard review how molecular markers have been used to clarify triatomine systematics, and give examples of how our understanding of triatomine population structure and accurate vector identification can be used to optimize vector control.     

Debate: Racism today: a perspective from international politics

In a recent contribution, Howard Winant aligns himself with scholars who contest the possibilities of general theories of ethnic and racial relations. He defines racism in terms of its social functions in specific historical contexts. As an approach to the constituents of 'racism today', this neglects the international dimension. In considering how the conclusions drawn from studies in one place at one time may be transferred for use in analyses elsewhere, it is important to note that the situation in the USA is in many respects exceptional. Winant also advances a theory of race formation which cannot easily be tested. An alternative approach would build on recent developments within the United Nations to identify a political framework distinct from the framework needed for socio-scientific studies. Within the political framework different components of racism are separately defined as violations of human rights.     

Ethics, evidence, and public policy

The growth of evidence-based medicine (EBM) raises a number of ethical issues that have too often been overlooked. These include issues that arise when clinicians make judgments under uncertainty, new challenges for the clinician-patient relationship, new duties for institutional review boards, issues in physician autonomy and reimbursement, and challenges for disclosure and informed consent. Ethics and EBM must be addressed by policy makers and integrated into medical education.