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New uses for old tools
p u b l i c h e a l t h 1 2 5 ( 2 0 1 1 ) 6 3 e6 4
available at www.sciencedirect.com
Public Health journal homepage: www.elsevier.com/puhe
Editorial
New uses for old tools
It may seem a rather strange starting point for a Public Health editorial, but we do wonder how many of the 12,000 or so attendees at the 2010 American Public Health Association Convention in Denver found the time to travel the five blocks to the Denver Art Museum? Had they done so, they would have been treated to a major cultural treat. During most of 2010, the Denver Art Museum was host to an important exhibition of artefacts from the tomb of the last Pharaoh of the 18th Egyptian Dynasty: Tutankhamen. There can be few people who are not aware of the archaeological sensation that was caused in 1922 when Howard Carter and Lord Caernarvon revealed the nearly complete tomb of the young Pharaoh in the Valley of the Kings. The image of the gold and blue semiprecious stone and glass funerary mask has become an enduring symbol of Ancient Egypt, yet it was only one of 5000 artefacts found in the forgotten tomb, the very walls of which were painted with richly embellished images, reflecting the rituals by which the earthly Pharaoh became restored to his divine nature in the afterlife. Of course, what is truly amazing about the discovery of the tomb of Tutankhamen is not the quality or number of exquisite grave goods, nor the beauty of the wall paintings; it is the way in which the tomb and its contents have inspired further and further investigation by each succeeding generation of researchers. Even as the Denver Art Museum was preparing for the exhibition, the story was being rewritten yet again. In February 2010, the Journal of the American Medical Association published the first study which analysed DNA taken from the mummified remains of Tutankhamen and ten other mummified remains, which textual or archaeological evidence had established as members of (or controls for) the royal family of the 18th Dynasty.1 Not only did this study confirm Tutankhamen was the son of the “heretical” Pharaoh Akhenaten (Amenhotep IV) by a queen e possibly the famed Nefertiti e who the analysis showed to be Akenhaten’s full sister, but radiographic analysis found evidence of familial scoliosis and other bony malformations which could be associated with genetic factors. From a public health perspective, perhaps the most interesting finding was DNA from strains of Plasmodium falciparum from Tutankhamen and from his great grand-parents Yuya and Thuya. The evidence is suggestive of multiple malaria tropica infections that may be indications of having lived in areas of Egypt where malaria
was endemic; perhaps in the marshy areas close to the River Nile itself. Whilst such a hypothesis remains untested, the findings push back the evidence for malaria infections to the period of 1410-13-60 BCE when Yuya and Thuya are known to have lived: some 3,400 years ago. What the authors of the JAMA paper really need in order to test their hypothesis would be to match the DNA evidence for strains of P. falciparum associated with the malarial infection in Yuya and Thuya to DNA evidence of Anopheles gambiae from contemporary water sources. Had this been in the Arctic or Antarctic, then use of 100,000 year-old deep ice core sequences may have supplied such samples for DNA analysis, but even three and a half millennia ago, Egypt was not covered by an ice sheet. This finding prompted us to reflect on the way in which existing research tools from one area of study can be applied in new areas to provide new insights or understandings. Such a study e the use of DNA techniques to identify multi-drug resistant strains of Salmonella sp. in Nigerian water supplies is published in this issue of Public Health.2 Arguably, the use of DNA typing as a means of establishing the prevalence of waterborne pathogens is not as dramatic as the creation of Molecular Egyptology,1 but that is a matter of opinion. In presenting this study we were struck by the way in which the application of a tool now used commonly in one area of public health practice provided an opportunity to explore another area in a novel way. Another example is the paper from Japan, where researchers have used existing tools drawn from physiology and psychology to show that physical environments do have an effect on the sense of wellbeing.3 Perhaps we e like the Egyptian Supreme Council for Antiquities did in allowing samples from mummified human remains to be made available for DNA analysis e should take the opportunity to apply this type of inter-disciplinary utilisation of tools more often in public health? However, such an approach to using existing tools in innovative ways should not be limited to research. A recent exploration of the website of the US National Institute of Environmental Health Sciences elicited the resources they have identified for use with children.4 In particular, it highlighted the public health opportunities provided by children’s songs, such as the Oompa-loompa song from Roald Dahl’s book, Charlie and the Chocolate Factory.5 The song deals with
64
p u b l i c h e a l t h 1 2 5 ( 2 0 1 1 ) 6 3 e6 4
the dangers of becoming obese and how chewing gum is less risky than smoking. It even considers the quality of parenting and the avoidance of excessive TV watching! But why is the use of such materials limited to children? Whilst the recent Tim Burton/Johnny Depp ‘Chocolate Factory’ film may be the contemporary point of cultural reference, some of us are of an age to recall reading the book or seeing the original film adaptation starring Gene Wilder. Marketing people tell us of the power of rediscovering childhood memories, prompted by cultural references from that time. Is the Oompa-loopma song really limited to encouraging children? Or could it have a role in reminding some “older” children about addressing their smoking behaviour or encouraging better parenting? Is it so far-fetched to think that when it comes to promoting better health and wellbeing, we may need to explore new applications of existing tools in the service of developing population wellbeing? This is something that we hope to explore more fully in our 2nd International Conference here in London in September of this year.6 Clearly there are some research tools that are not really useful when applied in new areas. It is arguable that investigations into the possibility that the builders of the Great Pyramid of Khufu in Giza, had access to advanced knowledge of ultrasonics to use sonic vibrations to levitate the limestone or granite blocks into place are unlikely to be making a major impact on Egyptology in the short term; even though the technique has been shown to have possible applications in decontaminating reusable medical devices.7 In general, we need to continue to think creatively and laterally and recognise that there may well be tools in unexpected areas of endeavour, which we should not overlook in developing our practice of public health, or applying them in novel settings. Perhaps all we need is the pure imagination e as Willie Wonka said e to try.
references
1. Haswass Z, Gad YZ, Ismail S, Khairat R, Fathalla D, Hasan N, et al. Ancestry and pathology in King Tutankhamun’s family. Journal of the American Medical Association 2010;303:638e47. 2. Akinyemi KO, Iwalokun BA, Foli F, Oshodi K, Coker AO. Prevalence of multiple drug resistance and screening of exterotoxin (stn) gene in Salmonella enterica serovsrs from water sources in Lagos, Nigeria. Public Health 2011;125(2): 65e71. 3. Lee J, Park BJ, Tsunetsugu Y, Ohira T, Kagawa T, Miyazaki Y. Effect of forest bathing on physiological and psychological reponses in young Japanese male subjects. Public Health 2011; 125(2):93e100. 4. NIEHS Kids’ Pages. Available at: http://kids.niehs.nih.gov/ home.htm [accessed 06.12.10]. 5. Dahl R. Charlie and the chocolate factory. Harmondsworth: Penguin; 1964. 6. Public Health International Conference. Available at: www.rsph. org.uk/healthandwellbeing; 2011 [accessed 14.12.10]. 7. Udea T, Hara M, Odagawa I, Shigihara T. Simultaneous treatment of washing, disinfection and sterilization using ultrasonic levitation, silver electrolysis and ozone oxidation. Biocontrol Science 2009;4:1e12. P. Mackie, F. Sim
Royal Society for Public Health, 3rd Floor, Market Towers, 1 Nine Elms Lane, London SW8 5NQ, UK E-mail address: [email protected] 0033-3506/$ e see front matter ª 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.puhe.2010.12.005
In this issue In this February issue of Public Health we are presenting a number of papers that consider aspects of communicable disease across the globe. From Nigeria, we lead with a study that has investigated the prevalence of multi-drug resistant strains of salmonella in water sources close to Lagos. From London, we have reflections on the management of the H1N1 pandemic as containment became a maintenance response. We present papers on Chinese caregivers responses to Japanese Encephalitis, on community perceptions of TB and a fascinating systematic review on the health impacts of dog fouling e which is very much a global problem! In the other domains of public health, we present papers on the evidence for physiological and psychological changes associated with promoting wellbeing, with access to sexual health promotion services in a region of the UK, and on the sources of occupational stress in Chinese teachers. Finally, we have a further commentary on the paper we published on the Glasgow effect. This time it is from the Regional Director of Public Health from the north west of England, the area covering the comparator cities of Manchester and Liverpool.
available at www.sciencedirect.com
Public Health journal homepage: www.elsevier.com/puhe
Editorial
New uses for old tools
It may seem a rather strange starting point for a Public Health editorial, but we do wonder how many of the 12,000 or so attendees at the 2010 American Public Health Association Convention in Denver found the time to travel the five blocks to the Denver Art Museum? Had they done so, they would have been treated to a major cultural treat. During most of 2010, the Denver Art Museum was host to an important exhibition of artefacts from the tomb of the last Pharaoh of the 18th Egyptian Dynasty: Tutankhamen. There can be few people who are not aware of the archaeological sensation that was caused in 1922 when Howard Carter and Lord Caernarvon revealed the nearly complete tomb of the young Pharaoh in the Valley of the Kings. The image of the gold and blue semiprecious stone and glass funerary mask has become an enduring symbol of Ancient Egypt, yet it was only one of 5000 artefacts found in the forgotten tomb, the very walls of which were painted with richly embellished images, reflecting the rituals by which the earthly Pharaoh became restored to his divine nature in the afterlife. Of course, what is truly amazing about the discovery of the tomb of Tutankhamen is not the quality or number of exquisite grave goods, nor the beauty of the wall paintings; it is the way in which the tomb and its contents have inspired further and further investigation by each succeeding generation of researchers. Even as the Denver Art Museum was preparing for the exhibition, the story was being rewritten yet again. In February 2010, the Journal of the American Medical Association published the first study which analysed DNA taken from the mummified remains of Tutankhamen and ten other mummified remains, which textual or archaeological evidence had established as members of (or controls for) the royal family of the 18th Dynasty.1 Not only did this study confirm Tutankhamen was the son of the “heretical” Pharaoh Akhenaten (Amenhotep IV) by a queen e possibly the famed Nefertiti e who the analysis showed to be Akenhaten’s full sister, but radiographic analysis found evidence of familial scoliosis and other bony malformations which could be associated with genetic factors. From a public health perspective, perhaps the most interesting finding was DNA from strains of Plasmodium falciparum from Tutankhamen and from his great grand-parents Yuya and Thuya. The evidence is suggestive of multiple malaria tropica infections that may be indications of having lived in areas of Egypt where malaria
was endemic; perhaps in the marshy areas close to the River Nile itself. Whilst such a hypothesis remains untested, the findings push back the evidence for malaria infections to the period of 1410-13-60 BCE when Yuya and Thuya are known to have lived: some 3,400 years ago. What the authors of the JAMA paper really need in order to test their hypothesis would be to match the DNA evidence for strains of P. falciparum associated with the malarial infection in Yuya and Thuya to DNA evidence of Anopheles gambiae from contemporary water sources. Had this been in the Arctic or Antarctic, then use of 100,000 year-old deep ice core sequences may have supplied such samples for DNA analysis, but even three and a half millennia ago, Egypt was not covered by an ice sheet. This finding prompted us to reflect on the way in which existing research tools from one area of study can be applied in new areas to provide new insights or understandings. Such a study e the use of DNA techniques to identify multi-drug resistant strains of Salmonella sp. in Nigerian water supplies is published in this issue of Public Health.2 Arguably, the use of DNA typing as a means of establishing the prevalence of waterborne pathogens is not as dramatic as the creation of Molecular Egyptology,1 but that is a matter of opinion. In presenting this study we were struck by the way in which the application of a tool now used commonly in one area of public health practice provided an opportunity to explore another area in a novel way. Another example is the paper from Japan, where researchers have used existing tools drawn from physiology and psychology to show that physical environments do have an effect on the sense of wellbeing.3 Perhaps we e like the Egyptian Supreme Council for Antiquities did in allowing samples from mummified human remains to be made available for DNA analysis e should take the opportunity to apply this type of inter-disciplinary utilisation of tools more often in public health? However, such an approach to using existing tools in innovative ways should not be limited to research. A recent exploration of the website of the US National Institute of Environmental Health Sciences elicited the resources they have identified for use with children.4 In particular, it highlighted the public health opportunities provided by children’s songs, such as the Oompa-loompa song from Roald Dahl’s book, Charlie and the Chocolate Factory.5 The song deals with
64
p u b l i c h e a l t h 1 2 5 ( 2 0 1 1 ) 6 3 e6 4
the dangers of becoming obese and how chewing gum is less risky than smoking. It even considers the quality of parenting and the avoidance of excessive TV watching! But why is the use of such materials limited to children? Whilst the recent Tim Burton/Johnny Depp ‘Chocolate Factory’ film may be the contemporary point of cultural reference, some of us are of an age to recall reading the book or seeing the original film adaptation starring Gene Wilder. Marketing people tell us of the power of rediscovering childhood memories, prompted by cultural references from that time. Is the Oompa-loopma song really limited to encouraging children? Or could it have a role in reminding some “older” children about addressing their smoking behaviour or encouraging better parenting? Is it so far-fetched to think that when it comes to promoting better health and wellbeing, we may need to explore new applications of existing tools in the service of developing population wellbeing? This is something that we hope to explore more fully in our 2nd International Conference here in London in September of this year.6 Clearly there are some research tools that are not really useful when applied in new areas. It is arguable that investigations into the possibility that the builders of the Great Pyramid of Khufu in Giza, had access to advanced knowledge of ultrasonics to use sonic vibrations to levitate the limestone or granite blocks into place are unlikely to be making a major impact on Egyptology in the short term; even though the technique has been shown to have possible applications in decontaminating reusable medical devices.7 In general, we need to continue to think creatively and laterally and recognise that there may well be tools in unexpected areas of endeavour, which we should not overlook in developing our practice of public health, or applying them in novel settings. Perhaps all we need is the pure imagination e as Willie Wonka said e to try.
references
1. Haswass Z, Gad YZ, Ismail S, Khairat R, Fathalla D, Hasan N, et al. Ancestry and pathology in King Tutankhamun’s family. Journal of the American Medical Association 2010;303:638e47. 2. Akinyemi KO, Iwalokun BA, Foli F, Oshodi K, Coker AO. Prevalence of multiple drug resistance and screening of exterotoxin (stn) gene in Salmonella enterica serovsrs from water sources in Lagos, Nigeria. Public Health 2011;125(2): 65e71. 3. Lee J, Park BJ, Tsunetsugu Y, Ohira T, Kagawa T, Miyazaki Y. Effect of forest bathing on physiological and psychological reponses in young Japanese male subjects. Public Health 2011; 125(2):93e100. 4. NIEHS Kids’ Pages. Available at: http://kids.niehs.nih.gov/ home.htm [accessed 06.12.10]. 5. Dahl R. Charlie and the chocolate factory. Harmondsworth: Penguin; 1964. 6. Public Health International Conference. Available at: www.rsph. org.uk/healthandwellbeing; 2011 [accessed 14.12.10]. 7. Udea T, Hara M, Odagawa I, Shigihara T. Simultaneous treatment of washing, disinfection and sterilization using ultrasonic levitation, silver electrolysis and ozone oxidation. Biocontrol Science 2009;4:1e12. P. Mackie, F. Sim
Royal Society for Public Health, 3rd Floor, Market Towers, 1 Nine Elms Lane, London SW8 5NQ, UK E-mail address: [email protected] 0033-3506/$ e see front matter ª 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.puhe.2010.12.005
In this issue In this February issue of Public Health we are presenting a number of papers that consider aspects of communicable disease across the globe. From Nigeria, we lead with a study that has investigated the prevalence of multi-drug resistant strains of salmonella in water sources close to Lagos. From London, we have reflections on the management of the H1N1 pandemic as containment became a maintenance response. We present papers on Chinese caregivers responses to Japanese Encephalitis, on community perceptions of TB and a fascinating systematic review on the health impacts of dog fouling e which is very much a global problem! In the other domains of public health, we present papers on the evidence for physiological and psychological changes associated with promoting wellbeing, with access to sexual health promotion services in a region of the UK, and on the sources of occupational stress in Chinese teachers. Finally, we have a further commentary on the paper we published on the Glasgow effect. This time it is from the Regional Director of Public Health from the north west of England, the area covering the comparator cities of Manchester and Liverpool.