1
499 policy goals. Powell comments, too, that in the UK detail is lacking on the nature and extent of alcohol-related workplace problems. Variations in cost figures, she suggests, partly reflect inadequacies in the data. Introducing an alcohol policy in the workplace-aiming both at primary prevention and at the identification and treatment of problem drinkers-entails expenditure on personnel, training, and the provision of information, and employers are understandably reluctant to invest in such policies unless they can foresee an improvement in profitability. The CHE report reviews the measures that employers should take into account in their assessment of likely costs and benefits. Loss of productivity through drinking, increased costs of absenteeism, sickness absence, and alcohol-associated injuries (which may lead to payment of compensation), and the costs of instituting an alcohol policy all have to be taken into account. But improved productivity, Powell observes, can alone justify the cost of a workplace policy. The benefits of specialised training can be recouped, she says, and the costs of dismissal and hiring avoided. And the efficient management that an alcohol policy implies will, she suggests, attract employees in short supply. She recommends that companies should collect precise data on their own records of productivity and absenteeism. But better-quality data are also needed on the numbers and types of policies already in existence and on company reasons for implementing them. The statistics collected by the author may be enough to persuade more companies that an alcohol policy would be beneficial: the cost of industrial days lost through alcohol in 1987 in the UK is estimated to be /T7 billion, and alcohol is implicated in a fifth of industrial accidents (the probability of an accident increases six-fold for a man who has drunk two pints of beer). In one survey 30% of male and 23% of female employees were found to be consuming more than the so-called safe limits of alcohol, and in another a quarter of the men interviewed reported regular lunchtime drinking. Various surveys have shown that the vast majority of dependent drinkers are in employment. 1. Reducing the costs of alcohol in the workplace the case for employer policies. By Melanie Powell. 1990. Copies (price £4.50 including postage) can be obtained from the Publications Secretary, Centre for Health Economics, University of York, York YO1 5DD. Cheques should be made payable to the University of York. Wild spread of fire ants Spare a thought for the untortunate residents ot the Cjult South area of the USA, where imported fire ants and their stings now form a part of life and where ant mounds, generally 0’2-0-38 m high but sometimes 0-9 m above ground and up to 1-5 m below, are a common feature of the landscaped In rural areas collision with these mounds causes injury to man and farm equipment. In urban areas 30-60% of the population in infested areas are stung a year-with 17-56% of them having large local reactions (pustule formation with sepsis being a special concern in diabetics) and probably 0-6-1% having an anaphylactic reaction. Both the black imported fire ant, Solenopsis richteri, and the red fire ant, S invicta, are thought to have been brought into the USA from South America via nursery stock early this century. With the detection of hybrids that are more cold tolerant than the original type, spread is now expected even beyond areas where the average minin.um yearly temperature is above -122°C (10°F). Another feature likely to accelerate spread is the tendency of several reproductive queens to share a mound. Thousands of people in infested areas who have been sensitised are on immunotherapy with whole-body extracts but, despite some evidence of efficacy, there is concern about its appropriateness because of the variability of amount of venom in whole-body extracts. There is a lack of venom for treatment-the proteins that generate IgE responses make up only 0-1 1 % of the venom by weight. Also, knowledge of the natural history of sensitivity to imported fire-ant stings is needed to determine the indications for immunotherapy. 1 de Shazo RD, Butcher BT, Banks WN Reactions to stings of the imported fire ant. N Engl J Med 1990, 323: 462-66. Getting about the NHS way Who are the people who can get help with the cost of travel for NHS hospital treatment? Department of Health leaflet Hll gives the answers-naturally these people include those on income support or family credit or those who have to travel over the water to get to a mainland hospital. But who would guess that one of the five groups of people who have automatic entitlement include patients attending a sexually transmitted disease clinic (albeit only when the clinic is more than 15 miles from home)? Those who are paid by order book need only bring the book with them to hospital to claim travel costs. Those not paid in this way need to know what forms to take-B3 for the unemployed, C3 for those who are sick (obviously not the form for malingerers), T3 for those on income support while on a training course. The leaflet also gives instructions on how to obtain refunds and how to work out whether one can be deemed to have a low income. It does not say specifically whether patients can claim for travel by skateboard or pogostick, illustrated on the poster publicising the leaflet, or whether these forms of transport are the last resort for those who don’t qualify for help. Surgical footwear The National Health Service spends 12 million a year on surgical or orthopaedic footwear yet 1 in 6 of the recipients would rather go barefooted than wear them because the footwear prescribed is inappropriate, uncomfortable, or unsightly; says the Disabled Living Foundation. Encouraged by the Department of Health, the Foundation, together with the Chartered Society of Physiotherapy, the King’s Fund, and the Society of Chiropodists, has formed a working party to examine the issue. The working party would like to hear from anyone who has had trouble with their prescribed footwear or who has information on how improvements in service have been achieved. Further details can be obtained from Ginny Jenkins, Clothing and Footwear Adviser, Disabled Living Foundation, 380-384 Harrow Road, London W9 2HU. AIDS—the carer’s guidebook If every AIDS patient had only one carer, there must be at least 3000 people in the UK having to cope with looking after or offering support to such patients-and perhaps wondering where to turn to for guidance. Caring for Someone with AIDS is largely a directory of resources in Britain that the carer, or the patient, can draw on for help on a wide range of physical, financial, legal, and spiritual difficulties; but it also gives information for the medical aspects of the disease. The emphasis in the book is that the carer should not feel that he or she has to assume all responsibility-sharing can help. 1. Caring for Someone with AIDS. Edited by David Yelding. London: Consumers’ Association and Hodder and Stoughton, for Research Institute for Consumer Affairs. 1990. Pp 312. £6.95. Health in the society of man The line of descent for social anthropology began in England with Radcliffe-Brown at Cambridge, in 1902. Fusing conventional observation studies in anthropology with the social theories of Durkheim, he focused upon the evolution of communities and how individuals within a community act in a common way. The application of social anthropology to health has now become a separate discipline, and the Health Policy Unit has published a summary of a short course in medical anthropology held at the London School of Hygiene and Tropical Medicine in September, 1989.1 The stated central theme of this work is the analysis of primary health care in developing countries, against a universal background of poverty. However, the text is largely taken up with attempts at defining medical anthropology and its legitimate area of investigation, and with discussions of the historical development in these areas. Clarity may not be the most conspicuous characteristic

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499

policy goals. Powell comments, too, that in the UK detail is lackingon the nature and extent of alcohol-related workplace problems.Variations in cost figures, she suggests, partly reflect inadequacies inthe data.

Introducing an alcohol policy in the workplace-aiming both atprimary prevention and at the identification and treatment ofproblem drinkers-entails expenditure on personnel, training, andthe provision of information, and employers are understandablyreluctant to invest in such policies unless they can foresee animprovement in profitability. The CHE report reviews the

measures that employers should take into account in their

assessment of likely costs and benefits. Loss of productivity throughdrinking, increased costs of absenteeism, sickness absence, andalcohol-associated injuries (which may lead to payment of

compensation), and the costs of instituting an alcohol policy all haveto be taken into account. But improved productivity, Powellobserves, can alone justify the cost of a workplace policy. Thebenefits of specialised training can be recouped, she says, and thecosts of dismissal and hiring avoided. And the efficient managementthat an alcohol policy implies will, she suggests, attract employees inshort supply. She recommends that companies should collectprecise data on their own records of productivity and absenteeism.But better-quality data are also needed on the numbers and types ofpolicies already in existence and on company reasons for

implementing them.The statistics collected by the author may be enough to persuade

more companies that an alcohol policy would be beneficial: the costof industrial days lost through alcohol in 1987 in the UK isestimated to be /T7 billion, and alcohol is implicated in a fifth ofindustrial accidents (the probability of an accident increases six-foldfor a man who has drunk two pints of beer). In one survey 30% ofmale and 23% of female employees were found to be consumingmore than the so-called safe limits of alcohol, and in another aquarter of the men interviewed reported regular lunchtime

drinking. Various surveys have shown that the vast majority ofdependent drinkers are in employment.

1. Reducing the costs of alcohol in the workplace the case for employer policies. ByMelanie Powell. 1990. Copies (price £4.50 including postage) can be obtained fromthe Publications Secretary, Centre for Health Economics, University of York, YorkYO1 5DD. Cheques should be made payable to the University of York.

Wild spread of fire ants

Spare a thought for the untortunate residents ot the Cjult South areaof the USA, where imported fire ants and their stings now form apart of life and where ant mounds, generally 0’2-0-38 m high butsometimes 0-9 m above ground and up to 1-5 m below, are acommon feature of the landscaped In rural areas collision with thesemounds causes injury to man and farm equipment. In urban areas30-60% of the population in infested areas are stung a year-with17-56% of them having large local reactions (pustule formationwith sepsis being a special concern in diabetics) and probably0-6-1% having an anaphylactic reaction.Both the black imported fire ant, Solenopsis richteri, and the red

fire ant, S invicta, are thought to have been brought into the USAfrom South America via nursery stock early this century. With thedetection of hybrids that are more cold tolerant than the originaltype, spread is now expected even beyond areas where the averageminin.um yearly temperature is above -122°C (10°F). Anotherfeature likely to accelerate spread is the tendency of severalreproductive queens to share a mound.Thousands of people in infested areas who have been sensitised

are on immunotherapy with whole-body extracts but, despite someevidence of efficacy, there is concern about its appropriatenessbecause of the variability of amount of venom in whole-bodyextracts. There is a lack of venom for treatment-the proteins thatgenerate IgE responses make up only 0-1 1 % of the venom by weight.Also, knowledge of the natural history of sensitivity to importedfire-ant stings is needed to determine the indications for

immunotherapy.

1 de Shazo RD, Butcher BT, Banks WN Reactions to stings of the imported fire ant.N Engl J Med 1990, 323: 462-66.

Getting about the NHS wayWho are the people who can get help with the cost of travel for NHShospital treatment? Department of Health leaflet Hll gives theanswers-naturally these people include those on income supportor family credit or those who have to travel over the water to get to amainland hospital. But who would guess that one of the five groupsof people who have automatic entitlement include patientsattending a sexually transmitted disease clinic (albeit only when theclinic is more than 15 miles from home)? Those who are paid byorder book need only bring the book with them to hospital to claimtravel costs. Those not paid in this way need to know what forms totake-B3 for the unemployed, C3 for those who are sick (obviouslynot the form for malingerers), T3 for those on income support whileon a training course. The leaflet also gives instructions on how toobtain refunds and how to work out whether one can be deemed tohave a low income. It does not say specifically whether patients canclaim for travel by skateboard or pogostick, illustrated on the posterpublicising the leaflet, or whether these forms of transport are thelast resort for those who don’t qualify for help.

Surgical footwear

The National Health Service spends 12 million a year on surgicalor orthopaedic footwear yet 1 in 6 of the recipients would rather gobarefooted than wear them because the footwear prescribed is

inappropriate, uncomfortable, or unsightly; says the Disabled

Living Foundation. Encouraged by the Department of Health, theFoundation, together with the Chartered Society of Physiotherapy,the King’s Fund, and the Society of Chiropodists, has formed aworking party to examine the issue. The working party would like tohear from anyone who has had trouble with their prescribedfootwear or who has information on how improvements in servicehave been achieved. Further details can be obtained from GinnyJenkins, Clothing and Footwear Adviser, Disabled LivingFoundation, 380-384 Harrow Road, London W9 2HU.

AIDS—the carer’s guidebookIf every AIDS patient had only one carer, there must be at least3000 people in the UK having to cope with looking after or offeringsupport to such patients-and perhaps wondering where to turn tofor guidance. Caring for Someone with AIDS is largely a directory ofresources in Britain that the carer, or the patient, can draw on forhelp on a wide range of physical, financial, legal, and spiritualdifficulties; but it also gives information for the medical aspects ofthe disease. The emphasis in the book is that the carer should notfeel that he or she has to assume all responsibility-sharing can help.

1. Caring for Someone with AIDS. Edited by David Yelding. London: Consumers’Association and Hodder and Stoughton, for Research Institute for ConsumerAffairs. 1990. Pp 312. £6.95.

Health in the society of man

The line of descent for social anthropology began in England withRadcliffe-Brown at Cambridge, in 1902. Fusing conventionalobservation studies in anthropology with the social theories ofDurkheim, he focused upon the evolution of communities and howindividuals within a community act in a common way. The

application of social anthropology to health has now become aseparate discipline, and the Health Policy Unit has published asummary of a short course in medical anthropology held at theLondon School of Hygiene and Tropical Medicine in September,1989.1 The stated central theme of this work is the analysis ofprimary health care in developing countries, against a universalbackground of poverty. However, the text is largely taken up withattempts at defining medical anthropology and its legitimate area ofinvestigation, and with discussions of the historical development inthese areas. Clarity may not be the most conspicuous characteristic