race to save the ozone layer

1
1091 were the focus of an international symposium on innovation in approaches to disability held by the Throgmortion Society at the Royal College of Physicians in London on April 28. A point made at the meeting was that an attempt should be made to rehabilitate profoundly disabled people. No longer should they be assumed to be permanent bed-occupiers, be bypassed on ward rounds, and be the reason for staff to fear social workers, who might inquire after the patients’ progress. The profoundly disabled are the ones who, if community care for less disabled people takes off successfully, will form the bulk of patients in rehabilitation units. If improvement in function, maintenance of optimum function, or a slowing of its deterioration can be achieved it is not only the patient who will benefit; family and carers could obtain much relief too. The difficulty in promoting the message that profoundly disabled people should be rehabilitated is that the evidence that something can be done for them is at present only anecdotal; and it will remain so unless larger numbers are treated. The technology for aiding mobility and communication is there (although there is room for improvement2), and innovations have been made in physiotherapy (such as the use of electrical biofeedback to teach new movements). The obstacles remain the usual ones of attracting staff to this kind of work and of ensuring that the resources required have not been obtained at the expense of larger numbers of less severely disabled people. One means of raising funds for rehabilitation of disabled people is the scheme introduced in France in 1987, which obliges firms with staff of 20 or more to allocate a proportion of their jobs to disabled people. Firms that do not comply have to pay a levy. RACE TO SAVE THE OZONE LAYER DEPLETION of the stratospheric ozone layer is advancing twice as fast as was predicted only two years ago, and the 1987 Montreal proposals for a freeze on the production and use of ozone-damaging chlorofluorocarbons (CFCs) at 1986 levels by Jan 1, 1989, and a 50% reduction by mid-1998 now seem too modest. The Government of Finland, which hosted an international meeting on ozone in Helsinki last week, has now proposed that CFC consumption should be halved by 1995 and eliminated by the year 2000. Dr Mostafa Tolba, executive director of the United Nations Environment Programme (UNEP), which convened the meeting, described how attitudes had changed since the Montreal meeting, which he described as a negotiating nightmare. But now there was no need to plead or cajole, he said. "Governments are running, not walking, to Helsinki", he added. "People get frightened when they hear that a 1 % decrease in ozone is likely to cause a 4% increase in skin cancer." Dr Tolba suggested that the greatest need was to monitor what was happening to the ozone layer, especially in the southern hemisphere and the tropics. Since CFCs have been indicted as "greenhouse" gases, the interplay between ozone, carbon dioxide, and other gases also needed to be studied. Dr Tolba is aiming, through collaboration between UNEP and the World Meteorological Organisation, to establish a Climate Warming Convention by 1992. Methods of measuring ultraviolet radiation need to be refined, said Dr Tolba. A delegate from the Caribbean told the meeting that crops in his region were very sensitive even to small variations in radiation. More research was needed into new crop varieties resistant to ultraviolet light. One likely sticking point in achieving a ban on CFCs is who is to pay for the substitution of ozone friendly chemicals (and the associated expensive technological changes) for the CFC used in refrigeration in developing countries. India and China, which see ozone depletion as a problem created by the developed nations, appealed for financial assistance at an ozone conference in London in March. Such assistance was approved in principle at the Helsinki meeting, but Dr Tolba had earlier reminded delegates that only 11 of the 35 governments which ratified the Montreal protocol had so far paid their dues. 2. Mulley GPO. Standards of wheelchairs. Br Med J 1989; 298: 1198-99. Another issue raised at the meeting was the ozone depleting potential of halons, which was said to need urgent investigation. Scientific knowledge of halons is less advanced than that of CFCs, but some halons, which are increasingly being used in fire extinguishers, are believed to be ten time more dangerous to the ozone layer than CFCs. Dr Tolba is optimistic. "When ozone layer depletion affects people in their daily lives," he said, "they get very interested in doing something about it." MIND OVER (TOO MUCH) MATTER A DIET of bran and skimmed milk is just as effective as any proprietary very-low-calorie diet, according to the Drug and Therapeutics Bulletin,l and it is very much cheaper. Two pints of skimmed milk a day for women (or three for men), with bran for bulk, unlimited calorie-free drinks, and iron and multivitamin tablets to make up any deficiencies may help the severely obese to lose weight quickly, but such a diet will do little to improve eating habits. The benefits of weight reduction in obese patients- reduction of raised blood pressure, improvement in impaired carbohydrate tolerance, lowered risk of osteoarthritis of weight- bearing joints, and increased life expectancy--can be reaped only if bad habits are permanently changed. Overweight patients are most effectively managed in groups, says the bulletin, and many people find the mutual learning and support gained from joining a slimning club helpful. Techniques aimed at recruiting the psyche seem to have the best chance of long-term success-behaviour therapy, for instance, can achieve excellent weight loss (an average of 17 kg in one year in one study, but the cost in time to patient and therapist was enormous); however, such treatment is rarely available within the National Health Service. Drug treatments (appetite suppressants, bulk-forming agents, and "starch blockers") are ineffective in the long term, says the bulletin, and so are surgical methods such as jaw-wiring, gastroplasty, and intragastric balloons. Regular aerobic exercise can contribute to weight maintenance by increasing resting metabolic rate, but the bulletin observes that obese people do not tolerate a weekly routine of 5 hours’ hard physical work. FOODBORNE DISEASE IN SCOTLAND 234 outbreaks of foodbome disease affecting 1825 people were reported to the Communicable Diseases (Scotland) Unit in 1987 2 In 49 of these, the food was eaten outside Scotland. Incriminated agents were species of Salmonella, Campylobacter, Shigella, and Bacillus, Staphylococcus aureus, Clostridium perfringens, and viruses; in 15 outbreaks the cause was unknown. 77% of the episodes were attributable to salmonellosis, S enteritidis phage type 4 (now a familiar contaminant of poultry and eggs) being the strain most frequently found. Although the number of listeriosis cases has risen in Scotland (as in England and Wales), none has yet been traced to infected food. The report also describes three outbreaks of hospital food- poisoning, which brings the total during 1978-87 to 48: meat and poultry were the source of infection in over 90% of outbreaks where a food vehicle was identified. Over the past 15 years, the overall frequency of outbreaks has fallen, but the number of people affected per outbreak has increased. Have the removal of Crown Immunity from hospital kitchens in February, 1986, and the introduction of cook-chill catering had any effect on hospital foodbome infection in Scotland? Only time will tell. A FERTILE DOWN SYNDROME MAN As the trend for community care for mentally handicapped adults grows, attention needs to be paid to contraceptive cover for these individuals. Men with Down syndrome are said to be infertile. However, a 29-year-old man with apparently non-mosaic trisomy 21 was most probably the father in a pregnancy in an educationally 1 Managing obesity successfully. Drug Ther Bull 1989; 27: no 9. 2. Surveillance programme for foodborne infections and intoxications Scotland—1987. Communicable Diseases (Scotland) Unit, Information and Statistics Division, Trinity Park House, South Trinity Road, Edinburgh EH5 3SQ. 1989. £1.50. ISSN 0263-8754.

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Page 1: RACE TO SAVE THE OZONE LAYER

1091

were the focus of an international symposium on innovation inapproaches to disability held by the Throgmortion Society at theRoyal College of Physicians in London on April 28.A point made at the meeting was that an attempt should be made

to rehabilitate profoundly disabled people. No longer should theybe assumed to be permanent bed-occupiers, be bypassed on wardrounds, and be the reason for staff to fear social workers, who mightinquire after the patients’ progress. The profoundly disabled are theones who, if community care for less disabled people takes offsuccessfully, will form the bulk of patients in rehabilitation units. Ifimprovement in function, maintenance of optimum function, or aslowing of its deterioration can be achieved it is not only the patientwho will benefit; family and carers could obtain much relief too.The difficulty in promoting the message that profoundly disabledpeople should be rehabilitated is that the evidence that somethingcan be done for them is at present only anecdotal; and it will remainso unless larger numbers are treated. The technology for aidingmobility and communication is there (although there is room forimprovement2), and innovations have been made in physiotherapy(such as the use of electrical biofeedback to teach new movements).The obstacles remain the usual ones of attracting staff to this kind ofwork and of ensuring that the resources required have not beenobtained at the expense of larger numbers of less severely disabledpeople.One means of raising funds for rehabilitation of disabled people is

the scheme introduced in France in 1987, which obliges firms withstaff of 20 or more to allocate a proportion of their jobs to disabledpeople. Firms that do not comply have to pay a levy.

RACE TO SAVE THE OZONE LAYER

DEPLETION of the stratospheric ozone layer is advancing twice asfast as was predicted only two years ago, and the 1987 Montrealproposals for a freeze on the production and use of ozone-damagingchlorofluorocarbons (CFCs) at 1986 levels by Jan 1, 1989, and a50% reduction by mid-1998 now seem too modest. TheGovernment of Finland, which hosted an international meeting onozone in Helsinki last week, has now proposed that CFC

consumption should be halved by 1995 and eliminated by the year2000.Dr Mostafa Tolba, executive director of the United Nations

Environment Programme (UNEP), which convened the meeting,described how attitudes had changed since the Montreal meeting,which he described as a negotiating nightmare. But now there wasno need to plead or cajole, he said. "Governments are running, notwalking, to Helsinki", he added. "People get frightened when theyhear that a 1 % decrease in ozone is likely to cause a 4% increase inskin cancer."Dr Tolba suggested that the greatest need was to monitor what

was happening to the ozone layer, especially in the southernhemisphere and the tropics. Since CFCs have been indicted as"greenhouse" gases, the interplay between ozone, carbon dioxide,and other gases also needed to be studied. Dr Tolba is aiming,through collaboration between UNEP and the World

Meteorological Organisation, to establish a Climate WarmingConvention by 1992.Methods of measuring ultraviolet radiation need to be refined,

said Dr Tolba. A delegate from the Caribbean told the meeting thatcrops in his region were very sensitive even to small variations inradiation. More research was needed into new crop varietiesresistant to ultraviolet light.One likely sticking point in achieving a ban on CFCs is who is to

pay for the substitution of ozone friendly chemicals (and theassociated expensive technological changes) for the CFC used inrefrigeration in developing countries. India and China, which seeozone depletion as a problem created by the developed nations,appealed for financial assistance at an ozone conference in Londonin March. Such assistance was approved in principle at the Helsinkimeeting, but Dr Tolba had earlier reminded delegates that only 11of the 35 governments which ratified the Montreal protocol had sofar paid their dues.

2. Mulley GPO. Standards of wheelchairs. Br Med J 1989; 298: 1198-99.

Another issue raised at the meeting was the ozone depletingpotential of halons, which was said to need urgent investigation.Scientific knowledge of halons is less advanced than that of CFCs,but some halons, which are increasingly being used in fire

extinguishers, are believed to be ten time more dangerous to theozone layer than CFCs.Dr Tolba is optimistic. "When ozone layer depletion affects

people in their daily lives," he said, "they get very interested indoing something about it."

MIND OVER (TOO MUCH) MATTER

A DIET of bran and skimmed milk is just as effective as anyproprietary very-low-calorie diet, according to the Drug andTherapeutics Bulletin,l and it is very much cheaper. Two pints ofskimmed milk a day for women (or three for men), with bran forbulk, unlimited calorie-free drinks, and iron and multivitamintablets to make up any deficiencies may help the severely obese tolose weight quickly, but such a diet will do little to improve eatinghabits. The benefits of weight reduction in obese patients-reduction of raised blood pressure, improvement in impairedcarbohydrate tolerance, lowered risk of osteoarthritis of weight-bearing joints, and increased life expectancy--can be reaped only ifbad habits are permanently changed. Overweight patients are mosteffectively managed in groups, says the bulletin, and many peoplefind the mutual learning and support gained from joining aslimning club helpful. Techniques aimed at recruiting the psycheseem to have the best chance of long-term success-behaviourtherapy, for instance, can achieve excellent weight loss (an averageof 17 kg in one year in one study, but the cost in time to patient andtherapist was enormous); however, such treatment is rarelyavailable within the National Health Service. Drug treatments(appetite suppressants, bulk-forming agents, and "starch

blockers") are ineffective in the long term, says the bulletin, and soare surgical methods such as jaw-wiring, gastroplasty, and

intragastric balloons. Regular aerobic exercise can contribute toweight maintenance by increasing resting metabolic rate, but thebulletin observes that obese people do not tolerate a weekly routineof 5 hours’ hard physical work.

FOODBORNE DISEASE IN SCOTLAND

234 outbreaks of foodbome disease affecting 1825 people werereported to the Communicable Diseases (Scotland) Unit in 1987 2In 49 of these, the food was eaten outside Scotland. Incriminatedagents were species of Salmonella, Campylobacter, Shigella, andBacillus, Staphylococcus aureus, Clostridium perfringens, and viruses;in 15 outbreaks the cause was unknown. 77% of the episodes wereattributable to salmonellosis, S enteritidis phage type 4 (now afamiliar contaminant of poultry and eggs) being the strain mostfrequently found. Although the number of listeriosis cases has risenin Scotland (as in England and Wales), none has yet been traced toinfected food.The report also describes three outbreaks of hospital food-

poisoning, which brings the total during 1978-87 to 48: meat andpoultry were the source of infection in over 90% of outbreaks wherea food vehicle was identified. Over the past 15 years, the overall

frequency of outbreaks has fallen, but the number of people affectedper outbreak has increased. Have the removal of Crown Immunityfrom hospital kitchens in February, 1986, and the introduction ofcook-chill catering had any effect on hospital foodbome infection inScotland? Only time will tell.

A FERTILE DOWN SYNDROME MAN

As the trend for community care for mentally handicapped adultsgrows, attention needs to be paid to contraceptive cover for theseindividuals. Men with Down syndrome are said to be infertile.However, a 29-year-old man with apparently non-mosaic trisomy21 was most probably the father in a pregnancy in an educationally

1 Managing obesity successfully. Drug Ther Bull 1989; 27: no 9.2. Surveillance programme for foodborne infections and intoxications Scotland—1987.

Communicable Diseases (Scotland) Unit, Information and Statistics Division,Trinity Park House, South Trinity Road, Edinburgh EH5 3SQ. 1989. £1.50.ISSN 0263-8754.