Patients' perceptions of joint teleconsultations: a qualitative evaluation.

Objective: To determine patient perceptions of joint teleconsultations (JTC), with particular reference to reasons underlying, and factors contributing to, patient satisfaction and dissatisfaction with this mode of health delivery.

Background: Telemedicine has been welcomed as one way of improving health-care delivery, by improving patient access to secondary care and specialist services hence widening patient choice, particularly for patients outside major conurbations. However, a recent systematic review found currently available data on patient satisfaction with telemedicine to be methodologically flawed.

All-cause mortality rates in patients with type 1 diabetes mellitus compared with a non-diabetic population from the UK general practice research database, 1992-1999.

Aims/hypothesis: We compiled up to date estimates of the absolute and relative risk of all-cause mortality in patients with type 1 diabetes in the UK.

Materials And Methods: We selected patients with type 1 diabetes (n=7,713), and for each of these diabetic subjects five age- and sex-matched control subjects without diabetes (n=38,518) from the General Practice Research Database (GPRD). Baseline was 1 January 1992; subjects were followed until 1999.

A sociodental approach to assessing dental needs of children: concept and models.

Objectives: Traditional normative methods of assessing dental needs do not correspond to current concepts of 'health' and 'need'. Although there is dental research on quality of life, evidence-based practice, and oral behaviours, those concepts are rarely applied to dental needs estimation. Dental needs are usually calculated mainly from clinical data and are likely to be inaccurate.

Is MSI-H of value in predicting the development of metachronous colorectal cancer?

Nearly 10% of patients with colorectal cancer (CRC) develop a metachronous cancer after curative resection of their primary malignancy, however identifying these patients is problematic. Although microsatellite instability (MSI) is associated with the development of multiple CRC, this is predominantly seen in those with hereditary non-polyposis colon cancer (HNPCC). This study has examined the value of MSI analysis in identifying patients at risk of developing metachronous cancer from the general population.

Mutational analysis in UK patients with a clinical diagnosis of familial hypercholesterolaemia: relationship with plasma lipid traits, heart disease risk and utility in relative tracing.

As part of a randomised trial [Genetic Risk Assessment for Familial Hypercholesterolaemia (FH) Trial] of the psychological consequences of DNA-based and non-DNA-based diagnosis of FH, 338 probands with a clinical diagnosis of FH (46% with tendon xanthomas) were recruited. In the DNA-based testing arm (245 probands), using single-strand conformation polymorphism of all exons of the low-density lipoprotein receptor (LDLR) gene, 48 different pathogenic mutations were found in 62 probands (25%), while 7 (2.9%) of the patients had the R3500Q mutation in the apolipoprotein B (APOB) gene.

Variations in associations of health risk behaviors among ethnic minority early adolescents.

Purpose: To investigate patterns of vulnerability and protection factors associated with risk behaviors and the co-occurrence of risk behaviors in minority ethnicity early adolescents.

Methods: Analysis of data from the Research with East London Adolescents Community Health Survey (RELACHS), a school-based study of a representative sample of 2789 adolescents age 11-14 in 2001 (sample 73% non-Caucasian, 21% born outside the United Kingdom). Questionnaire data were obtained on sociodemographic variables, ethnicity, smoking, drinking, drug use, psychological well-being, physical health, and social support from family and peers.

Assessment of a register-based rheumatic heart disease secondary prevention program in an Australian Aboriginal community.

Objective: To assess specific performance indicators relating to a register-based acute rheumatic fever and rheumatic heart disease (ARF/RHD) prevention program in a remote Australian Aboriginal community in order to identify the most appropriate avenues for improvements in delivery of services.

Methods: Information kept on the central ARF/RHD register was compared with an amalgamated dataset from three other sources. The community clinic charts of identified patients were reviewed for information regarding accuracy of diagnosis and the number of doses of benzathine penicillin received in the last year.

Pharmacogenetics: progress, pitfalls and clinical potential for coronary heart disease.

Much has been written about the potential of pharmacogenetic testing to inform therapy based on an individual's genetic makeup, and to decide the most effective choice of available drugs, or to avoid dangerous side effects. Currently, there is little hard data for either in the field of cardiovascular disease. The usual approach has been opportunistic use of drug trials in unrelated patients, and to look for differences in response or outcome by "candidate gene" genotype, for example genes coding for drug metabolising enzymes (activators and metabolisers), and enzymes and receptors involved in lipid metabolism, adrenergic response, etc.

Urinary retention, erectile dysfunction and penile anaesthesia after circumcision: a mixed dissociative (conversion) disorder.

We report on the long-term followup of a mixed dissociative (conversion) disorder after circumcision in childhood.

Plasma homocysteine and microvascular and macrovascular complications in type 1 diabetes: a cross-sectional nested case-control study.

Objectives: To examine the independent relationship between plasma total homocysteine (tHcy) and microvascular and macrovascular complications.

Design: We performed a cross-sectional nested case-control study from the EURODIAB Prospective Complications Study.

Setting: A hospital-based multicentre study at 24 centres in 13 European countries.

Fine mapping of a susceptibility locus for bipolar and genetically related unipolar affective disorders, to a region containing the C21ORF29 and TRPM2 genes on chromosome 21q22.3.

Linkage analyses of bipolar families have confirmed that there is a susceptibility locus near the telomere on chromosome 21q. To fine map this locus we carried out tests of allelic association using 30 genetic markers near the telomere at 21q22.3 in 600 bipolar research subjects and 450 ancestrally matched supernormal control subjects.

Failure to confirm allelic association between markers at the CAPON gene locus and schizophrenia in a British sample.

Background: Linkage studies have confirmed that chromosome 1q23.3 is a susceptibility locus for schizophrenia. It was then claimed that markers at the carboxyl-terminal PDZ ligand of neuronal nitric oxide synthase (CAPON) gene showed allelic association with schizophrenia in Canadian families.

First-trimester diagnosis of conjoined twins.

Conjoined twins are a rare and complex complication of monozygotic twinning, which is associated with high perinatal mortality. Early prenatal diagnosis of conjoined twins allows better counselling of the parents regarding the management options, including continuation of pregnancy with post-natal surgery, termination of pregnancy or selective fetocide in case of a triplet pregnancy. With the introduction of high-resolution and transvaginal ultrasound imaging, accurate prenatal diagnosis of conjoined twins is possible early in pregnancy.

Inhibition of in-stent restenosis in rabbit iliac arteries with photodynamic therapy.

Objectives: Photodynamic therapy (PDT, the combination of light with a photosensitising drug in the presence of oxygen) inhibits restenosis after angioplasty without stenting. This study assesses the potential of PDT for prevention of in-stent re-stenosis.

Design And Methods: Normal rabbits were given the photosensitising agent 5-aminolaevulinic acid (ALA) 60 mg/kg, 3 h prior to endovascular illumination of the iliac artery (635 nm at 50 J/cm(2)) either immediately before or after deployment of an oversized (3 mm diameter) stent.

Changes in expression of P2X purinoceptors in rat cerebellum during postnatal development.

Changes in expression of P2X receptors (P2X1-7) during postnatal development of the rat cerebellum are described. At P3, immunoreactivity (ir) to all the P2X receptors, except for P2X3 receptors, was found in Purkinje cells and deep cerebellar nuclei, P2X5-ir being most prominent. Granular and microglial cells were labeled for P2X5 (weakly) and P2X4 receptors, respectively.

Vitamin D concentrations among people aged 65 years and over living in private households and institutions in England: population survey.

Background: vitamin D deficiency among older people results in poor bone and muscle health and an increased risk of fractures. In the UK, government initiatives and the launch of the Osteoporosis Strategy have been in place since 1998, highlighting the importance of adequate levels of vitamin D for its prevention. The aim of this analysis is to assess vitamin D status and examine associations of deficiency with risk factors among older people in England.

Combined affinity labelling and mass spectrometry analysis of differential cell surface protein expression in normal and prostate cancer cells.

Differences in the expression of cell surface proteins between a normal prostate epithelial (1542-NP2TX) and a prostate cancer cell line (1542-CP3TX) derived from the same patient were investigated. A combination of affinity chromatographic purification of biotin-tagged surface proteins with mass spectrometry analysis identified 26 integral membrane proteins and 14 peripheral surface proteins. The findings confirm earlier reports of altered expression in prostate cancer for several cell surface proteins, including ALCAM/CD166, the Ephrin type A receptor, EGFR and the prostaglandin F2 receptor regulatory protein.

Tumour-stromal interactions in breast cancer: the role of stroma in tumourigenesis.

Mammary stromal tissue has a major role in the control and regulation of physiological processes in the breast. Recently, the function of stroma in supporting the tumourigenic process as well as responding to the oncogenic lesion has become clearer. This review differs from the conventional view in that it focuses on and discusses the newly available evidence that points to the fact that mammary stroma has a significant contribution in actively generating transformed lesions and tumours.

ATP is a mediator of chemosensory transduction in the central nervous system.

Extracellular signalling by the purine nucleotide ATP has long been associated with sensory function. In the periphery, ATP mediates nociception, mechanosensitivity, thermal sensitivity and O2 chemosensitivity. These processes share a common mechanism that involves the release of ATP to excite afferent fibres via activation of ionotropic P2X and/or metabotropic P2Y receptors.

Three-dimensional tissue culture models in cancer biology.

Three-dimensional (3D) tissue culture models have an invaluable role in tumour biology today providing some very important insights into cancer biology. As well as increasing our understanding of homeostasis, cellular differentiation and tissue organization they provide a well defined environment for cancer research in contrast to the complex host environment of an in vivo model. Due to their enormous potential 3D tumour cultures are currently being exploited by many branches of biomedical science with therapeutically orientated studies becoming the major focus of research.

P2 receptor blockade attenuates fever and cytokine responses induced by lipopolysaccharide in rats.

Adenosine 5'-triphosphate (ATP) has been shown to induce release of cytokines implicated in fever, including interleukin(IL)-1beta, IL-6, and tumour necrosis factor-alpha (TNF-alpha). The role of ATP-mediated purinergic signalling in fever and cytokine release during systemic inflammation was investigated by studying the effects of P2 receptor antagonists suramin, pyridoxal-5'-phosphate-6-azophenyl-2',4'-disulphonic acid (PPADS), and Brilliant Blue G (BBG) on changes in body temperature and the increases in plasma levels of IL-1beta, IL-6, and TNFalpha induced by bacterial lipopolysaccharide (LPS) in rats. LPS (Escherichia coli; 50 microg kg(-1))-induced febrile response was attenuated by suramin (25 mg kg(-1) and 100 mg kg(-1)), PPADS (25 mg kg(-1)), and a more selective P2X(7) receptor antagonist BBG (100 mg kg(-1)) injected intraperitoneally before the induction of fever.

The menopausal transition was associated in a prospective study with decreased health functioning in women who report menopausal symptoms.

Objective: To examine change in health functioning as women progress through the menopausal transition.

Study Design And Setting: Prospective study of 2,489 women followed through four phases of the Whitehall II study. Health functioning was assessed with the eight subscales of the SF-36.

Social dynamics of health inequalities: a growth curve analysis of aging and self assessed health in the British household panel survey 1991-2001.

Objectives: To study how social inequalities change as people age, this paper presents a growth curve model of self assessed health, which accommodates changes in occupational class and individual health with age.

Design: Nationally representative interview based longitudinal survey of adults in Great Britain.

Setting: Representative members of private households of Great Britain in 1991.

The role of ultrasound imaging in diagnosing and investigating early pregnancy failure.

The advent of high-resolution transvaginal ultrasound (TVS) has revolutionized our understanding of the pathophysiology and the management of early pregnancy failure. Knowledge of the ultrasound appearances of normal early pregnancy development and a good understanding of its pitfalls are essential for the diagnosis and management of early pregnancy failure. Ultrasound imaging has rapidly replaced all other techniques used to study normal human development in the first trimester, and ultrasound features of the early gestational sac have corroborated anatomical studies showing that the first structures to appear are the celomic cavity and the secondary yolk sac.