Review of risk factors for sudden infant death syndrome.

Sudden infant death syndrome (SIDS) accounts for the largest number of deaths during the first year of life in developed countries. The possible causes of SIDS are numerous and, to date, there is no adequate unifying pathological explanation for SIDS. Epidemiological studies have played a key role in identifying risk factors, knowledge of which has underpinned successful preventive programmes.

Long-acting inhaled beta 2-agonists in the management of asthma: recent advances and current recommendations.

Salmeterol and formoterol belong to a new class of inhaled beta 2-agonists with a prolonged duration of action. At the time these agents were introduced, there was uncertainty regarding the safety of beta 2-agonist therapy in asthma and concern that they might lead to a deterioration in asthma control. Recent studies, in contrast, have demonstrated both their safety and therapeutic efficacy.

What do general practice receptionists think and feel about their work?

Background: Although there is some published work acknowledging that the general practice receptionist's role is both important and difficult, receptionists' own views have rarely been sought.

Aim: To explore general practice receptionists' ideas and feelings about their work.

Method: A questionnaire was distributed to all 150 receptionists in a representative sample of 26 practices in the area covered by Leeds family health services authority.

Accessing the literature on outcome studies in group psychotherapy: the sensitivity and precision of Medline and PsycINFO bibliographic database searching.

Background: Bibliographic databases such as Medline and PsycINFO are major sources of initial information for systematic reviews. This study investigates the adequacy of Medline and PsycINFO in retrieving articles describing outcome studies of group-based psychological treatments.

Method: Ten journals publishing a high number of group psychotherapy articles were hand searched for the publication years 1993 and 1994.

The self-reported well-being of employees facing organizational change: effects of an intervention.

The objective of this study was to investigate the self-reported well-being of employees facing organizational change, and the effect of an intervention. It was a controlled intervention study. Subjects were allocated to study and control groups, and brief individual counselling was offered to the subjects in the study groups.

HSP-derived peptides inducing uveitis and IgG and IgA antibodies.

Heat shock protein (HSP) 65 kD-derived peptides, which specifically stimulate T cells from patients with Behçet's disease (BD), are capable of inducing uveitis in rats. Mycobacterial HSP 65 kD and BD-specific peptides were injected into Lewis rats and the development of uveitis was monitored clinically and histologically, and IgG and IgA antibodies were measured using an enzyme-linked immunosorbent assay (ELISA). Rats immunized with HSP peptides that developed uveitis showed significantly higher serum IgG antibody levels to peptide 311-326 (P < 0.

Single centre open study to compare patient recording of PRN salbutamol use on a daily diary card with actual use as recorded by the MDI compliance monitor.

The aim of this study was to assess the patients' use of inhaled short acting bronchodilators as rescue therapy during a 4-week study period. In this study an electronic metered-dose inhaler compliance monitor (MDI-CM) was used to measure the time and date of actuations of the device and this information was then compared with the patients' self reporting diary card (DC). Salbutamol canisters were used in the compliance monitor.

The role of knowledge and beliefs in help seeking behaviour for cancer: a quantitative and qualitative approach.

The study involved quantitative methods to assess the relationship between knowledge about cancer related symptoms and help seeking behaviour and qualitative methods to explore the role of patient's beliefs about cancer in explaining the gap between knowledge and behaviour. Patients (288) (response rate 72%) from one urban general practice completed a questionnaire consisting of 25 symptoms which they rated for whether they were cancer symptoms (knowledge) and whether the symptoms would prompt them to visit the doctor (hypothetical help seeking behaviour). Twenty patients were then selected who represented a range of knowledge levels and help seeking behaviour and interviewed about their beliefs about cancer.

Correlation of SMNt and SMNc gene copy number with age of onset and survival in spinal muscular atrophy.

Childhood-onset autosomal recessive spinal muscular atrophy (SMA) is associated with absence of the telomeric survival motor neuron gene (SMNt) in most patients, and deletion of the neuronal apoptosis inhibitory protein (NAIP) gene in the majority of severely affected patients. Analysis of SMNt has been complicated by the existence of a centromeric copy, SMNc, which is almost identical to SMNt but which can be distinguished from it by restriction enzyme analysis. In this study 143 SMA patients have been genotyped for the presence or absence of the SMNt, SMNc and NAIP genes, and the data correlated with quantifiable clinical variables.

Developing, validating and consolidating the doctor-patient relationship: the patients' views of a dynamic process.

Background: Previous research has examined the doctor-patient relationship in terms of its therapeutic effect, the need to consider the patients' models of their illness, and the patients' expectations of their doctor. However, to date, no research has examined the patients' views of the doctor-patient relationship.

Aim: To examine patients' views of the process of creating a relationship with their general practitioner (GP).

Guillain-Barré syndrome: recent advances.

Guillain-Barré syndrome is an autoimmune disease of peripheral nerves. Sufferers may require prolonged intensive care and may be permanently disabled. New understanding of the aetiology is revealing different pathological subtypes and helping predict the outcome.

Is type II diabetes mellitus a disease of the innate immune system?

Type II (non-insulin-dependent) diabetes mellitus is associated with increased blood concentrations of markers of the acute-phase response, including sialic acid, alpha-1 acid glycoprotein, serum amyloid A, C-reactive protein and cortisol, and the main cytokine mediator of the response, interleukin-6. The dyslipidaemia common in Type II diabetes (hypertriglyceridaemia and low serum levels of HDL cholesterol) is also a feature of natural and experimental acute-phase reactions. We review evidence that a long-term cytokine-mediated acute-phase reaction occurs in Type II diabetes and is part of a wide-ranging innate immune response.

A browser based image bank, useful tool or expensive toy?

DIBS, the Digital Image Banking System, is a web browser based environment for depositing and withdrawing generic medical images. These can be annotated or modified on an individual's computer for use in talks and lectures. DIBS is programmed in 'C', to query and update a database as well as producing web pages on the 'fly'.

A helical region on human lactoferrin. Its role in antibacterial pathogenesis.

Human lactoferrin contains a 47 amino acid peptide, named lactoferricin H, which is thought to be responsible for its antimicrobial activity. Lactoferricin includes a loop region, which resides on the outer surface of the N-lobe of lactoferrin, adopting an alpha helix with a hydrophobic tail. Peptides have been synthesised corresponding to the highly charged alpha helix (HLP 2) and hydrophobic tail region (HLP 5).

Neuroimaging and spectroscopy in children with epileptic encephalopathies.

Aims: To investigate the nature of the unifocal cortical abnormalities on FDG positron emission tomography (PET) in children with an epileptic encephalopathy but no focal abnormality on electroencephalogram or standard magnetic resonance imaging (MRI).

Methods: Repeat FDG PET, surface rendered high resolution MRI, and single voxel magnetic resonance proton spectroscopy of the areas of abnormal metabolism compared to the contralateral side in 11 children aged 2 to 12 years. Imaging was repeated after a median of 13 months.

Cellular response to Mineral Trioxide Aggregate.

This investigation studied the cytomorphology of osteoblasts in the presence of Mineral Trioxide Aggregate (MTA) and examined cytokine production. MTA and Intermediate Restorative Material (IRM) were prepared and placed in separate Petri dishes. Osteoblasts (cell-line MG-63), grown to confluence in Hams F12/Dulbecco's modified Eagle's medium, were seeded into the dishes, which were incubated for 1 to 7 days.

A single exposure of solar simulated radiation suppresses contact hypersensitivity responses both locally and systemically in humans: quantitative studies with high-frequency ultrasound.

Ultraviolet radiation (UVR)-induced suppression of cutaneous cell-mediated immunity plays an important role in the development of photocarcinogenesis in the mouse and a similar role is suspected in humans. Cell-mediated immunity is readily tested in vivo by measuring the contact hypersensitivity (CHS) response to topically applied haptens. CHS in humans is usually determine clinically, with a subjective scoring system.

Grade predictions for school-leaving examinations: do they predict anything?

The attributes of 721 medical students admitted to the United Medical and Dental Schools (UMDS) of Guy's and St. Thomas' Hospitals, London, UK between the years 1991 and 1994 were examined to determine the relationship between A-level grade predictions (as completed on each student's UCAS form by their school/college at the time of their application to the school) and subsequent assessments of their academic ability and performance. Predicted A-level grades were found to be significantly, if weakly, correlated with the rating of academic ability made at interview by the UMDS interviewing panel.

Genetic influences on childhood hyperactivity: contrast effects imply parental rating bias, not sibling interaction.

Background: Previous twin studies of hyperactivity have supported a 'contrast effect', whereby the more hyperactive the rating of one twin, the less the rating of the other. It has not been clear whether contrast effects occur in the twins' behaviour or in the ratings made of their behaviour but the implications for hyperactivity are different under the two models.

Method: We use hyperactivity ratings from mothers and teachers for 1644 twin pairs in the Virginia Twin Study of Adolescent Behavioral Development (VTSABD) to explore the origin of contrast effects, making use of independent teacher reports in a proportion of twins.

Extracorporeal photopheresis in Sézary syndrome. No significant effect in the survival of 44 patients with a peripheral blood T-cell clone.

Background: Several retrospective studies have claimed that extracorporeal photopheresis (ECP) prolongs survival in patients with erythrodermic cutaneous T-cell lymphoma. In a retrospective study of 44 patients with Sézary syndrome, we compared survival in patients treated with ECP with that of patients treated conventionally at the same institute. All patients had genotypic evidence of a peripheral blood T-cell clone.

African-Caribbean men remanded to Brixton Prison. Psychiatric and forensic characteristics and outcome of final court appearance.

Background: African-Caribbean men are over-represented in psychiatric and forensic services and in the prison population. A failure of community services to engage mentally ill African-Caribbean men and their presentation through the criminal justice system culminates in a repeated pattern of forensic service and criminal justice system contact.

Method: We carried out a cross-sectional survey during a one-year period of a sample of potentially mentally ill men remanded to HMP Brixton in south London.

Enterococci and vancomycin resistance.

The frequency of infections with multiply antibiotic-resistant gram-positive bacteria is increasing, and in some cases these organisms remain susceptible only to the glycopeptides vancomycin and teicoplanin. The appearance of transferable high-level glycopeptide resistance in enterococci--producing some strains that are now resistant to all available antibiotics--is thus a cause for concern. The enterococci readily colonize the bowel, spread rapidly among hospital patients, and transfer their antibiotic resistances widely among themselves and other gram-positive species.

Lessons from the past: a personal view.

We know a great deal about the diversity of the genetic and biochemical mechanisms of antibiotic resistance and are thus well equipped by this experience to study new phenomena as they appear in the future. In addition, we have identified relationships between epidemiological patterns in resistance and major external events that we believe are responsible for the development of resistance, namely antibiotic use and the creation of opportunities for the spread of resistance determinants and resistant organisms, although we have tended to ignore these anomalies. However, perhaps because of the latter circumstance, there remain skeptics, both among those who have a particular interest in the subject and, more important, among physicians in general, who are often not persuaded of the relationships between their use of antibacterial drugs and the patterns and prevalence of antibiotic resistance observed by epidemiologists.