In reply to 'The categorization and control of people with disabilities'

Objective: to define the use of disablement resettlement officers (DRO) by patients with locomotor disorders. Design: questionnaire for patients with locomotor disorders potentially handicapping them from obtaining work. Setting: outpatient clinics. Patients: 52 patients, capable of work, aged 55 years or less, with a locomotor disorder; 19 had chronic arthritis and 18 back disorders. Questionnaire: obtained details of diagnosis, work status, contact with DRO and results of referral. Results: 21 had seen the DRO and three of these were dissatisfied; 15 were referred to the DRO and only three of these were placed in employment; 16 did not want referral to the DRO; overall 60% were unemployed. Conclusions: Many patients are reluctant to see the DRO. Only a minority either attend or find work on referral. A modified system is needed to improve the employment prospects of patients with locomotor disorders.     

Efficacy of low‐dose i.v. iron therapy in haemodialysis patients

Aim: i.v. iron therapy is more effective in maintaining adequate iron status in haemodialysis (HD) patients than oral iron therapy (OIT). However, data on lower doses of i.v. iron therapy are insufficient. Methods: A non‐randomized, open‐label study was performed to compare the efficacy of low‐dose (≤50 mg/week of iron sucrose) i.v. iron therapy (LD‐IVIT) with OIT in HD patients with 100–800 µg/L serum ferritin levels over 4 months. Results: Eighty‐nine patients in the LD‐IVIT group (40 men, 49 women; aged 61 ± 13 years) and 30 patients in the oral iron therapy group (17 men, 13 women; aged 59 ± 7 years) were evaluated. After 4 months of each treatment, serum ferritin levels increased from 398 ± 137 to 529 ± 234 µg/L in the LD‐IVIT group (P < 0.01) but decreased from 351 ± 190 to 294 ± 175 µg/L in the OIT group (P < 0.01). In the LD‐IVIT group, transferrin saturation (from 28% ± 11% to 30% ± 14%, P = 0.49), weekly doses of recombinant human erythropoietin (from 5822 ± 2354 to 5636 ± 2306 IU/week, P = 0.48) and haemoglobin (from 101 ± 9 to 103 ± 9 g/L, P = 0.15) levels remained stable. Conclusion: LD‐IVIT may be one of the regimens that may be considered for maintaining iron status in HD patients. However, efficacy of LD‐IVIT should be verified by further randomized study.     

Irritant susceptibility and weal and flare reactions to bioactive agents in atopic dermatitis. I. Influence of disease severity

The two main pathogenetic characteristics of atopic dermatitis (AD) are: (i) antigen-dependent ‘specific’ reactivity, and (ii) altered non-immimological ‘non-specific’ reactivity. Our understanding of the role of non-specific reactivity is hampered by the fact that methods available for its quantification are limited. The aim of the present study was to assess the usefulness of two parameters as quantitative measures of non-specific skin reactivity in AD: (i) susceptibility to repeated epicutaneous exposure to an irritant (sodium lauryl sulphate, SLS), assessed by visual scoring and transepidermal water loss(TEWL) measurement, and (ii) reactivity to intracutaneously injected bioactive agents (codeine, FMLP, histamine, methacholine, substance P, trypsin), assessed by measurement of weal and flare size. These two parameters were tested in a group of AD patients, subdivided according to the severity of their dermatitis, and a control group. The visual score and TEWL after SLS exposure tended to be higher in the AD group than in the control group. Furthermore, visual score and post-exposure TEWL were positively correlated with the dermatitis severity score. Weal size following injection of codeine, histamine and substance P, and flare size following injection of all agents, except methacholine, were significantly lower in the AD group than in the control group. Negative correlations were found between weal and flare sizes and the dermatitis severity score. These findings can be explained by down-regulation of structures involved in weal and flare reactions. In conclusion, we propose that epicutaneous irritant susceptibility and reactivity to intracutaneous bioactive agents may be useful indicators of non-specific skin reactivity in AD.     

Squamous carcinoma of the nasal vestibule

Twenty-two patients with squamous carcinoma of the nasal vestibule are reported. If a sufficiently large volume of tissue is irradiated, radiotherapy is to be preferred to surgery as the primary form of treatment on cosmetic grounds. Local recurrence can be treated successfully by surgery and the ultimate prognosis remains good. The prognosis is very unfavourable if regional lymph node metastases appear. We propose that all patients should undergo an ipsilateral suprahyoid neck dissection to identify occult nodes. If these are found radical radiotherapy should be given.     

A safe and rapid method of collecting the urticating hairs from Euproctis caterpillars (Lepidoptera, Lymantriidae)

A method of collecting the urticating hairs of anthropotoxic Euproctis caterpillars is described. The technique is based on depilating by vacuum using a commercially available filtration unit. The advantages of the method are safety, rapidity and a high yield of spicules requisite for analysis of their skin irritating properties.     

Cooking skills are important competencies for promoting healthy eating in an urban Indigenous health service

Aim: A recent article in this journal asked whether cooking should be a dietetic competency and recommended finding dietitians’ views on the use of cooking skills interventions as nutrition education. This article presents views about the value of cooking skills in the work of nutrition professionals and students working in an urban Indigenous health service. Methods: We reflect on our experience facilitating a series of practical cooking workshops in adult Aboriginal and Torres Strait Islander groups and the importance of cooking skills for professionals promoting nutrition in community contexts. Results: Cooking skills were essential for facilitating practical workshops to promote healthy cooking and eating among urban community groups. The workshops provided participants with new cooking ideas, opportunities to cook new recipes and some unfamiliar ingredients as well as learning new cooking skills. These enabled participants to be more confident preparing healthy meals at home. Cooking skills enhanced the processes of both effective community engagement and nutrition promotion. Conclusion: Cooking interventions make an important contribution to promoting nutrition in urban Indigenous contexts and cooking skills are therefore important competencies for nutrition and dietetic professionals delivering practical community nutrition programs.     

Immunofluorescent localization of antithrombin III in human skin

The presence in clinically normal human skin of the proteinase inhibitor antithrombin III (ATIII) has been studied by indirect immunofluorescence (IF) microscopy. The IF staining reaction for ATIII in skin tissue sections was most prominent in vessel wall structures. The simultaneous use of fluorescent staining techniques for nuclear DNA revealed that ATIII antigen tends to be concentrated at the level of the vascular cndothelial basement membrane, in contrast to the typical intra-endothelial distribution of Factor VIII related antigen. Although our findings indicate that ATIII is normally associated with dermal vessel walls, it remains to be seen whether its presence there is of importance, e.g. in modulating inflammatory skin responses.