The determinants and effect of shared care on patient outcomes and psychiatric admissions

OBJECTIVE: The aim of this study was to determine the factors associated with receipt of different levels of shared care, and the effect of shared care on patient outcomes. METHOD: A total of 349 patients with severe mental illness were selected from general practice lists. Patient functioning was assessed using standardised questionnaires, and GPs completed a questionnaire about patients' shared care arrangements at baseline (response-rate 79%). Patients were followed up at 12 months. RESULTS: Receipt of high shared care was associated with greater patient satisfaction with services and social functioning at baseline (p < 0.005). Patients receiving high shared care showed greater improvements in SF-12 mental health scores at follow-up compared to low shared care groups (p = 0.02). This effect was abolished after adjustment for age, sex and psychiatric diagnosis. CONCLUSION: Receipt of high shared care was not associated with demographic or clinical characteristics. High shared care had limited value for patients in terms of improved clinical, social or general health functioning over one year.     

Resistance-associated point mutations of organophosphate insensitive acetylcholinesterase,in the olive fruit fly Bactrocera oleae

A 2.2-kb full length cDNA containing an ORF encoding a putative acetylcholinesterase (AChE) precursor of 673 amino acid residues was obtained by a combined degenerate PCR and RACE strategy from an organophosphate-susceptible Bactrocera oleae strain. A comparison of cDNA sequences of individual insects from susceptible and resistant strains, coupled with an enzyme inhibition assay with omethoate, indicated a novel glycine-serine substitution (G488S), at an amino acid residue which is highly conserved across species (G396 of Torpedocalifornica AChE), as a likely cause of AChE insensitivity. This mutation was also associated with a 35-40% reduction in AChE catalytic efficiency. The I199V substitution, which confers low levels of resistance in Drosophila, was also present in B. oleae (I214V) and in combination with G488S produced up to a 16-fold decrease in insecticide sensitivity. This is the first agricultural pest where resistance has been associated with an alteration in AChE, which arises from point mutations located within the active site gorge of the enzyme.     

Natural swarming behaviour of the molecular M form of Anopheles gambiae

In Anopheles gambiae, as in most species of mosquitoes, mating is initiated in flight. The males aggregate in aerial swarms and conspecific females individually fly to these swarms where they mate with males. In this study, we investigated the swarming behaviour of A. gambiae and conducted 2 surveys in the rice field area of the Vallée du Kou in Burkina Faso in 1999 and 2002. A high number of anopheline mosquitoes were observed in this area and both molecular M and S forms of A. gambiae were found in sympatry. Swarms formed a few minutes after sunset in different places and no obvious markers were associated with their occurrence. However, swarms occurred close to cow herds generally in open flat areas, 2-3 m above the ground. Overall, 2829 anopheline mosquitoes were collected from 21 swarms composed primarily of males. A few specimens of Culex quinquefasciatus were collected from 3 swarms. Although both molecular M and S forms were found in sympatry in the village, swarms were composed almost exclusively of the molecular M form. This suggests that there are alternative swarming habits for both molecular M and S forms of A. gambiae in nature.     

Acute adrenal insufficiency presenting as high output ileostomy

We report a patient with ulcerative colitis who, in the period following surgery, developed recurrent episodes of acute adrenal insufficiency presenting clinically as a high output ileostomy.     

WONCA Online电子病例介绍——吾-巴-怀三氏综合征

·病例简介:患者,女,37岁,因持续性心悸就诊。既往有类似经历,但持续时间不超过几分钟。·体格检查:面色苍白、出汗、嗜睡,呼吸困难,脉细,脉率与心脏听诊及触诊不符。血压80/46 mm Hg(1 mmHg=0·133 kPa),心电图表现类似于室性心动过速,节律不匀齐。采用同步电复律后,心律恢复到58次/m in,随后再次行心电图检查,有典型预激综合症表现,Delta波、QRS波群增宽,PR间期缩短。·提示:心电图无室性心动过速·诊断:吾-巴-怀三氏综合征(W olff-Parkinson-White syndrome,WPW)·讨论:WPW综合征的发生是因存在异常的房室旁路传导束而发生的,如K…     

Percutaneous transluminal angioplasty of the distal abdominal aorta

Percutaneous Transluminal Angioplasty (PTA) has become widely practised and is a significant advance in the treatment of arterial disease. Its use in the treatment of atheromatous abdominal aortic stenoses in thirteen patients is described. Technical success was achieved in all with no complications. In a follow-up period from 7 to 70 months all patients have benefitted and 85% remain symptom free.