Do people with type 2 diabetes and their carers lose income? (T2ARDIS-4)

T(2)ARDIS is a study of the full costs of care for a sample of people with type 2 diabetes in the UK. This paper reports on individual earnings lost by patients (n=653) and carers (n=253) aged <65 years, based on 1998 values. Mean annual lost earnings are calculated on three different bases. Across the total survey population aged <65 years, mean lost earnings are estimated at pound 869 (S.D. pound 4109) per patient and pound 1300 (S.D. pound 4093) per carer. However, for the sub-set of respondents who actually lose earnings, the mean levels are pound 13841 (S.D. pound 9551) and pound 10960 (S.D. pound 6002), respectively. Patients and carers who lose earnings incur higher personal care-related expenditure than those who do not lose earnings (although for the patients this is not statistically significant). Patients who lose earnings also report poorer health-related quality of life and carers who lose earnings report higher levels of strain. Only one third of carers report receiving state benefits, and for both carers and patients the shortfall between reported benefits received and lost earnings is substantial. A strong association was found between patients' loss of earnings and the presence of diabetic complications (P<0.001), especially micro-vascular complications. Policy priorities should, therefore, include facilitating comprehensive access to state benefits (especially for carers) and a clear focus on reducing the incidence of diabetic complications.     

Comparison of black and white patients attending hypertension clinics in England.

Reports suggest that hypertension and death due to hypertensive disease are commoner among black than among white people. One hundred and thirty-five black patients attending hypertension clinics at three English hospitals were compared with age-, sex-, and clinicmatched white patients. The black women had higher blood pressures and weighed more than the white women, but there were no differences between the men. The black patients had not increased risk from family, obstetric, or smoking history. Proteinuria and nocturia were more common in black patients while urinary infections were less common. Heart size and left ventricular voltage were greater in black patients. Haemoglobin and plasma cholesterol and triglyceride concentrations were smaller and serum globulin concentration greater in black patients. No difference in response to treatment, attributable to race, was observed during the period of clinic attendance, which averaged 1.7 years. There was a slightly greater rate of default among black men during the first year of attendance.     

Treatment of tick-bite fever with erythromycin

Because of the occasional need for an alternative drug for the treatment of tick-bite fever, a study of the value of erythromycin for the variety of tick-borne typhus fever occurring in southern Africa was undertaken. In guinea-pigs erythromycin 125 mg/kg for 5 days largely prevented the fever and other signs of the infection, but did not prevent the serological reaction as determined by the rickettsial complement fixation test. A series of 17 human patients were treated for 4 days with erythromycin 500 mg 6-hourly for adults and 30-50 mg/kg/d in 4 divided doses for children. Eleven patients appeared to respond favourably. It was concluded that erythromycin does not have as specific a value as tetracycline in the treatment of tick-bite fever, but that when tetracycline is contraindicated erythromycin is a useful alternative drug.     

Histocompatibility antigens in patients with hepatocellular carcinoma and their relationship to chronic hepatitis B virus infection in these patients.

Although hepatocellular carcinoma is probably caused by one or more environmental carcinogens, a genetically determined susceptibility to the development of the tumor has not been excluded. In looking for such a predisposition, we have compared the histocompatibility antigens (HLA) of 102 southern African blacks with histologically proved HCC with those of 208 healthy blacks. The standard two-stage lymphocyte microcytotoxicity method was used to test for 40 antigens: 17 in the A locus, 20 in the B locus, and 3 in the C locus. None of the HLA antigens had a frequency that was significantly different in the patients and the controls. A close association undoubtedly exists between chronic hepatitis B virus infection and hepatocellular carcinoma. If this virus is proved to be oncogenic with respect to hepatocellular carcinoma, a genetic predisposition to the hepatitis B virus carrier state may have an indirect bearing on the etiology of the tumor. Sera from the hepatocellular carcinoma patients were therefore tested for hepatitis B virus markers (HBV surface antigen and antibody against HBV core antigen), and these were related to the patients' histocompatibility antigens. None of the HLA antigen frequencies was significantly different in the surface antigen-positive and the surface antigen-negative patients. As 88% of the patients were anticore positive, no meaningful correlation could be carried out with this marker. Analysis of histocompatibility antigens thus failed to show evidence of a genetic predisposition either to hepatocellular carcinoma or to chronic hepatitis B surface antigenemia in patients with this tumor.     

An assessment of the accuracy of modern endoscopic diagnosis of oesophageal stricture

The results of 135 fibreoptic endoscopic examinations of oesophageal strictures carried out in a district general hospital are reported. The endoscopic diagnosis was correct in 90 per cent, uncertain in 3 per cent and incorrect in 7 per cent of these cases. This study indicates that endoscopic examination should include tissue sampling; this not only allows a precise tissue diagnosis to be made but also is shown to increase the accuracy of diagnosis. Tissue sampling should include cytological as well as histological material. Analysis of cases of stricture correctly diagnosed has shown that target biopsy and brush cytology each makes a significant contribution to diagnosis. The routine collection of cytological specimens in addition to the more commonly obtained histological specimens in addition to the more commonly obtained histological speciments is strongly advocated. The natural history of malignant oesophageal strictures in this study is reviewd. The mean survival in 58 cases was 6.9 months.