Primary hyperpara-thyroidism: Is there anything new?

Primary hyperparathyroidism remains the most common cause of hypercalcemia encountered in outpatient practice. Management of the asymptomatic patient with mild disease remains conroversial. Surgery is the only curative therapy, and minimally invasive procedures are now possible. The author has stated that she does not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The author acknowledges discussing the off-label (which includes unlabeled or unapproved) use of alendronate, raloxifene, and estrogen in use in primary hyperparathyroidism.     

HLA-DR2 predicts susceptibility and disease chronicity in Irish sarcoidosis patients

BACKGROUND: HLA-DR2 (15) and 14 (6) have been recently proposed as susceptibility alleles for the development of sarcoidosis and HLA-DR15 as a marker of poor outcome, but validation in other populations is necessary. METHODS: Employing serological techniques, we HLA-typed 103 Irish sarcoidosis patients and 105 ethnically-matched healthy controls for class I A and B and II DR and DQ alleles. RESULTS: HLA-B5 (10% vs. 2%, p = 0.018) and DR2 (45% vs. 27%, p = 0.007) were positively associated and B15 (0% vs. 7%, p = 0.01) negatively associated with sarcoidosis compared to control subjects. Seventy-five patients were followed > 2 years and 47 (63%) had chronic and 28 (37%) non-chronic disease. HLA-DR2 (55% vs. 27%, p = 0.001) and DR11 (26% vs. 5%, p<0.0001) were significantly more frequent in chronic disease vs. controls, in contrast to HLA-DR3 (13% vs. 38%, p = 0.002), which had a significant negative association. HLA-B5 (11% vs. 2%, p = 0.029) and DR3 (64% vs. 38%, p = 0.005) were significantly more frequent in non-chronic disease. Of the 29 patients achieving spontaneous remission, 24 (83%) were HLA-DR3 -positive and DR3-positivity was associated with significantly greater carbon monoxide diffusion at follow-up compared to DR3-negative patients (90% vs. 82% predicted, p = 0.027). CONCLUSIONS: This study supports the role of HLA-DR2 (15) as both a susceptibility and poor prognostic marker in sarcoidosis and DR2 positive patients may particularly benefit from close follow-up and early treatment. In contrast, DR3 positive patients are at a much lesser risk of chronic disease. Studies for long-term treatment effects require stratification for HLA-DR2 and DR3 status.     

Attentional ability among survivors of leukaemia treated without cranial irradiation

Background: Previous research has indicated that children who have received treatment for leukaemia which includes cranial irradiation exhibit deficits in their ability to focus attention. It has been suggested that the use of cranial irradiation may have a role to play in long term sequelae. Aims: To investigate neuropsychological functioning among children treated for leukaemia without cranial irradiation. Methods: In a cross sectional study, 17 leukaemic patients and their sibling controls were assessed using a neuropsychological model of attention. All were treated on the UKALL XI protocol and none had received cranial irradiation. Participants completed the Arithmetic subtest and Digit Span subtest of the Weschler Intelligence Scale for Children–Revised to assess focus–encode elements of attention; the Coding subtest and the Speed of Information subtest of the BAS to assess focus–execute aspects of attention; the VIGIL computerised battery to assess sustain elements of attention; and the Wisconsin Card Sorting test to assess the ability to shift attention. Results: These children did not exhibit the deficits witnessed in previous cohorts, and were performing at comparable levels to their controls on all measures of attention Conclusions: These findings suggest that children who have received treatment for leukaemia without the use of cranial irradiation do not show the neuropsychological insult found in earlier treatment groups.     

Assessing the health impact of local amenities: a qualitative study of contrasting experiences of local swimming pool and leisure provision in two areas of Glasgow

STUDY OBJECTIVE: To assess the health impacts of local public swimming pool and leisure provision. DESIGN: Retrospective qualitative study using focus groups. Reports from two areas with contrasting experience of provision of a public swimming pool (opening and closure) were compared within the context of general reports about health and neighbourhood. SETTING: Two deprived neighbourhoods in south Glasgow. PARTICIPANTS: Local adult residents of mixed ages, accessed through local community groups. MAIN RESULTS: In both areas the swimming pool was reported as an important amenity that was linked to health and wellbeing. However, few residents reported regular use of the pool for physical activity. Use of the pool facility for social contact was directly linked to reports of relief of stress and isolation, and improved mental health. Pool closure was one in a series of amenity closures and area decline and was used to represent other area changes. Health impacts were strongly linked to the pool closure. The pool opening was associated with local area regeneration, similar but less prominent links between swimming pool provision and health were reported. Health benefits of social contact were diffuse and linked to other local amenities as well as the new pool facility. CONCLUSIONS: Although theoretically linked to increased physical activity, the health benefits conveyed by the swimming pool may be more closely linked to the facilitation of social contact, and a supervised facility for young children. The use of qualitative work to investigate area based change provides rich contextual data to strengthen and explain the reported health impacts.     

Leveling the playing field for EMS services

Pinellas County's emergency medical services system is a public utility model EMS system where as the purchaser of services, the EMS Authority can achieve the highest-quality, most cost-effective and most reliable EMS services. Pinellas County's use of an absolute level-playing-field, non-political bidding process that isolated quality and pricing issues has raised the bar for government purchasing. The entire EMS industry has seen how contract services can be evaluated fairly, in a non-political atmosphere, for the betterment of the citizens of the community. Our EMS Authority voted to award the contract to the best overall proposal based on fact and merit. The new agreement allows us to provide significantly improved paramedic ambulance services to our citizens at a substantial cost reduction to the county.