Comparing population estimates for drug users, the prevalence of blood-borne viruses and the provision of services in one London borough: Evidence of a gap in provision?

Aims: To estimate the size of the drug-using population in Lambeth, an inner city London borough, and the prevalence of blood-borne virus (BBV) infections in the drug-using population. To identify possible shortfalls in service provision for drug users.

Methods: Direct and indirect estimates of the drug-using population size using national and local data sources. Prevalence estimates for BBV infections were derived from local survey data. Routine data and a survey of borough services for drug users were compiled.

Findings: Based on indirect methods we estimated there were 3117 drug users in Lambeth in 2001-2002 (20 per 1000, 15- to 44-year-olds), of whom 1641 were injecting users (11 per 1000); 1353 were reported as being in drug treatment programmes. BBV prevalence rates: hepatitis B, 37%; hepatitis C, 71%; HIV, 6%. Estimated demand for needle exchange services, in terms of one syringe per injection, and methadone maintenance may be up to double local provision.

Conclusions: More accurate and feasible methods are needed for the routine estimation of the population of drug users. Accurate information is needed for service planning.     

A recurrent mutation in the loricrin gene underlies the ichthyotic variant of Vohwinkel syndrome

Vohwinkel syndrome (VS) is a family of genodermatoses which exhibits extensive clinical and genetic heterogeneity. Here, we studied a pedigree originating from the UK with typical features of the ichthyotic variant of VS and identified a recurrent insertion mutation in the loricrin gene resulting in a mutant polypeptide with an unusual C terminus. Functional studies in transgenic mice have shown that the accumulation of mutant loricrin in the nucleus appears to interfere with the later stages of epidermal differentiation, thereby explaining the clinical manifestations of ichthyosis, keratoderma and pseudoainhum. Our findings extend the body of evidence implicating mutations in the loricrin gene as the underlying cause of VS.     

Effect of total knee arthroplasty on recreational and sporting activity

BACKGROUND: Common concerns of patients undergoing total knee arthroplasty (TKA) are whether they can continue with certain recreational and sporting activities or even commence new ones after the procedure. The present study was designed to determine preoperative and postoperative activities, the numbers participating and the time to resume these activities. METHODS: Between 1 and 2 years after TKA, patients who had undergone 144 arthroplasties, were surveyed by postal questionnaire to ascertain how the arthroplasty had affected their recreational and sporting ability. Their preoperative and postoperative activity along with the time to resume was recorded. The Oxford knee score and estimate of physical activity was also collected. RESULTS: Out of the 144 TKA performed, 122 participated in sport and recreational activity preoperatively and 108 participated postoperatively. Patients stated that the surgery had a beneficial effect on their performance of sporting and recreational activities although the number of sporting events decreased. By multiplying individuals by the number of activities they participated in, there were 254 occurrences of sport and recreational activities preoperatively giving a mean for the group of 1.76 sports/patient. Postoperatively this had reduced to 204, giving a mean of 1.41. Three activities showed a significant change for individual patients from pre- to postoperation. Those which showed an increase were exercise walking, where 19 patients (13.2%) who did not walk before surgery took up walking afterwards (P < 0.006) and aqua aerobics, where five took up aqua aerobics postoperatively for the first time (P < 0.025). Golf was the only sport which had a significant fall in participation from pre- to postoperation, with 10 out of 19 golfers giving up (P < 0.025). CONCLUSION: The present study has shown that patients are adopting lower impact activities to participate in after TKA. The total number of patients performing a sport decreases postoperatively and the total amount of sport played decreases. These data will help to counsel patients.