Providing welfare rights advice in primary care

OBJECTIVE: To evaluate the introduction of dedicated open access welfare rights advice sessions in a general practice setting. DESIGN: A retrospective study of 416 client visits over a 11 month period from August 1995. A prospective questionnaire survey of 34 attendees over a three month period from April 1996. Semi-structured interviews with 11 involved primary care staff. SETTING: An inner city health centre. OUTCOMES: Social characteristics of clients attending; problems presented; benefit uptake; views from the health centre staff and welfare rights advisers and comments on future development. RESULTS: A total of 270 new clients used the service during the study period with 146 repeat visits (35%). Of the new clients, 158 out of 270 (59%) reported that they were disabled and 50% of the 158 had specific disability based welfare rights enquiries. 15% of new clients (40 out of 270) were found to be owed money by the current benefit system. Of these, 24 clients obtained one-off payments totalling ?15,863 and 16 clients obtained regular payments totalling ?539 a week. 58% of interviewed clients had not previously accessed any welfare rights advisory services. The welfare rights service was considered by the primary health care team to be a very useful contribution in a highly deprived area. CONCLUSIONS: The advice service increased the uptake of social security benefits in 15% of all new attendees. An open access service may not have been the most efficient method of delivering such advice. However, the high proportion of new clients who reported having a disability suggested that a health centre setting may be particularly accessible for those reporting disability. Further work is required to explore these findings and the most effective and efficient method of delivering the service in a deprived inner city setting.     

Medical treatment of primary sclerosing cholangitis

Until 1970, primary sclerosing cholangitis (PSC) was considered to be a medical curiosity. With the development of endoscopic cholangiography, PSC is now recognized more frequently and is a common indication for liver transplantation. PSC is usually progressive, leading to cirrhosis, portal hypertension, and liver failure. The manifestations of disease may be clinically similar to those of other causes of bile duct obstruction and must be distinguished from gallstone disease, bile duct carcinoma, primary biliary cirrhosis, and secondary biliary cirrhosis due to bile duct stricture. Medical management of PSC must take into account the likelihood that destroyed bile ducts do not regenerate as hepatocytes do. Hence, PSC should be treated early in its course. The goal of therapy is to prevent further damage and destruction of bile ducts. In this article, we will present relevant data concerning the medical management of primary sclerosing cholangitis. Received for publication on March 8, 1999; accepted on April 5, 1999     

Recent status of primary sclerosing cholangitis in Japan

Patients with primary sclerosing cholangitis (PSC) in Japan have two peaks in age distribution, one in their twenties and the other in their fifties and sixties. PSC patients in Japan have different characteristics from those in other countries: there is a higher incidence of eosinophilia (27%) and positivity for anti-nuclear antibody (30%), less frequent complication with inflammatory bowel diseases (IBD; 21%), and more frequent complication with chronic pancreatitis (15%). In younger patients in Japan (those aged less than 40 years), the incidence of positivity for anti-nuclear antibody was lower (20% vs 38% P < 0.05), complication with IBD was more frequent (39% vs 9% P < 0.01), complication with chronic pancreatitis was less frequent (4% vs 22% P < 0.01), and damage to both the intra- and extrahepatic bile ducts was more frequent (89% vs 56% P < 0.01) than in older patients (those aged 40 years or more). These findings suggest that younger PSC patients in Japan have characteristics similar to those of patients in other countries, and that in Japan older PSC patients have a different pathogenesis from that of younger patients. Received for publication on Feb. 16, 1999; accepted on April 5, 1999     

c-Jun expression after axotomy of corneal trigeminal ganglion neurons is dependent on the site of injury

The proto-oncogene c-Jun has been implicated in the control of neuronal responses to injury and in axonal growth during regenerative processes. We have investigated the expression of c-Jun during normal terminal remodelling in trigeminal ganglion neurons innervating the cornea and after acute injury of epithelial nerve terminals or parent axons. Remodelling and rearrangement, or damage limited to corneal epithelium endings, was not a trigger for activation of c-Jun expression. However, injury of parent axons in the stroma or in the orbital ciliary nerves induced c-Jun expression in 50% of the population of corneal neurons, which included all of the large myelinated and 20% of the small neuropeptide-containing corneal neurons. This suggests that c-Jun expression in trigeminal ganglion neurons is not associated with normal remodelling or regeneration of peripheral nerve terminals, and that it takes place only when parent axons are injured. A substantial number of damaged neurons do not express c-Jun, indicating that in primary sensory neurons, injury and regeneration may not always be coupled to the expression of this proto-oncogene.     

Designing an intervention to prevent suicide: PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial)

Suicide is a major public health problem with greatest risk in the very old. This paper describes an approach to reducing the risk of suicide by intervening on depression in elderly primary care patients. Depression is an appropriate target for an intervention as it is highly prevalent in primary care, is a strong risk factor for suicide, and is more often than not inadequately treated. PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial) is a National institute of Mental Health (NIMH)-funded collaborative study that is testing this approach to suicide risk prevention in 18 primary care practices in the United States. PROSPECT'S intervention of "guideline management" introduces a health specialist into the primary care setting to help physicians provide "on-time, on-target" treatment and long-term management of late-life depression following structured clinical guidelines. The effectiveness of the intervention in reducing suicidal risk and depression is evaluated by following a representative sample of older patients identified using a 2-stage design.     

Needs for Youth Substance Abuse and Violence Prevention in Schools and Communities

Substance abuse and violence among today's youth are at an all time high. Numerous prevention programs have been implemented to address these issues. Not all are successful. Research has found that when schools and communities are involved in the planning of prevention programs, youth are more cognizant of risk factors and of behaviors that strengthen risk factors. The purpose of this study was to assess the emerging needs for prevention and health education among youth, and to identify effective approaches for prevention program development and service delivery in schools and communities. This study surveyed 312 youth prevention specialists, school and community health educators and counselors, and parents in a regional sample of ten states. Results indicated that substance abuse and violence are the two most critical and priority issues in need of comprehensive prevention. Multiple prevention service delivery strategies appropriate to youth, including training, technical assistance, conferencing and networking, needs assessment and evaluation, and information requests are discussed in detail. Implications for prevention programming emphasized reducing risk factors and strengthening protective factors, reaching and motivating youth participation.     

Acceptance and effects of nasal lavage in volunteer woodworkers

Wood dust is an irritant and is carcinogenic to the nasal mucosa. It inhibits its own clearance from the nose. It therefore makes sense to lavage retained wood dust from the nose following exposure. To our knowledge this is the second study conducted to determine whether the procedure of nasal lavage reduces nasal symptoms in woodworkers. Forty-six woodworkers from 150 approached volunteered to trial nasal lavage using gravity fed, home-made unbuffered isotonic saline for 2 months in a crossover trial and then be followed-up a year later. The group reported significantly decreased nasal symptoms and over half continued to use nasal lavage voluntarily after 1 year. Results support the findings of the previous study that nasal lavage improves nasal symptoms and supplements those findings with data indicating patterns of voluntary usage following the study's conclusion. It is concluded that nasal lavage is an acceptable, effective and inexpensive option with minimal side effects for woodworkers who experience nasal symptoms and who wish to try the procedure.     

Using socio-economic differences in knowledge and attitudes to shape community alcohol programmes: experiences from the Kirseberg Project

Community-based public health projects have become increasinglyimportant as a tool for health promotion. This approach hasbeen considered appropriate also in addressing socio-economicdifferences in health, although little is known about socio-economicdifferences in perception of health as a community issue. Ouraim was to study socio-economic differences in awareness andknowledge about the Kirseberg Project and in attitudes towardsthe concept of health as a local community issue. The KirsebergProject was initiated in 1988. The primary prevention aims areto reduce alcohol consumption in the population in order todecrease the incidence of alcohol-related problems. Kirsebergis an area with 10000 inhabitants in the north-eastern partof the city of Malmö (population 230000), Sweden. A sampleof 400 people in the area between the ages of 20 and 75 yearsof age was randomised from the population register and interviewedby telephone. Of the sample, 73.3% responded. Of the respondents,65.2% were aware of the project and 38.6% had knowledge aboutit. Socio-economic differences were found both regarding knowledgeand attitudes. Individuals in the high socio-economic status(SES)-group were better informed about the project than thelow SES-group, more often associated the project with the promotionof the community spirit, tended to give more positive answersto the questions about important local health issues, demonstratedhigher adherence to the social environment issues and were moreinterested in local health promotion activities. Our conclusionis that the socio-economic knowledge differences which werefound in the Kirseberg Project should be seen as shortcomingsin the health educational campaign rather than as a first stepin a determined social process. The issue of how the explicitnotions and the hidden agenda of a health promotion campaigncorrespond with central attitudes and values in different populationgroups in the target community must be carefully investigated.