A study of the provision of health checks and health-promotion clinics in 18 general practices

Summary

• ? The objective of this study was to describe the variation in provision of health checks and health-promotion clinics operating under the regulations of the 1990 Contract for general practice in the UK.
• ? Eighteen group practices in three Family Health Service Authority (FHSA) areas of England (two in the South West Thames region and one in the Yorkshire region) were selected for the study. The nurses, largely responsible for the implementation of the health checks at these practices, were interviewed using semi-structured interview schedules. They were asked about age-groups targeted, means of recruiting patients for clinics, duration of clinic appointments, and procedures carried out in clinics.
• ? All practices offered health checks, and 55% had started doing so before introduction of the 1990 Contract. Recruitment for health checks took place in a number of ways: self-referral (83% of practices); opportunistically in those with coronary heart disease risk factors (78%); opportunistically during attendance for cervical smears (62%); screening in at least one patient group (78%). Blood pressure, height, weight, urinalysis and life-style advice were included by all practices. Stress management and quit smoking strategies were offered only by a minority of practices. Duration of first health-check appointment ranged between 15 and 30 minutes.
• ? The basic content of health checks, and life-style advice given appeared consistent between the widely varying practices. However, the resources available for intervention and follow up showed more variation.

     

Human monoclonal antibodies against Plasmodium falciparum: production, stabilization and characterization

Nine human monoclonal antibodies (MoAbs) recognizing 7 different antigenic structures of blood-stages of the human malarial parasite P. falciparum (Pf) were produced by Epstein-Barr virus transformed B-cell lines (EBV-TCL) with or without fusion to the lymphoblastoid cell line KR4. The peripheral blood B-lymphocytes were obtained from 8 Gambian donors immune to Pf malaria. Two of the EBV-TCL could be expanded and maintained for more than 6 months but neither one could be cloned. Six additional EBV-TCL were stabilized after fusion with the KR4 lymphoblastoid cell line. All resulting hybridomas permitted easy cloning. Some of the MoAbs produced distinct fluorescent staining patterns of asexual Pf blood-stage parasites when using high-resolution digitized video-intensified fluorescence microscopy. Antigens on 195 kD and 155 kD proteins were recognized by 3 and 1 MoAb, respectively, using Western blotting and immunoprecipitation techniques.     

Demographic Characteristics and the Frequency of Heavy Drinking as Predictors of Self-reported Drinking Problems

The distribution of both heavy drinking and drinking problems are well known from several previous studies. Not surprisingly, drinking problems are more prevalent among the demographic groups where heavy drinking is also more prevalent. This well-known conjunction, however, does little to determine whether some groups are more likely than others to experience drinking problems when we control for the amount of alcohol consumed. Here, this question is punned through a multiple regression analysis in which the dependent variable is a score on a drinking problem scale and the independent variables are: the frequency of heavy drinking occasions, sex, age, marital status, region, urbanicity, income, and education. The results indicate that none of these demographic variables had a strong association with the reported problem level.     

Acquisition of antibody isotypes against Plasmodium falciparum blood stage antigens in a birth cohort

Information on the period during which infants lose their maternally derived antibodies to malaria and begin to acquire naturally their own immune responses against parasite antigens is crucial for understanding when malaria vaccines may be best administered. This study investigated the rates of decline and acquisition of serum antibody isotypes IgG1, IgG2, IgG3, IgG4, IgM and IgA to Plasmodium falciparum antigens apical membrane antigen (AMA1), merozoite surface proteins (MSP1‐19, MSP2 and MSP3) in a birth cohort of 53 children living in an urban area in the Gambia, followed over the first 3 years of life (sampled at birth, 4, 9, 18 and 36 months). Antigen‐specific maternally transferred antibody isotypes of all IgG subclasses were detected at birth and were almost totally depleted by 4 months of age. Acquisition of specific antibody isotypes to the antigens began with IgM, followed by IgG1 and IgA. Against the MSP2 antigen, IgG1 but not IgG3 responses were observed in the children, in contrast with the maternally derived antibodies to this antigen that were mostly IgG3. This confirms that IgG subclass responses to MSP2 are strongly dependent on age or previous malaria experience, polarized towards IgG1 early in life and to IgG3 in older exposed individuals.     

Epicardial repolarization mapping in man

A simple method was developed for recording epicardial monophasicaction potentials intraoperatively in man. Potentials were recordedrapidly and reliably from multiple epicardial sites using ahand-held probe. The feasibility of repolarization mapping wasassessed in 30 patients. It was possible to record technicallyadequate signals from most left ventricular and posterior rightventricular sites (success rates 72% and 61%, respectively),but it was more difficult to achieve satisfactory recordingsover the free wall of the right ventricle (success rate 36%).The onset of cardiopulmonary bypass resulted in a transientrise in action potential duration of approximately 30–40ms in the first minutes of bypass. An approximate steady statewas achieved thereafter. Reproducibility of the method was assessedby mapping a small number of sites repeatedly. The 95% confidencelimits for an estimate of repolarization time, based on a singlepotential, were ±21 ms. With 4 probe applications ateach site, the confidence limits of the estimated site meanwere reduced to ±8 ms. Based on this approach, statisticallysignificant differences between sites were demonstrated in 9of 10 patients, confirming that the method is sensitive enoughto provide information on regional differences in repolarization. Intraoperative epicardial repolarization mapping has been shownto be a practical possibility. The technique holds promise asa means of assessing the role of dispersion of repolarizationin arrhythmogenesis in man.