Sickness Absence from Work and Influenza Immunization

The worth of influenza immunization for employees in U.K. industryhas been debated for more than a decade. In this study no evidencecould be found of a protective effect for sickness absence patterns.Other evidence is also cited that suggests routine influcnzalimmunization programmes for healthy adults of working age areno longer justilied. *Requests for reprints should be addressed to: Dr Robin Philipp, Department of Epidemiology and Community Medicine, University of Bristol, Bristol BS8 2PR.     

Titration of Power Output During Radiofrequency Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia

Radiofrequency lesions in the anterior, superior aspect of the tricuspid annulus result in selective elimination of fast pathway function in patients with typical atrioventricular (AV) nodal reentry tachycardia. This technique is simple and effective, but has been associated with a significant risk of inadvertent complete AV block. The purpose of this study was to compare the safety and effectiveness of two different techniques for radiofrequency catheter ablation of the fast AV nodal pathway. Initially, a fixed power output was used at each target site. This method was compared retrospectively to a newer technique where power output was gradually incremented at each site. Radiofrequency power was initially applied at 10 watts for 10–15 seconds. If no junctional ectopy or a change in PR intervoi was seen, power output was incremented by 2 to 4 watts every 10 to 15 seconds up to a maximum of 30 watts. Thirty seven of 38 (96%) patients treated using this incremental power output were cured of their AV nodal reentry tachycardia. None of these patients developed inadvertent complete AV block. In contrast, 92% of historic controls treated with a fixed power output between 20 and 30 watts achieved a primary success and nine of these 89 (10%) historic controls developed inadvertent complete AV block (P = 0.04). There was no difference in the amplitudes of atrial, His, or ventricular electrograms at the effective sites between the two groups. Conclusions: (1) the anterior approach to radiofrequency catheter ablation of typical AV nodal reentry is associated with a significant risk of inadvertent complete AV block if a fixed power output is used; (2) starting at low power and gradually incrementing the output during radiofrequency energy application reduces the risk of complete AV block; (3) this incremental technique does not compromise efficacy.     

COMPUTER CONTROLLED INFUSION OF PROPOFOL

A computer controlled infusion pump was used to deliver propofolto two groups of eight patients undergoing body surface surgery.The patients were premedicated with morphine sulphate i.m. andanaesthesia was supplemented with 66% nitrous oxide in oxygen.Patients in group 1 breathed spontaneously, whereas patientsin group 2 underwent artificial ventilation to a normal Pa_co2.The computer program was designed to achieve and maintain ablood concentration of propofol 3 µg ml^–1 as rapidlyas possible, basing calculations on a three-compartment pharmacokineticmodel. Mean blood propofol concentrations were found to be closeto the predicted target from 10 to 120 min in group 1, but were5–20% higher from 20 min in group 2. ^*Department of Anaesthetics, Royal Devon and Exeter Hospital(Wonford), Barrack Road, Exeter, Devon. Department of Anaesthetics, Weston General Hospital, WestonGeneral Hospital, Weston Super Mare, Devon.     

Sources and incidence of airborne Aspergillus fumigatus (Fres)

Specific surveys of the air for Aspergillus fumigatus were carried out in rural and urban situations over a 2-year period. Overall, low concentrations of spores were recorded with a higher incidence during the ‘winter’ months. Counts in the open air and in a hospital ward showed similar fluctuations, the indoor counts being consistently lower. Plant debris in the form of compost heaps and stacks of hay and straw baled with a high moisture content in which self-heating occurs, produces large numbers of spores which may be liberated into the air causing high but localized counts if disturbed. The widespread distribution of decaying leaves following leaf fall represents a potential source of smaller concentrations of spores but over a much larger area. This availability of decaying plant debris with high water content fulfils the growth requirements of Aspergillus fumigatus and is the probable explanation of its winter seasonality.     

The Process of Transforming Mental Health Services in Australia

Australia commenced a nationally coordinated transformation of its public and private mental health services in 1993. This paper presents an overview of the changes in mental health service delivery using data from the 2004 Australian National Mental Health Report. In the 10 years from 1993 to 2002, government spending on mental health increased 65 percent in real terms, with a 145 percent growth in expenditure for community-based services. Government subsidies to the private psychiatrist sector have declined. Consumer and carer participation in service planning and delivery increased, measures to improve quality introduced and patient level outcome measures are being adopted widely. However, some consumers with specific needs have been neglected and the transformation has not been implemented uniformly across the country.     

THE RELATIONSHIP OF HAEMOGLOBIN TO SERUM ERYTHROPOIETIN CONCENTRATIONS IN THE ANAEMIA OF RHEUMATOID ARTHRITIS: THE EFFECT OF ORAL PREDNISOLONE

Previous studies of the erythropoietin response to anaemia inRA have yielded conflicting findings. Some have found the responseto be impaired and others have found a normal response. We havecompared erythropoietin (EPO) levels measured by radioimmunoassay,in 54 anaemic rheumatoid patients and 55 patients with irondeficiency anaemia but no inflammatory disease. The erythropoietin response in the rheumatoid patients was impairedcompared with the control group (P < 0.025) but only sevenrheumatoid patients showed a response which fell below the 95%confidence intervals predicted for the control group. Rheumatoidpatients who fell within the highest quartile for serum ferritinconcentrations (i.e. those most likely to have anaemia of chronicdisease) had significantly lower EPO levels compared with thecontrol group (P < 0.01). EPO levels in rheumatoid patientswithin the lowest quartile for ferritin (i.e. those with irondeficiency anaemia) were not significantly different from thecontrol group (P = 0.670). The difference in EPO response betweenthe RA patients in the upper and lower quartile for ferritinapproached but did not achieve significance (P = 0.056). Ina second study 15 anaemic RA patients were given a 5-day courseof oral prednisolone 1.5 mgkg^-1. Haemoglobin did not rise significantlyuntil day 4 but EPO levels fell by day 1 (P < 0.005) andremained lower than pretreatment values throughout the study.Thus, in RA patients, anaemia of chronic disease is associatedwith inappropriately low EPO concentrations but this does notappear to be the major cause of the anaemia and Hb responseto prednisolone does not depend upon an increase in EPO concentration. KEY WORDS: Rheumatoid arthritis, Anaemia of chronic disease, Erythropoietin, Prednisolone