Identifying target segments of male drinkers for health promotion

Data from a 1988 national drinking survey was cluster analysedto identify different types of male drinkers, to assist in thetargeting of health promotion strategies. Of the five segmentsgenerated by the clustering, one labelled Young Heavy DrinkingMales was identified as the most appropriate target segment,because although they were the segment reporting the highestlevel of alcohol-related problems they were also the segmentmost likely to feel they were drinking too much They were thereforethe segment most likely to be responsive to advertising thatsought to support people who wanted to change their drinkinghabits. They were also the most appropriate target for the longer-termgoal of changing the climate of opinion regarding the acceptabilityof more moderate drinking. Comparisons with two previous clusteranalyses showed a high degree of similarity, suggesting thatclustering is a reliable vehicle for identifying drinker types.     

Patient Characteristics Associated with the Labelling of Asthma

Patient characteristics associated with the asthma label wereinvestigated in 262 children, aged 8 years, who reported wheezingillness in the previous 12 months. Children were first identifiedby a screening questionnaire administered to the parents ofall 8 year old schoolchildren in Croydon, south London. Interviewswere conducted with those reported to have had a wheezing illnessin the previous 12 months to obtain details of the child's illness,medical care, demographic and socioeconomic characteristics.Multivariate analysis showed that the likelihood of being labelledasthmatic was increased in those who had a parental historyof hayfever [odds ratio (OR) = 2.24, 95% confidence interval(Cl) = 1.22–4.14] or at least two allergic provoking factors(OR = 3.83, 95% Cl = 1.44–10.15). No significant associationswere found between asthma labelling and children's socioeconomiccharacteristics or use of general practitioner services. Thesefindings suggest that wheeze is likely to be labelled asthmawhen the clinical history suggests an allergic aetiology.     

Evaluation of an Australian intervention to encourage breast feeding in primiparous women

Breast feeding has nutritional, immunologic and antiallergicadvantages for the infant. Although it has been widely recommendedthat infants be exclusively breast fed until 4–6 monthsof age, only about half of all Australian babies currently receiveextended breast feeding. The present study evaluated an intensiveprogramme designed to increase the proportion ofprimi-parousmothers who breast fed for 4 months or longer. Women who registeredwith the hospital at least 20 weeks before delivery and whointended to breastfeed were eligible for the study. Two hundredand thirty-five women were allocated to receive either usualcare or an intensive breast feeding programme when they registeredwith the hospital. The intensive programme consisted of writtenmaterials, and group and individual sessions with a lactationcounsellor. It also included a visit from a breastfeeding consultantwhile in hospital after the birth and contact on return home.Women were followed up 6 weeks and 4 months after delivery.There were no significant differences in breastfeeding ratesbetween the control and intervention groups at either follow-uppoint. Breast feeding until 4 months was more likely among womenwhose baby did not receive a bottle feed while still in hospitaland who did not smoke, use the combined oral contraceptive pillor introduce solid food before 4 months. Those mothers who enjoyedand felt satisfied with breastfeeding were more likely to continueto 4 months. It seems likely that programmes designed to increasebreastfeeding will need to address underlying factors such ashospital policy rather than simply providing more health education.     

Stochastic models for geriatric in-patient behaviour

Departments of geriatric medicine engage in two distinct formsof clinical activity: acute/rehabilitative and long-stay care.These are organizationally distinct and have very differentresource needs. Current hospital planning models, however, assumethat patients all move through the system at the same rate,thereby ignoring this effect of inherent heterogeneity in patientbehaviour. The present paper describes the movement of patientsthrough geriatric hospitals by a two-stage continuous-time Markovmodel, where the stages represent acute/rehabilitative and long-staypatients respectively. Patients are initially admitted to thefirst stage, from which they may depart from the system, bydeath or discharge, or move into the second stage, from whichthey eventually depart by death or discharge (unlikely). Admissionsare modelled in two ways: either as replacements for departuresor as a Poisson stream. Expressions for the distribution andmovement of numbers of patients are derived and evaluated fordata from a number of hospitals. Such an approach has the advantage,over previous crude models, of taking into account differenttypes of patients and introducing variability, thus making itpossible to extract variances as well as means of numbers ofgeriatric patients requiring hospital care.     

The spectrum of livedo reticularis and anticardiolipin antibodies

We document a study of 65 patients presenting to our clinics, over a 2-year period, with livedo reticularis. All patients were screened for the presence of anti-cardiolipin antibodies and assessed for the presence of central nervous system disease and features of the 'antiphospholipid' syndrome, including venous and arterial thromboses and foetal loss. Patients were also assessed for other clinical features such as Raynaud's phenomenon and valvular lesions. Twenty-eight anti-cardiolipin positive patients were compared with 37 anti-cardiolipin negative patients. There was a statistically significant difference in the incidence of cerebrovascular disease (including strokes and transient ischaemic attacks) thrombocytopenia, valvular heart lesions and foetal loss in the anti-cardiolipin positive patients as compared with the anticardiolipin negative groups.     

Use of Bromoergocryptine in the Validation of Protocols for the Assessment of Mechanisms of Early Pregnancy Loss in the Rat

Use of Bromoergocryptine in the Validation of Protocols forthe Assessment of Mechanisms of Early Pregnancy Loss in theRat. CUMMINGS, A. M., PERREAULT, S. D., AND HARRIS, S. T. (1991).Fundam. Appl. Toxicol 17, 563–574. Validated protocolsfor evaluating maternally mediated mechanisms of early pregnancyfailure in rodents are needed for use in the risk assessmentprocess. To supplement previous efforts in the validation ofa panel of protocols assembled for this purpose, bromoergocryptine(BEC) was used as a model compound because it is known to inhibitpituitary prolactin secretion. BEC was tested using the earlypregnancy protocol (EPP), the decidual cell response technique(DCR), the pre- vs postimplantation protocol (PPP), and embryotransport rate analysis (ETRA). These protocols evaluate theeffects of chemicals on multiple endpoints following exposureduring (a) the first 8 days of pregnancy, (b) early pseudopregnancyaccompanied by decidual induction, (c) the pre- and postimplantationintervals of early pregnancy, or (d) the period of embryo transport.In the EPP, dosing with BEC during Days 1–8 of pregnancyreduced the number of implantation sites found on Day 9 as wellas serum progesterone. The DCR technique revealed a dose-dependentinhibition of decidual growth concomitant with decreased serumprogesterone as a result of BEC treatment. A modified DCR techniqueusing hormone-supplemented ovariectomized rats demonstratedthat BEC did not impair decidual growth in the presence of adequateprogestogenic support. Pie- vs postimplantation dosing indicatedthat implantation is vulnerable to BEC effects at least throughDay 4. BEC had no effect on embryo transport rate. Data fromthese protocols identified BEC as having adverse maternal effectsduring early pregnancy. While the pituitary was not identifiedby these protocols as the site of BECs's primary action, theprotocols did identify a reduction in serum progesterone andimpaired uterine function as toxicological mechanisms mediatingthe reduced fertility seen following BEC exposure.     

IS DIET IMPORTANT IN RHEUMATOID ARTHRITIS?

There is evidence from several well documented case reportsthat occasional patients with rheumatoid arthritis (RA) maydevelop aggravation of their arthritis as a result of allergyto some ingredient in the diet. A variety of foodstuffs havebeen implicated including milk and milk products, corn and cereals.Total fasting results in improvement in rheumatoid arthritis,but appears to be mediated by diminution in production of chemicalmediators of inflammation, rather than by elimination of a dietaryallergen. There is conflicting evidence from studies using variousintestinal probes that patients with rheumatoid arthritis mayhave a ‘leaky’ intestinal mucosa allowing food allergensto be more easily absorbed. Clinical therapeutic trials of exclusiondiets have employed the standard strategy of the double-blindrandomized method. However, this presupposes that patients enteredinto such a study are capable of improvement with dietary manipulation.Since this is often not the case, a more appropriate methodwould be to employ the ‘intensive research design’also known as ‘single case experiment’ and ‘Nof 1’ study. ‘Masked food intolerance’ isan attractive hypothesis, but extremely difficult to prove. It is doubtful whether fish oils and/or evening primrose oilwill be of significant long term benefit for patients with RA.However, they do provide for the possibility that a fatty acid-likesubstance may be found which may be incorporated into cell membranes,thereby preventing production of mediators of inflammation,such as prostaglandin E₂ and leukotriene B₄ KEY WORDS: Arthritis, Allergy, Food, Fasting, Gut permeability, Trace elements, Protein, Fatty acids, Therapy     

Is it worth the wait? A survey of patients' satisfaction with an oncology outpatient clinic

Increasing numbers of cancer survivors and the tradition of long-term follow-up in the outpatient clinic has resulted in overcrowded oncology clinics and long waiting times. Little is known about patients' perceptions of their clinic attendance. This survey of 252 oncology patients investigated patients' satisfaction with the clinic, anxiety associated with clinic attendance and the strengths and weaknesses of the oncology service. Results demonstrated high levels of satisfaction. Far from being perceived as anxiety-provoking, the clinic was looked upon as a valuable source of reassurance, 92% of patients reporting they were 'always' or 'usually' reassured as a consequence of their visit. Qualitative data showed that clinic staff were the most important source of satisfaction. Waiting was overwhelmingly the worst aspect of the clinic, described by 27% of patients as 'excessively long'. One-fifth of the total sample had attended the clinic for 10 years or more and over a third of this group reported they would be worried at the prospect of being discharged to the care of their geneal practitioners. Despite disadvantages associated with long waits, the clinic was perceived as providing a valuable source of reassurance which a proportion of patients were clearly reluctant to be without.