Gender differences in consulting a general practitioner for common symptoms of minor illness

The aim of this paper is to examine whether, in response to the same symptoms of minor illness, women reported a greater propensity to consult a general practitioner than men. Respondents taking part in the West of Scotland Twenty-07 Study (853 aged 39 and 858 aged 58) were presented with a check-list of 33 symptoms during the course of a home interview conducted by nurses. They were asked whether they had experienced any of these symptoms in the last month, and if they had, whether they consulted a general practitioner about it. A summary indicator for reporting, or consulting for, at least one symptom was constructed, and statistical associations between gender, reporting and consulting for symptoms were examined using chi-square tests with Yates' correction. Women were more likely to have consulted a general practitioner for at least one of the 33 symptoms of minor illness reported in the previous month (34% of women, 27% of men aged 39, chi2 = 3.97, p < 0.05; 49% of women, 43% of men aged 58, chi2 = 3.21, (NS)). Women were significantly more likely to have consulted for five individual symptoms in the younger cohort, and for three symptoms in the older cohort, whilst men were significantly more likely to have consulted for only one symptom, in the younger cohort. However, when only those who had reported a symptom in the last month were included in analysis there were no gender differences in consulting for any of the 33 symptoms in the older cohort, and for just 3 symptoms in the younger cohort. These data do not support the most widely suggested explanation for gender differences in consulting, that once symptoms are perceived, women have a higher propensity to consult a general practitioner with the symptom than men.

Morbidity and Irish Catholic descent in Britain: an ethnic and religious minority 150 years on

Ethnic and religious minorities often suffer disadvantages both in socio-economic status and in health. Data from the West of Scotland Twenty-07 study suggest some differences in morbidity between those descended from Irish Catholic migrants of the great emigration from 1840 onwards and others. Catholic religion of at least one parent or at birth is used here as a proxy measure to indicate Irish Catholic descent, on the basis of estimates of sensitivity and specificity in the local area. Higher proportions of "Catholics" are in manual social classes. Differences between "Catholics" and "non-Catholics" in one or more age cohorts are observed for the following aspects of health and physical development: general and physical health (self-assessed health, number of symptoms, accidents), psychological distress (depression, anxiety, number of psychosomatic symptoms), impairments and disabilities (sight, hearing, wearing dentures, disability), and physical measures (height, waist-to-hip ratio, lung function). Furthermore, for all aspects except hearing, wearing dentures and number of psychosomatic symptoms, significant differences remain after accounting for sex and social class. For each measure where a difference is observed, it is those respondents with a Catholic parent or who were born Catholic who experience poorer health or physical development. This suggests that those of Irish Catholic descent are at some disadvantage compared with the rest of the population, with respect to health as well as social class, 150 years after the start of the main migration.

Mycobacterium kansasii infection in a patient presenting with porphyria cutanea tarda

Mycobacterium kansasii, an atypical mycobacterium, is an uncommon cause of cutaneous and joint disease in immunocompetent patients. We report an unusual case of infection with this organism in a patient who initially presented with porphyria cutanea tarda (PCT), and who was noted also to have a crusted ulcer over the middle phalanx and swelling of the proximal interphalangeal joint of the right middle finger. The cutaneous ulcer healed with minocycline, but the joint disease required a combination of rifampicin and ethambutol before a therapeutic response was obtained.

Putting feeding back into the hands of patients

At the Behavioral Health Unit of Baton Rouge General Medical Center, the author and registered dietitians of the Clinical Nutrition Department developed "utensil-less" diets for patients with acute psychiatric conditions. Initially, the diet was developed for patients with dementia; however, the staff quickly realized that the diet would be appropriate for patients with many acute psychiatric disorders, or for those patients with physical limitations. The "Dementia Diet" includes five nutritionally balanced, small meals each day, consisting of finger foods such as sandwiches, vegetable sticks, fruit slices, and other items that patients can eat on their own without feeding assistance or utensils (Figure). After introducing the diet on the Behavioral Health Unit, the staff found that 7 of 10 patients on the diet improved their food intake and gained weight. Not only were nutritional needs met, but mealtimes became more enjoyable for the patients, families, and staff (Table). Unit safety advanced, and most importantly, quality of life and self-esteem were cultivated by helping adult patients regain some of their independence associated with meal times.

Aggressive squamous cell carcinomas developing in patients receiving long-term azathioprine

We report three patients who developed unusually aggressive squamous cell carcinomas after receiving long-term azathioprine treatment for dermatological disorders. Two patients gave a history suggestive of moderate to excessive sun exposure, and the third suffered from chronic actinic dermatitis. Hence, ultraviolet light damage may have been a significant cofactor in the development of these malignancies. Careful follow-up is necessary in patients who are taking azathioprine long term, and who have previously been excessively exposed to ultraviolet light (UVL), or in whom future exposure is likely to be excessive. We suggest that strict sun avoidance measures are followed by patients on long-term azathioprine, or that alternatives to azathioprine therapy are considered, especially in individuals inherently at risk of UVL damage, and in those already showing clinical signs of such damage.

The effects of caring on health: a community-based longitudinal study

This paper begins with a critical review of studies which have examined the effects of caring on health. Most are shown to suffer from defects in sampling and design, so that the evidence for detrimental effects is suggestive rather than conclusive. The substantive part of the paper then utilizes data on a cohort of 55-year-olds to compare the health of carers with the health of non-carers and to examine changes in caring and health over a 3-year period. The comparison yields no systematic evidence of the deleterious effects of caring on health; indeed, if there is a tendency in the accumulated data, it is in the opposite direction i.e. that carers report better health and functioning than non-carers. It is suggested that part of the explanation relates to selection and self-selection and the longitudinal data reveals high volatility in caring status, even over a short time period. The paper goes on to examine sub-groups of carers considered to be at greater risk. There is no evidence that their health is compromised but the authors acknowledge weaknesses in the data and argue for a specially designed study. The paper concludes with a discussion of the findings and their implications for research, policy and practice.

Patterns of class inequality in health through the lifespan: class gradients at 15, 35 and 55 years in the west of Scotland

Data confirming the existence of social inequalities in health have continued to accumulate since the Black Report reported class inequalities across a broad range of causes of mortality, with an increasing emphasis on indicators of morbidity and current health status. Although evidence of continuing inequalities mounts, elucidation of underlying mechanisms generating and maintaining such inequalities has been more elusive, and much of the debate has oscillated from the very broad to the very specific. In this paper, the class patterning of a range of non-fatal indicators of health are modelled in an attempt to outline first the adequacy of models of linear relationships for this range of measures, and secondly, the extent to which these are generalizable across a series of age/sex subgroups and across different domains of health. Data are presented here for representative community samples of men and women in adolescence, early- and late-midlife. While orderly relationships between social class and health were seen for the majority of the measures considered; the detailed patterns show considerable diversity. Thus for some aspects of health, notably height (itself often heralded as a broad indicator of health and early life experience), common class gradients were observed for both sexes at each of the stages of the life course examined. For others (notably mental health and presence of chronic illness), gradients were evident in later life but not in adolescence. Others still showed sex but not age differences in class patterning (typically measures of body shape), or no clear patterns (notably blood pressure and consultations with general practitioners). The current analysis draws attention to the consistency of gradients in early- and late-midlife, which are apparent despite the marked increase in the burden of poorer health which manifests between these life stages for almost all indicators of health (an exception being mental health). The challenges which this presents for understanding the mechanisms and processes which have been candidate explanations for social inequalities in health are discussed.

How sick is the West of Scotland? Age specific comparisons with national datasets on a range of health measures

The Central Clydeside Conurbation (CCC) has relatively high mortality rates. This paper examines whether it also has relatively high rates of ill health, using data from three cohorts (aged 15, 35 and 55 in 1987/88) in the West of Scotland. Comparisons on a range of self-reported physical and mental health indicators, anthropometric measures, blood pressure, and respiratory function were made with comparable age groups in ten British or Scottish national studies. The older two cohorts in the CCC exhibited relatively high rates of longstanding and limiting longstanding illness and the youngest cohort had relatively poor psychosocial health, compared to their age peers elsewhere. Fewer differences were found in blood pressure, anthropometric measures or respiratory function although older CCC residents were slightly shorter than in Britain as a whole and had slightly poorer respiratory function. Central Clydesiders in the late 1980s were generally in poorer health than those of the same sex and similar age elsewhere in the UK, but the extent of the disadvantage varied across different dimensions of health, and was not as marked as some stereotypes of the West of Scotland would suggest.

Enzyme immunoassay using native envelope glycoprotein (gp160) for detection of human immunodeficiency virus type 1 antibodies

An enzyme immunoassay using the purified native gp160 for the detection of human immunodeficiency virus type 1 (HIV-1) antibody was developed. This assay was determined to be highly specific, since (i) 157 serum samples that were confirmed negative by Western blot (immunoblot) (WB) were negative, (ii) 41 serum samples from populations with medical conditions that might cause nonspecific assay reactivity were all negative, and (iii) all 15 serum samples that showed false-positive reactions in one or more commercial HIV-1 screening tests were negative. The assay gave 100% specificity with a randomly selected and unlinked panel of 1,000 serum samples from healthy blood donors. The sensitivity of the assay was assessed by testing 238 samples confirmed as HIV-1 antibody positive by a standardized WB assay. All 238 serum samples (100%) were reactive in the native gp160 assay. In a dilution panel of 14 weakly WB-positive serum samples, 7 samples reacted two-to fivefold more strongly in the gp160 assay than in a virus lysate-based assay; the remaining 7 samples gave comparable reactivities in the two tests. The reactivities of 13 of these 14 serum samples in the gp160 assay were higher than in a commercial enzyme immunoassay that uses a recombinant envelope protein as the antigen. The native gp160 assay was more sensitive to identify seroconversion. In a well-characterized panel of sequential blood samples from a seroconverter, the new assay detected antibodies at least one sample ahead of the other commercial assays tested.

Clinical experience with hyperthermia in conjunction with radiation therapy

The authors have reviewed the medical records of 421 sessions of hyperthermia treatments in 73 patients treated between 1987 and 1992 at the University Heights Cancer Center and the Indiana University Medical Center in Indianapolis, Ind. Temperatures attained during the course of therapy on each patient have been averaged and the results were evaluated for complete, partial, or no response. All patients had previously failed conventional radiation therapy, chemotherapy and surgery. Responses were defined as: (1) Complete response-lesions that completely disappeared during treatment and the response was sustained for a minimum of 6 months. (2) Partial response-lesions that underwent a reduction in size of greater than 50%. (3) No response-less than 50% reduction in tumor size during the course of treatment. Response varied somewhat according to histology and anatomical site of treatment; however, complete response was achieved in 45%, partial response in 48% (for an overall response of 93%), and no response in 7% of the patients. The response achieved varied with temperature attained and a minimum temperature of 40 degrees C for 40 min produced the greatest number of responses. Response to hyperthermia was directly related to the temperature achieved and the length of time the temperature was applied.

Prolonged and multipatient use of prefilled disposable oxygen humidifier bottles: safety and cost

OBJECTIVES

Multipatient use and prolonged use of prefilled disposable oxygen humidifier bottles (Aquapak 301, Respiratory Care, Inc., Arlington Heights, IL) were evaluated by performing microbiologic monitoring and a cost analysis on bottles used for varying numbers of patients and lengths of time.

METHODS

Humidifiers were hung for a maximum of one month. Monitoring was conducted in 6 different nursing areas. Quantitative cultures were done for aerobes and Legionella. Reusable humidifier bottles also were monitored.

RESULTS

Cultures were obtained from 1,311 disposable and 60 reusable humidifiers. No significant bacterial contamination was detected in the prefilled disposable oxygen humidifier units. Ten percent of the reusable bottles were contaminated by organisms associated with skin flora.

CONCLUSIONS

Multipatient use and increased duration of use of disposable humidifiers result in cost savings without increasing patient risk. Restricted multipatient use of prefilled disposable oxygen humidifier bottles for a period of one month is a safe and cost-efficient practice.

The management of neonatal rhinitis

Life-threatening upper airway obstruction secondary to neonatal rhinitis is a rare and poorly understood condition. Despite potential lethal effects, there has been no basic scientific research investigating the nature of this curious condition. This paper retrospectively reviews 8 patients suffering from neonatal rhinitis. Both the medical and surgical management of neonatal rhinitis and possible aetiological factors involved are discussed. Increasing clinical awareness of this condition may, therefore, serve as inspiration for future research of both an epidemiological and basic scientific nature.

Competing explanations for associations between marital status and health

This paper is based on baseline data from a survey of 1042 fifty-five year olds living in the Central Clydeside Conurbation, who constitute the eldest cohort of the 'West of Scotland Twenty-07 Study'--a longitudinal study of health and everyday life. The relationship between marital status and a number of measures of health and illness is explored. The paper examines which of four 'social causation' explanations--that married people have better health because they have more material resources, less stress, indulge in less risky health behaviour and have more social support--can actually account for the observed patterning. It finds that more risky health behaviour (measured by smoking and drinking), and 'objective' levels of social support, cannot account for very much of the effect of marital status on health measures; but that material resources, stress and perceived quality of social support could do so. However, elucidation of the direction of the relationships between these explanations and health measures, and indeed of the effect of health 'selection' into and out of marriage must await future sweeps of this longitudinal study.

Survivors of extreme prematurity--outcome at 8 years of age

Of 149 infants liveborn in a large maternity hospital in 1980 to 1982 and delivered between 24 and 29 completed weeks of gestation inclusive, 91 (61%) survived; 88 (97%) survivors were assessed at 8 years' corrected age; 77% of children were not disabled; disability was mild in 13%, moderate in 2% and severe in 4% of children. Although survival decreased with decreasing gestation, disability in survivors did not increase. An earlier assessment of the same children at approximately 2 years of age had been unduly pessimistic particularly for those born less than or equal to 26 weeks' gestation. The only other reports in the literature on outcome by gestation have all assessed the children in early childhood, and estimates of severe disability rates from these studies will probably also be too pessimistic. Since the rate of severe disabilities in infants of borderline viability is not much higher than in more mature infants the obstetrician should mainly consider survival chances for the fetus, and not be overly concerned with long-term neurological outcome, when making clinical decisions.

Persistent infection of rhesus macaques with a molecular clone of human immunodeficiency virus type 2: evidence of minimal genetic drift and low pathogenetic effects

In an attempt to generate a suitable animal model to study the infectivity and possible pathogenicity of human immunodeficiency viruses, we intravenously inoculated juvenile rhesus macaques and African green monkeys with a molecularly cloned virus, human immunodeficiency virus type 2 HIV-2sbl/isy, as well as with the uncloned HIV-2nih-z virus. Infection was monitored by virus recovery from the peripheral blood cells and by seroconversion against HIV-2 antigens measured by Western immunoblot, radioimmunoprecipitation, and enzyme-linked immunosorbent assay. We successfully infected two out of two macaques with the molecularly cloned virus and one macaque out of two with the HIV-2nih-z. No evidence of infection was seen in the African green monkeys with either virus. We followed the infected animals for 2 years. The animals remained healthy, although we observed intermittent lymphadenopathy and a transient decrease in the absolute number of circulating CD4+ T lymphocytes in both animals infected with the molecularly cloned virus. Virus isolation from the peripheral blood cells of the infected animals was successful only within the first few months after inoculation. Evidence of persistent infection was provided by the detection of proviral DNA by polymerase chain reaction analysis of the blood cells of the inoculated animals and by the stability of antiviral antibody titers. To evaluate the genetic drift of the proviral DNA, we molecularly cloned viruses which were reisolated 1 and 5 months postinoculation from one of these animals. Comparison of the DNA sequences of the envelope genes of both these isolates indicated that a low degree of variation (0.2%) in the envelope protein had occurred in vivo during the 5-month period. These data suggest that the use of HIV-2sbl/isy in rhesus macaques may represent a good animal model system to study prevention of viral infection. In particular, molecularly cloned virus can be manipulated for functional studies of viral genes in the pathogenesis of acquired immune deficiency syndrome and provides a reproducible source of virus for vaccine studies.