General practices and the new contract. I--Reactions and impact

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Delay in diagnosis of childhood asthma and its influence on respiratory consultation rates

A survey of cases of asthma in two general practices with a special interest in the disease identified 212 asthmatic children aged 0-16 years by the end of January 1989 who had been registered in that practice since birth. Delay in diagnosis, both in terms of time (median 2.95 years) and number of consultations (median 7), was considerable. Annual rates of consultations for respiratory symptoms that were initiated by the patients fell significantly after diagnosis (median before = 1.80, after = 0.95 consultations/year), but the number initiated by the doctors rose significantly (median before = 0, after = 1.01 consultations/year). The overall rates before and after diagnosis were not significantly different (median before = 2.04, after = 2.21 consultations/year). Increased efforts are required to reduce this delay thereby minimising the morbidity of asthma in childhood.

The new NHS. Budget holding: a step into the unknown

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Childhood otalgia: acute otitis media. 2. Justification for antibiotic use in general practice

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Sexual sadism: brain, blood, and behavior

The behavior of sadists is bizarre and poorly understood. There are gross endocrine and brain abnormalities in a small number of these men. Approximately two-fifths show subtle temporal lobe brain abnormalities that are logically linked to sexual behavior and require further exploration. It would be interesting to explore the interface of the endocrine system and the brain--that is, to determine if there are interactive processes that may be related to the development of sexual anomalies, perhaps early in life as suggested by Kolarsky et al. Certainly, biological factors cannot determine whether an individual will act on his sexual impulses. Many psychological factors, such as family background and substance abuse, play a significant role in the dangerousness of the individual. However, it appears that biological factors are noteworthy in sexual sadism. Brain pathology, especially, shows some correlation with force used in offences and likelihood of recidivism, and for this reason alone it merits further study.

Rational decisions in managing sore throat: evaluation of a rapid test

Sixty nine general practitioners recorded what they had prescribed for a total of 1189 episodes of sore throat. Antibiotics were prescribed in 763 (64%) episodes and broad spectrum antibiotics in 161 (21%) of these. If there was dysphagia, hoarseness, cervical adenopathy, and inflamed or purulent tonsils a prescription was more likely to be written. An enzyme immunoassay rapid test was evaluated as a means of rationalizing prescribing. Among 23 general practitioners and 250 patients the sensitivity of the test was 63% and the specificity 91.7% compared with 74% and 58% for clinical assessment alone. Test results rarely caused previous prescribing decisions (34 [corrected] (13%) episodes) to be altered. We suggest that the time is not ripe for the use of the enzyme immunoassay rapid test on a wide scale in the routine assessment of sore throats.

Evaluation of directed coughing in cystic fibrosis

Supervised directed coughing was compared to conventional physiotherapy (postural drainage, vibration and/or percussion and coughing) in 38 patients with cystic fibrosis aged 9-18 years admitted to hospital with an exacerbation of their pulmonary symptoms. Assessment included objective measures of pulmonary function and sputum characteristics. Both treatment groups showed significant improvement at the end of the 2-week period. When the patients were graded according to their pulmonary disease, those with mild-moderate disease demonstrated a significant improvement in both treatment groups whereas those with severe lung disease showed little improvement with either treatment. Directed coughing is as effective as conventional physiotherapy in the management of patients with cystic fibrosis admitted to hospital for treatment of an exacerbation of their pulmonary symptoms.

Serum pituitary and steroid hormone levels in the adult male: one value is as good as the mean of three

The result of the hormone concentration of one blood sample was used to determine the accuracy of predicting not only the hormone concentrations of a second and third sample drawn 15 minutes apart, but also the mean value of the three samples. Three blood specimens from 73 men involved in two previously reported studies (A and B) were assayed individually for luteinizing hormone, follicle-stimulating hormone, prolactin, testosterone, androstenedione, dehydroepiandrosterone sulfate, estradiol, and cortisol. The predictive correlation of one single hormone value, when compared with the mean of three values, was 0.90 or greater, except for prolactin in study A (0.86) and testosterone in study B (0.86). Since the hormone level obtained for one sample has such a high predictive value for the hormone levels of the other two samples, drawing more than one sample is redundant.

Evidence for an immune-dependent action of praziquantel on Schistosoma mansoni in mice

Effective schistosomicidal action of praziquantel against Schistosoma mansoni infections in mice appears to be dependent to some extent on appropriate immunological stimulation. Indirect evidence consistent with this hypothesis was obtained by demonstrating a positive relationship between drug efficacy and both the intensity and the age of the parasitic infection. More directly, it has previously been shown that praziquantel kills fewer S. mansoni worms in immunosuppressed T cell-deprived mice than in immunologically intact controls; and we show here that infections 5 weeks old, against which the drug alone is sub-optimally active, are more effectively killed by a combination of drug and a rabbit antiserum raised against adult worm antigens.

Parasitological evaluation of curative and subcurative doses of 9-acridanone-hydrazone drugs against Schistosoma mansoni in baboons, and observations on changes in serum levels of anti-egg antibodies detected by ELISA

Derivatives in the class of 9-acridanone-hydrazones were found to be highly active against Schistosoma mansoni in baboons. Single doses of 25 mg/kg were fully effective. Data are presented showing changes detected by ELISA in antibody levels against schistosome eggs which correlated positively with the effect of chemotherapy. This approach may help to evaluate the effects of treatment of human schistosomiasis where the detection of low egg counts is problematic.

Gonadal function in women treated with cyclophosphamide for childhood nephrotic syndrome: a long-term follow-up study

The gonadal function of 18 women who were treated for childhood nephrotic syndrome at a mean age of 10.7 years with cyclophosphamide (mean dosage, 28 gm; mean duration of therapy, 354 days) was evaluated at a mean of 14.5 years after treatment by means of detailed questionnaires. Menstrual patterns were normal in all except two, who were still receiving intermittent prednisone therapy. Eight healthy children had been born to five mothers. Compared with males, there is little current evidence of gonadal toxicity in this patient group. Further follow-up is required to determine whether these women will undergo premature menopause.

Three-day and seven-day treatment in acute otitis media: a double-blind antibiotic trial

Ninety-six children with acute otitis media were randomized into a double-blind general practice trial of three-day and seven-day courses of cefaclor 125 mg tds. These regimens were equally effective in terms of resolution of symptoms and signs of otitis media, even in children presenting with bulging of the tympanic membrane. There was no difference between the groups in the recurrence of middle-ear infection during the six weeks after entry to the trial. The results provide further evidence about the effectiveness of short courses of antibiotics for children with presumed middle-ear infection.