Delivering more with less? Making the NHS Health Check work in financially hard times: real time learning from Stoke-on-Trent

BACKGROUND

The NHS Health Check Programme presents the opportunity to reduce death and ill health caused by cardiovascular diseases (CVDs). Owing to the current restructuring of health care in the UK, financial resources will in future be limited. It is important to develop cost-effective ways of delivering this programme. There are practical alternatives to strategies that advocate using existing data to pre-stratify patients and prioritise those aged between 50 and 74 years.

METHOD

Data on patients eligible for a health check were retrospectively collected from two early implementer practice teams. The characteristics of attenders and non-attenders, such as demographic factors, consulting behaviour, clinical measures and lifestyle measures, were collected. Costs of two approaches to delivery (drop-in clinic with choice of booked appointment versus booked appointment alone) were compiled.

RESULTS

Nearly half of all patients had accessed their GP or practice nurse with four or more appointments in the 12 months prior to their health check. There remained a margin of error between estimated CVD risk (calculated prior to the health check by the practice, using existing information) and actual CVD risk (calculated after a health check had been completed). Drop-in clinics with choice of booked appointment cost half the price of offering patients the option of booked appointments alone.

DISCUSSION

The cost-effectiveness of drop-in clinics was achieved by a reduction in staffing costs through intensively offering health checks; this approach provides a practical solution to maintaining a population-wide approach. Using existing data to pre-stratify patients is dependent on the quality and completeness of data used to estimate CVD risk. Concentrating efforts on 50 to 74 year olds may improve sensitivity to detect CVD but would reduce the chance of engaging with patients about their health at an earlier stage. Offering health checks opportunistically and using existing data no older than 12 months to complete a health check provide the potential for further cost savings.

Study of betasatellite molecule from leaf curl disease of sunn hemp (Crotalaria juncea) in India

Leaves of sunn hemp (Crotalaria juncea) showing geminiviral symptoms were collected from Lucknow, India during rainy season in 2008. DNA template isolated from the symptomatic leaf tissues were subjected to polymerase chain reaction (PCR) using specific primers to amplify coat protein (CP) gene of DNA-A as well as betasatellite DNA associated with the leaf curl disease. CP gene showed 97% sequence identity with that of Cotton leaf curl Burewala virus (CLCuBwV). Further, the betasatellite DNA molecule revealed sequence similarity with previously characterized betasatellite DNA of begomoviruses affecting malvaceous crops from different regions of India and Pakistan. Maximum similarity (>90%) of betasatellite DNA under study was observed with Cotton leaf curl Multan betasatellite (CLCuMB-[Pak: Mul17:08) and other betasatellite DNA from Pakistan thus confirming possible infection of C. juncea with begomovirus. A complementary sense open reading frame (ORF) βC1 is present at nucleotide position 194-550. Sequence comparison of this ORF with other members of begomoviruses further confirmed association of a begomovirus with C. juncea. The betasatellite DNA when expressed under the control of CaMV35S promoter Nicotiana tabacum, showed leaf deformities. Our results demonstrated that a malvaceous betasatellite is adapted by a nonmalvaceous host and causes similar disease symptoms.

Haematolohical profile of subacute oral toxicity of molybdenum and ameliorative efficacy of copper salt in goats

Molybdenum toxicity produces a state of secondary hypocuprosis, resulting into alterations in normal hematological profile. In the present study, ammonium molybdate alone and with copper sulfate (II) pentahydrate (ameliorative agent) was administered orally for 30 consecutive days in healthy goats of group 1 and 2, respectively, to access the effect on the hematological profile on different predetermined days of dosing. Administration of ammonium molybdate alone produced significant decline in the mean values of hemoglobin (Hb), packed cell volume (PCV), total leukocyte count (TLC), total erythrocyte count (TEC), and mean corpuscular hemoglobin concentration (MCHC), with a significant increase in neutrophil level and mean corpuscular volume (MCV). However, values of erythrocyte sedimentation rate, mean corpuscular hemoglobin, and differential leukocyte count were not significantly altered. On comparing observations of ameliorative group with the group 1 goats, it is concluded that the ameliorative copper salt has beneficial effects in alleviating the alterations in the values of Hb, PCV, TLC, TEC, MCV, MCHC, and neutrophils.

Identification and molecular characterization of begomovirus and associated satellite DNA molecules infecting Cyamopsis tetragonoloba

Monopartite begomoviruses comprise DNA-A as the main genome and associated satellite DNAs. Viral DNA extracted from guar (Cyamopsis tetragonoloba) showing leaf curl symptoms exhibited positive amplification of coat protein (CP) gene of DNA-A component, suggesting the presence of begomovirus. Full length DNA-A was amplified by primer pair re-designed from CP gene nucleotide sequence. The associated alphasatellite and betasatellite DNA molecules were amplified and sequenced, confirming the presence of monopartite begomovirus. Sequence comparisons showed 89% identity with other begomoviruses. The Neighbor-Joining tree based on full length DNA-A nucleotide sequence showed that the guar infecting begomovirus clustered separately from other known begomoviruses. The betasatellite shared a high (96%) nucleotide identity to Cotton leaf curl Multan betasatellites. The alphasatellite showed 91% nucleotide identity to alphasatellite associated with begomovirus infecting Okra. Recombination analyses showed three recombinant fragments in DNA-A, two in betasatellite, and four in alphasatellite. The results suggest that the begomovirus identified in this study was a new recombinant virus. Its name was proposed as Cyamopsis tetragonoloba leaf curl virus (CyTLCuV).

Identification and molecular characterization of begomovirus and associated satellite DNA molecules infecting Cyamopsis tetragonoloba

Monopartite begomoviruses comprise DNA-A as the main genome and associated satellite DNAs. Viral DNA extracted from guar (Cyamopsis tetragonoloba) showing leaf curl symptoms exhibited positive amplification of coat protein (CP) gene of DNA-A component, suggesting the presence of begomovirus. Full length DNA-A was amplified by primer pair re-designed from CP gene nucleotide sequence. The associated alphasatellite and betasatellite DNA molecules were amplified and sequenced, confirming the presence of monopartite begomovirus. Sequence comparisons showed 89% identity with other begomoviruses. The Neighbor-Joining tree based on full length DNA-A nucleotide sequence showed that the guar infecting begomovirus clustered separately from other known begomoviruses. The betasatellite shared a high (96%) nucleotide identity to Cotton leaf curl Multan betasatellites. The alphasatellite showed 91% nucleotide identity to alphasatellite associated with begomovirus infecting Okra. Recombination analyses showed three recombinant fragments in DNA-A, two in betasatellite, and four in alphasatellite. The results suggest that the begomovirus identified in this study was a new recombinant virus. Its name was proposed as Cyamopsis tetragonoloba leaf curl virus (CyTLCuV).

Raman spectral investigation of thiourea complexes

Spectroscopic properties of metal complexes of thiourea single crystals (tris thiourea zinc acetate, bis thiourea cadmium zinc acetate and bis thiourea ammonium chloride) which are non-linear optic materials were investigated by Raman scattering spectroscopy. The vibrational frequencies of the functional groups are identified and assigned. Effects due to the coordination of thiourea with metal ions are analyzed. Hydrogen bonding interactions involved in the metal complexes are observed in the Raman spectra.

Chiari I malformation with holocord syrinx

We present the magnetic resonance imaging findings of a classical case of Chiari I malformation with holocord syringohydromyelia. The clinical presentation, imaging findings and treatment options are discussed.

Growth and characterization of manganese doped gallium nitride nanowires

Manganese doped GaN nanowires have been grown by chemical vapour transport method on sapphire (0001) substrates in the temperature range of 800-1050 degrees C. The surface features of nanowires have been investigated using Scanning Electron Microscopy (SEM), Energy Dispersive X-ray analysis (EDAX), Raman scattering studies and Electron Paramagnetic Resonance (EPR). SEM images showed that the morphology of the one dimensional materials included straight nanorods and nanowires around 70-80 nm. Raman spectrum showed the GaMnN vibrational modes at 380, 432 and 445 cm(-1). EPR measurements were performed on Mn doped GaN nanowires in order to evaluate the magnetic behaviour.

Symptomatic primary hyperparathyroidism: a retrospective analysis of fifty one cases from a single centre

OBJECTIVE

Widely prevalent vitamin D deficiency and delayed diagnosis contributes to severe symptomatic primary hyperparathyroidism in India. We analysed fifty one consecutive patients of primary hyperparathyroidism managed at our centre. All of them were symptomatic.

DESIGN

Retrospective analysis.

MATERIAL AND METHODS

Fifty one consecutive cases of symptomatic primary hyperparathyroidism, presenting to our centre from January 1994 to May 2007 were retrospectively analyzed. Clinical presentation, biochemical, radiological and details of underlying parathyroid lesion were noted.

RESULTS

A total of 51 cases of primary hyperparathyroidism were studied. Mean age was 39.5 +/- 11.5 yrs (Range 13 to 70 years, Female: Male 2:1). Mean duration of symptoms was 35.8 + 29.1 months. Bone pains and painful proximal myopathy were the commonest presentation (24/51), followed by pathological fractures in 12 cases. Distal Renal tubular acidosis was diagnosed in 4 cases, 3 of whom normalized after surgery. At initial evaluation, twenty one patients had elevated alkaline phosphatase with normal calcium levels indirectly suggesting associated vitamin D deficiency. Low serum levels of 25-hydroxy vitamin D were documented in five of them. Parathyroid carcinoma was diagnosed in 3 patients. Ectopic parathyroid adenoma was seen in 7 cases (3 mediastinal, 3 intrathyroidal, 1 near left carotid sheath). All the cases responded well to surgical excision.

CONCLUSION

Lack of universal screening for hypercalcemia, normocalcemia contributed by associated vitamin D deficiency and lack of awareness about unusual presentations of primary hyperparathyroidism led to delayed diagnosis in our patients. Delayed diagnosis and associated vitamin D deficiency in our patients contributed to greater severity of symptomatic primary hyperparathyroidism.