Paediatric dental A&E service during the COVID-19 pandemic in the Greater London area

PURPOSE

The UK government introduced a nationwide lockdown on the 23rd March 2020 to prevent the spread of COVID-19. All elective hospital and dental practice assessments and procedures were mandated to stop. Key hospital dental workers were required to work, and Guy's and St Thomas' NHS Foundation Trust became a designated Urgent Dental Care Centre (UDC) for the greater London area. The paediatric dental emergency walk-in service was suspended and replaced with a telephone triage system and evaluation of digital images sent by parents/carers when needed. The aim of this paper is to describe the emergency service provided by staff in the department of Paediatric Dentistry at St Thomas' Hospital during the first lockdown.

METHODS

A prospective service evaluation of the modified paediatric dental emergency service was carried out between 25th March and 29th May 2020.

RESULTS

Four-hundred and sixty-four patients accessed the paediatric dental emergency service via telephone during the service evaluation period. Of these, 192 (41%) had dental pain, 121 (26%) had pain and swelling of dental origin, and 89 (19%) had trauma.

CONCLUSIONS

Remote telephone consultations and digital photographs were useful to screen emergency paediatric dental patients, but lack of face-to-face consultations with radiographic assessment and access to general anaesthetic services were major limiting factors.

Cultural competency and communication skills of dental students: clinical supervisors' perceptions

OBJECTIVES

This study explored clinical supervisor's (CS) views and experiences of dental students' cultural competence (CC) at the Melbourne Dental School, The University of Melbourne, Australia. Additionally, this study explored CS insights into how CC could be taught.

METHODS

Semi-structured one-to-one interviews were organised with consenting CS. Interview topics included the following: the importance of CC, communication and rapport, the role of culture in oral health and the need for curriculum enhancement. Interviews were recorded, transcribed and thematically analysed to identify key areas using NVivo software.

RESULTS

A total of 12 CS participated in this study. CS acknowledged the importance of CC and felt that it was important for good patient management. CS's definition of CC focused primarily on language and communication skills. CS felt that dental students were generally able to manage culturally diverse patients. However, CS indicated that additional training in this area would be beneficial. Concerns were raised about the students' ability to establish good rapport and communication, with CS highlighting areas such as misuse of interpreters and use of jargon. CS felt that clinical experience, confidence and a positive attitude are effective tools for overcoming cultural barriers. Furthermore, some CS also felt that cultural competency was a skill that is learnt through experience.

CONCLUSIONS

For most CS, cultural competence was an important part of the clinician-patient exchange which would benefit from enhanced curriculum. They also highlighted areas where transcultural education could be improved. The majority of CS believed dental students managed culturally diverse patients well.

Precise measurement of the neutron magnetic form factor G(M)n in the few-GeV2 region

The neutron elastic magnetic form factor was extracted from quasielastic electron scattering on deuterium over the range Q;{2}=1.0-4.8 GeV2 with the CLAS detector at Jefferson Lab. High precision was achieved with a ratio technique and a simultaneous in situ calibration of the neutron detection efficiency. Neutrons were detected with electromagnetic calorimeters and time-of-flight scintillators at two beam energies. The dipole parametrization gives a good description of the data.

Search for the photoexcitation of exotic mesons in the pi+pi+pi- system

A search for exotic mesons in the pi;{+}pi;{+}pi;{-} system photoproduced by the charge exchange reaction gammap-->pi;{+}pi;{+}pi;{-}(n) was carried out by the CLAS Collaboration at Jefferson Lab. A tagged-photon beam with energies in the 4.8 to 5.4 GeV range, produced through bremsstrahlung from a 5.744 GeV electron beam, was incident on a liquid-hydrogen target. A partial wave analysis was performed on a sample of 83 000 events, the highest such statistics to date in this reaction at these energies. The main objective of this study was to look for the photoproduction of an exotic J;{PC}=1;{-+} resonant state in the 1 to 2 GeV mass range. Our partial wave analysis shows production of the a_{2}(1320) and the pi_{2}(1670) mesons, but no evidence for the a_{1}(1260), nor the pi_{1}(1600) exotic state at the expected levels. An upper limit of 13.5 nb is determined for the exotic pi_{1}(1600) cross section, less than 2% of the a_{2}(1320) production.

Downstream from calcium signalling: mitochondria, vacuoles and pancreatic acinar cell damage

Ca(2+) is one of the most ancient and ubiquitous second messengers. Highly polarized pancreatic acinar cells serve as an important cellular model for studies of Ca(2+) signalling and homeostasis. Downstream effects of Ca(2+) signalling have been and continue to be an important research avenue. The primary functions regulated by Ca(2+) in pancreatic acinar cells--exocytotic secretion and fluid secretion--have been defined and extensively characterized in the second part of the last century. The role of cytosolic Ca(2+) in cellular pathology and the related question of the interplay between Ca(2+) signalling and bioenergetics are important current research lines in our and other laboratories. Recent findings in these interwoven research areas are discussed in the current review.

Search for medium modifications of the rho meson

The photoproduction of vector mesons on various nuclei has been studied using the CLAS detector at Jefferson Laboratory. The vector mesons, rho, omega, and varphi, are observed via their decay to e;{+}e;{-}, in order to reduce the effects of final-state interactions in the nucleus. Of particular interest are possible in-medium effects on the properties of the rho meson. The rho mass spectrum is extracted from the data on various nuclei, 2H, C, Fe, and Ti. We observe no significant mass shift and some broadening consistent with expected collisional broadening for the rho meson.

Experimental study of exclusive 2H(e,e'p)n reaction mechanisms at high Q2

The reaction 2H(e,e'p)n has been studied with full kinematic coverage for photon virtuality 1.75<Q2<5.5 GeV2. Comparisons of experimental data with theory indicate that for very low values of neutron recoil momentum (p(n)<100 MeV/c) the neutron is primarily a spectator and the reaction can be described by the plane-wave impulse approximation. For 100<p(n)<750 MeV/c, proton-neutron rescattering dominates the cross section, while Delta production followed by the NDelta-->NN transition is the primary contribution at higher momenta.

Measurement of the N-->Delta(+)(1232) transition at high-momentum transfer by pi(0) electroproduction

We report a new measurement of the exclusive electroproduction reaction gamma(*)p-->pi(0)p to explore the evolution from soft nonperturbative physics to hard processes via the Q(2) dependence of the magnetic (M(1+)), electric (E(1+)), and scalar (S(1+)) multipoles in the N-->Delta transition. 9000 differential cross section data points cover W from threshold to 1.4 GeV/c(2), 4pi center-of-mass solid angle, and Q(2) from 3 to 6 GeV(2)/c(2), the highest yet achieved. It is found that the magnetic form factor G(M)(*) decreases with Q(2) more steeply than the proton magnetic form factor, the ratio E(1+)/M(1+) is small and negative, indicating strong helicity nonconservation, and the ratio S(1+)/M(1+) is negative, while its magnitude increases with Q(2).

Measurement of deeply virtual compton scattering with a polarized-proton target

The longitudinal target-spin asymmetry AUL for the exclusive electroproduction of high-energy photons was measured for the first time in ep-->e;'pgamma. The data have been accumulated at JLab with the CLAS spectrometer using 5.7 GeV electrons and a longitudinally polarized NH3 target. A significant azimuthal angular dependence was observed, resulting from the interference of the deeply virtual Compton scattering and Bethe-Heitler processes. The amplitude of the sinvarphi moment is 0.252+/-0.042stat+/-0.020sys. Theoretical calculations are in good agreement with the magnitude and the kinematic dependence of the target-spin asymmetry, which is sensitive to the generalized parton distributions H and H.

Eta' photoproduction on the proton for photon energies from 1.527 to 2.227 GeV

Differential cross sections for the reaction gamma p --> eta' p have been measured with the CLAS spectrometer and a tagged photon beam with energies from 1.527 to 2.227 GeV. The results reported here possess much greater accuracy than previous measurements. Analyses of these data suggest for the first time the coupling of the eta'N channel to both the S11(1535) and P11(1710) resonances, known to couple strongly to the etaN channel in photoproduction on the proton, and the importance of J = 3/2 resonances in the process.

Depot-specific regulation of glucose uptake and insulin sensitivity in HIV-lipodystrophy

Altered fat distribution is associated with insulin resistance in HIV, but little is known about regional glucose metabolism in fat and muscle depots in this patient population. The aim of the present study was to quantify regional fat, muscle, and whole body glucose disposal in HIV-infected men with lipoatrophy. Whole body glucose disposal was determined by hyperinsulinemic clamp technique (80 mU x m(-2) x min(-1)) in 6 HIV-infected men and 5 age/weight-matched healthy volunteers. Regional glucose uptake in muscle and subcutaneous (SAT) and visceral adipose tissue (VAT) was quantified in fasting and insulin-stimulated states using 2-deoxy-[18F]fluoro-D-glucose positron emission tomography. HIV-infected subjects with lipoatrophy had significantly increased glucose uptake into SAT (3.8 +/- 0.4 vs. 2.3 +/- 0.5 micromol x kg tissue(-1) x min(-1), P < 0.05) in the fasted state. Glucose uptake into VAT did not differ between groups. VAT area was inversely related with whole body glucose disposal, insulin sensitivity, and muscle glucose uptake during insulin stimulation. VAT area was highly predictive of whole body glucose disposal (r2 = 0.94, P < 0.0001). This may be mediated by adiponectin, which was significantly associated with VAT area (r = -0.75, P = 0.008), and whole body glucose disposal (r = 0.80, P = 0.003). This is the first study to directly demonstrate increased glucose uptake in subcutaneous fat of lipoatrophic patients, which may partially compensate for loss of SAT. Furthermore, we demonstrate a clear relationship between VAT and glucose metabolism in multiple fat and muscle depots, suggesting the critical importance of this depot in the regulation of glucose and highlighting the significant potential role of adiponectin in this process.

Beam-helicity asymmetries in double-charged-pion photoproduction on the proton

Beam-helicity asymmetries for the two-pion-photoproduction reaction gammap-->ppi(+)pi(-) have been studied for the first time in the resonance region for center-of-mass energies between 1.35 and 2.30 GeV. The experiment was performed at Jefferson Lab with the CEBAF Large Acceptance Spectrometer using circularly polarized tagged photons incident on an unpolarized hydrogen target. Beam-helicity-dependent angular distributions of the final-state particles were measured. The large cross-section asymmetries exhibit strong sensitivity to the kinematics and dynamics of the reaction. The data are compared with the results of various phenomenological model calculations, and show that these models currently do not provide an adequate description for the behavior of this new observable.

Onset of asymptotic scaling in deuteron photodisintegration

We investigate the transition from the nucleon-meson to the quark-gluon description of the strong interaction using the photon energy dependence of the d(gamma,p)n differential cross section for photon energies above 0.5 GeV and center-of-mass proton angles between 30 degrees and 150 degrees. A possible signature for this transition is the onset of cross-section s(-11) scaling with the total energy squared, s, at some proton transverse momentum P(T). The results show that the scaling has been reached for proton transverse momentum above about 1.1 GeV/c. This may indicate that the quark-gluon regime is reached above this momentum.

Proton source size measurements in the eA-->e'ppX reaction

Two-proton correlations at small relative momentum q were studied in the eA(3He,4He,C,Fe)-->e(')ppX reaction at E(0)=4.46 GeV using the CLAS detector at Jefferson Lab. The enhancement of the correlation function at small q was found to be in accordance with theoretical expectations. Sizes of the emission region were extracted, and proved to be dependent on A and on the proton momentum. The size of the two-proton emission region for He was measured in eA reactions for the first time.

Two-nucleon momentum distributions measured in 3He(e,e'pp)n

We have measured the 3He(e,e'pp)n reaction at 2.2 GeV over a wide kinematic range. The kinetic energy distribution for "fast" nucleons (p>250 MeV/c) peaks where two nucleons each have 20% or less, and the third nucleon has most of the transferred energy. These fast pp and pn pairs are back to back with little momentum along the three-momentum transfer, indicating that they are spectators. Calculations by Sargsian and by Laget also indicate that we have measured distorted two-nucleon momentum distributions by striking one nucleon and detecting the spectator correlated pair.

Observation of an exotic baryon with S=+1 in photoproduction from the proton

The reaction gamma p-->pi(+)K(-)K(+)n was studied at Jefferson Laboratory using a tagged photon beam with an energy range of 3-5.47 GeV. A narrow baryon state with strangeness S=+1 and mass M=1555+/-10 MeV/c(2) was observed in the nK(+) invariant mass spectrum. The peak's width is consistent with the CLAS resolution (FWHM=26 MeV/c(2)), and its statistical significance is (7.8+/-1.0)sigma. A baryon with positive strangeness has exotic structure and cannot be described in the framework of the naive constituent quark model. The mass of the observed state is consistent with the mass predicted by the chiral soliton model for the Theta(+) baryon. In addition, the pK(+) invariant mass distribution was analyzed in the reaction gamma p-->K(-)K(+)p with high statistics in search of doubly charged exotic baryon states. No resonance structures were found in this spectrum.

Measurement of the proton spin structure function g1(x,Q2) for Q2 from 0.15 to 1.6 GeV2 with CLAS

Double-polarization asymmetries for inclusive ep scattering were measured at Jefferson Lab using 2.6 and 4.3 GeV longitudinally polarized electrons incident on a longitudinally polarized NH3 target in the CLAS detector. The polarized structure function g(1)(x,Q2) was extracted throughout the nucleon resonance region and into the deep inelastic regime, for Q(2)=0.15-1.64 GeV2. The contributions to the first moment Gamma(1)(Q2)= integral g(1)(x,Q2) dx were determined up to Q(2)=1.2 GeV2. Using a parametrization for g(1) in the unmeasured low x regions, the complete first moment was estimated over this Q2 region. A rapid change in Gamma(1) is observed for Q2<1 GeV2, with a sign change near Q(2)=0.3 GeV2, indicating dominant contributions from the resonance region. At Q(2)=1.2 GeV2 our data are below the perturbative QCD evolved scaling value.

Measurement of ep-->e' ppi+ pi- and baryon resonance analysis

The cross section for the reaction ep-->e(')ppi(+)pi(-) was measured in the resonance region for 1.4<W<2.1 GeV and 0.5<Q2<1.5 GeV(2)/c(2) using the CLAS detector at Jefferson Laboratory. The data show resonant structures not visible in previous experiments. The comparison of our data to a phenomenological prediction using available information on N(*) and Delta states shows an evident discrepancy. A better description of the data is obtained either by a sizable change of the properties of the P13(1720) resonance or by introducing a new baryon state, not reported in published analyses.

Photoproduction of the omega meson on the proton at large momentum transfer

The differential cross section, dsigma/dt, for omega meson exclusive photoproduction on the proton above the resonance region (2.6<W<2.9 GeV) was measured up to a momentum transfer -t=5 GeV2 using the CLAS detector at Jefferson Laboratory. The omega channel was identified by detecting a proton and pi(+) in the final state and using the missing mass technique. While the low momentum transfer region shows the typical diffractive pattern expected from Pomeron and Reggeon exchange, at large -t the differential cross section has a flat behavior. This feature can be explained by introducing quark interchange processes in addition to the QCD-inspired two-gluon exchange.

Eta photoproduction on the proton for photon energies from 0.75 to 1.95 GeV

Differential cross sections for gammap-->etap have been measured with tagged real photons for incident photon energies from 0.75 to 1.95 GeV. Mesons were identified by missing mass reconstruction using kinematical information for protons scattered in the production process. The data provide the first extensive angular distribution measurements for the process above W=1.75 GeV. Comparison with preliminary results from a constituent quark model support the suggestion that a third S11 resonance with mass approximately 1.8 GeV couples to the etaN channel.

A visual motor psychological test as a predictor to treatment in nocturnal enuresis

BACKGROUND AND AIMS

The neurological control of bladder function and the ability to be dry at night involves not only the acquisition of normal daytime control, but also the establishment of a circadian rhythm in vasopressin release and the ability to arouse to a full bladder during sleep. We postulated that in some children there might be a delay in maturation of the normal neurological pathways involved in establishment of nocturnal continence and examined this by using a specific neuropsychological test.

METHODS

Children attending an established nocturnal enuresis clinic were examined using the Rey-Osterrieth test to assess the presence or absence of boundary errors in both copy and memory reproductions. The results of the test were scored independently and blind to the response to treatment with the vasopressin analogue DDAVP.

RESULTS

A significant association was found between boundary type errors and response to DDAVP, with non-responders making significantly more errors. No child with three or more errors responded to DDAVP. Using this test, the ability to predict response to treatment was 70%.

CONCLUSIONS

It is postulated that the Rey-Osterrieth test, through the presence or absence of boundary errors, reflects a delay in maturation and/or a disorganisation of the retinal-hypothalamic-cortical pathways in the brain. The association previously described with growth hormone neurosecretory dysfunction syndrome would be compatible with this.

Q2 Dependence of quadrupole strength in the gamma*p --> Delta(+)(1232) --> p pi(0) transition

Models of baryon structure predict a small quadrupole deformation of the nucleon due to residual tensor forces between quarks or distortions from the pion cloud. Sensitivity to quark versus pion degrees of freedom occurs through the Q2 dependence of the magnetic (M1+), electric (E1+), and scalar (S1+) multipoles in the gamma*p-->Delta(+)-->p pi(0) transition. We report new experimental values for the ratios E(1+)/M(1+) and S(1+)/M(1+) over the range Q2 = 0.4-1.8 GeV2, extracted from precision p(e,e(')p)pi(0) data using a truncated multipole expansion. Results are best described by recent unitary models in which the pion cloud plays a dominant role.

First measurement of the double spin asymmetry in (-->)e(-->)p-->e(prime)pi(+)n in the resonance region

The double spin asymmetry in the (-->)e(-->)p --> e(prime)pi(+)n reaction has been measured for the first time in the resonance region for four-momentum transfer Q2 = 0.35-1.5 GeV(2). Data were taken at Jefferson Lab with the CLAS detector using a 2.6 GeV polarized electron beam incident on a polarized solid NH3 target. Comparison with predictions of phenomenological models shows strong sensitivity to resonance contributions. Helicity-1/2 transitions are found to be dominant in the second and third resonance regions. The measured asymmetry is consistent with a faster rise with Q(2) of the helicity asymmetry A1 for the F(15)(1680) resonance than expected from the analysis of the unpolarized data.

Photoproduction of the rho(0) meson on the proton at large momentum transfer

The differential cross section, d sigma/dt, for rho(0) meson photoproduction on the proton above the resonance region was measured up to a momentum transfer -t = 5 GeV2 using the CLAS detector at the Thomas Jefferson National Accelerator Facility. The rho(0) channel was extracted from the measured two charged-pion cross sections by fitting the pi(+)pi(-) and p pi(+) invariant masses. The low momentum transfer region shows the typical diffractive pattern expected from Reggeon exchange. The flatter behavior at large -t cannot be explained solely in terms of QCD-inspired two-gluon exchange models. The data indicate that other processes, like quark interchange, are important to fully describe rho photoproduction.

The ep -->e'p eta reaction at and above the S11(1535) baryon resonance

New cross sections for the reaction e p-->e p eta are reported for total center of mass energy W = 1.5--1.86 GeV and invariant momentum transfer Q2 = 0.25--1.5 (GeV/c)(2). This large kinematic range allows extraction of important new information about response functions, photocouplings, and eta N coupling strengths of baryon resonances. Newly observed structure at W approximately 1.65 GeV is shown to come from interference between S and P waves and can be interpreted with known resonances. Improved values are derived for the photon coupling amplitude for the S11(1535) resonance.

Unpacking the black box of nursing and therapy practice for post-stroke shoulder pain: a precursor to evaluation

OBJECTIVES

To describe current nursing and therapy interventions for the prevention and treatment of post-stroke shoulder pain and to explore the extent of their reported use in England.

DESIGN

Semi-structured, the med interviews followed by a postal questionnaire.

PARTICIPANTS

Six nurses, five occupational therapists (OTs) and six physiotherapists (PTs) were interviewed. Twelve nurses, 12 OTs and 12 PTs were sent the pilot questionnaire and the main questionnaire was posted to 332 nurses, 332 OTs and 332 PTs.

SETTING

NHS Trusts in England which provide acute stroke care/rehabilitation.

PROCEDURE

Two researchers independently condensed the transcripts of the interviews into a list of interventions which were then transformed into a pilot postal questionnaire. Following the pilot small changes were made. Participants sent the main questionnaire were given three weeks to return it before being posted a reminder. After a further two weeks a researcher gave a telephone reminder.

RESULTS

One hundred and seventy-five different types of interventions were identified. The main questionnaire (57.8% response rate) found that all of the interventions were used by at least one respondent and that only 22.9% of the interventions were used to the same extent by nurses, OTs and PTs. The data also suggest variation in reported use within professions.

CONCLUSIONS

This study has found a large number of interventions for post-stroke shoulder pain which are reported to be used. This might reflect different causes of shoulder pain or variation between clinicians. Answers to these questions are expected to guide future evaluative research.

Recruitment strategies in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial: the first six years

The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial has a total enrollment goal of almost 150,000 participants. These participants are being recruited at ten screening centers across the United States. All screening centers tested recruitment methodologies during a 1-year pilot phase. The main phase of recruitment was planned to take place over a 3-year period. The majority of participants are being recruited during the main phase of the study. Each of the screening centers tailors recruitment to its individual catchment area. Recruitment strategies in the PLCO trial are described. As the trial began, several protocol changes were made to help to increase enrollment. The National Cancer Institute (NCI) initiated recruitment efforts at the national level. The individual screening centers describe some of the specific recruitment experiences encountered. As the study progressed, the NCI implemented special initiatives to increase the enrollment of minority participants.

Social determinants of GHQ score by postal survey

BACKGROUND

To develop interventions to reduce the morbidity associated with depression and anxiety, more information is needed about the social and demographic determinants of these disorders and the relative contributions of different potential predictors.

METHODS

Using stratified sampling from the Family Health Services Authority (FHSA) register, postal surveys were sent to 61,000 adults across the North Western Regional Health Authority. Psychological morbidity was assessed using the 12-item General Health Questionnaire (GHQ). Nine potential predictors of morbidity were rated, including socio-demographic details and the presence of longstanding limiting physical illness and of a confidante. Logistic regression analyses were used to consider each of the nine potential predictors separately and in combination.

RESULTS

A total of 38,014 questionnaires were returned (63 per cent). After adjustment for all other variables the strongest predictors of a high GHQ score were the absence of a confidante (odds ratio (OR) 3.64), longstanding limiting physical illness (OR 2.93), unemployment (OR 1.91), being a student (OR 1.78), being female (OR 1.64), single parenthood (OR 1.55) and living alone (OR 1.32). GHQ scores were highest in the 18-34 age range. Ethnicity exerted no significant effect after adjustment for other variables.

CONCLUSION

In keeping with other research the data suggest that sociodemographic factors are strong predictors of depression and anxiety. The most vulnerable population groups are those with longstanding limiting physical illness and no-one to talk to. This should help in identifying high-risk individuals and informing preventive strategies.

Informal care and psychiatric morbidity

BACKGROUND

We aimed to examine and quantify the relationship between psychiatric morbidity and the provision of informal care in the community.

METHODS

The study involved a comparison of carers and non-carers in a mixed urban and rural community (Morecambe Bay Health Authority). Data were collected by postal survey for 4550 adults; 10.9 per cent of respondents were identified as carers. Subjects were selected by quasi-random methods from the Family Health Services Authority (FHSA) registers. Potential psychiatric morbidity was defined as three or more symptoms on a standardized measure, the General Health Questionnaire (12-item version).

RESULTS

The prevalence of morbidity was significantly higher in people who care for others in their own homes, even after adjustment for other known risk factors for psychiatric morbidity (odds ratio 1.51, 95 per cent confidence interval 1.11-2.05). In contrast, there was no significant relationship between morbidity and care outside the home in these data.

CONCLUSION

Health Authorities need to review support for carers and to consider ways to improve monitoring.

Mental health in the north west region of England: associations with deprivation

Minor psychiatric morbidity is known to be associated with social disadvantage, but few studies have explored this association at the population level. This study reports data from a postal survey across 19 health districts in one region, with a total sample of 38,000 respondents. The percentage scoring above the General Health Questionnaire (GHQ) threshold for each health district was correlated with measures of deprivation derived from the 1991 census and standardised mortality ratios. Highly significant correlations were seen between the percentage above the GHQ threshold and the Underprivileged Area (UPA) score (r = 0.84), under 65 Standardised Mortality Ratio (SMR; r = 0.80), lack of amenities (r = 0.56), overcrowding (r = 0.54), lone-parent families (r = 0.84), unemployment (r = 0.87), unskilled workers (r = 0.77), ethnic minority composition (r = 0.58) and social mobility (r = 0.85). However, the three most deprived districts had the lowest response rates and when these were excluded from the analysis, only the correlations with under 65 SMR (r = 0.57, P < 0.05), UPA score (r = 0.52, P < 0.05) and unskilled workers (r = 0.60, P < 0.05) remained significant. There may be a threshold effect for the impact of social disadvantage on mental health, with much higher rates of psychological morbidity among markedly disadvantaged populations.

Dengue haemorrhagic fever/dengue shock syndrome. An unwelcome arrival in Trinidad

This is the first report of dengue haemorrhagic fever and dengue shock syndrome in Trinidad. Dengue infection was confirmed serologically or by viral isolation in five patients, aged 15 to 53 years, who presented with fever, thrombocytopenia and haemoconcentration. Three patients developed dengue shock syndrome, which was fatal; although there was no haemorrhagic tendency among these patients, bleeding occurred shortly before death in one of them. Two patients who had dengue haemorrhagic fever survived. The co-circulation of dengue virus serotypes 1, 2, and 4 in the Caribbean facilitates the development of dengue shock syndrome (DSS) or dengue haemorrhagic fever (DHF). Clinicians should therefore be aware of their clinical features, laboratory diagnosis and clinical management. Appropriate public health interventions and improved surveillance should be implemented to reduce the risk of DHF/DSS associated mortality in Trinidad and Tobago.

Recent trends, future needs: management training for consultants

Describes the results of a postal questionnaire survey of all 1,383 hospital consultants in the North Western Region of the UK in 1994; updating a similar survey conducted in 1987. In both surveys, consultants were asked to describe their current management role, management training received and any perceived future training needs. A series of open questions in the 1994 survey explored barriers and incentives to the take-up of management training. The results show that in 1994 more doctors were taking on greater management responsibility and from an earlier age. Consequently, the proportion of consultants expressing a need for management training had risen from 62 per cent in 1987 to 73 per cent in 1994. The most useful courses were local budgeting and business planning. However, many consultants described problems in accessing training. Concludes by highlighting policy implications arising from the surveys which will need to be addressed if consultants are to fulfil their management potential.

Encoding, remembering and awareness in lorazepam-induced amnesia

The effects of lorazepam (1,2 mg) and placebo on encoding, remembering and awareness were assessed in a study with 54 healthy volunteers. All subjects studied stimulus materials in a levels of processing (L-o-p) task. Half the subjects were assessed on an explicit memory task of word recognition and the other half were given an implicit memory task of word-stem completion. Following the implicit task, awareness of retrieval was further investigated by questions and by subjects' recollective experience in recognising the actual words they had completed from stems. L-o-p effects and marked lorazepam-induced impairments were found in the implicit task of word-stem completion although the interaction between L-o-p and drug effects emerged only as a trend in the data. Lorazepam-induced impairments on stem-completion may then be explained at least in part as being due to contamination by explicit retrieval processes, but we cannot rule out the possible role of drug effects on perceptual processes at encoding. Results from responses to "awareness" questions and from analysis of subsequent recollective experience indicated that subjects were not aware of using explicit retrieval during the implicit task. Results also replicated previous findings showing that both lorazepam and L-o-p independently affect performance in an explicit memory task of word recognition. Thus drug-induced deficits at encoding persist regardless of the level at which information is initially processed.

Social deprivation and psychiatric admission rates among different diagnostic groups

BACKGROUND

In the search for population-based indicators of need for mental health services, psychiatric admission rates have been correlated with sociodemographic variables. We explored such correlations for different diagnostic groups.

METHOD

Admissions data for the 19 districts in the North West Region were derived from the Korner Episode System for 1992/93 and divided into eight broad diagnostic groups using ICD-9 codes. Admission rates per 1000 were correlated with measures of deprivation derived from the 1991 census data and with standardised mortality ratios. For the two largest diagnostic groups, correlations with age-standardised admission rates were also calculated.

RESULTS

For schizophrenia/delusional disorder, eight of the 10 sociodemographic measures were significantly correlated with admission rates (Pearson's r 0.52 - 0.79). On all measures these correlations were greater than those seen for total mental illness. Significant positive correlations of a lower order were seen for organic brain syndromes and mania. Admission rates for depression, personality disorder and substance misuse were not significantly correlated with any of the sociodemographic measures. Admission rates for neurotic illness were negatively correlated with all deprivation measures, with the negative correlation statistically significant at the 5% level for ethnic composition and overcrowding. Standardising admission rates for age and repeating the analysis after removal of influential data points did not greatly alter these findings.

CONCLUSIONS

The association between psychiatric admission rates and measures of deprivation varies considerably with diagnosis. Measures of social deprivation may indicate need for services for patients with psychotic disorders; admission rates for non-psychotic illnesses may reflect the availability of beds rather than need.

Setting standards for cervical screening fail-safe mechanisms: a target based on an audit of cytopathology laboratory records

OBJECTIVE

To examine the efficacy of cytopathology laboratories in monitoring action following an abnormal cervical smear.

SETTING

11 screening laboratories serving 19 districts in the former North Western region of the United Kingdom.

METHOD

944 validated cases were identified at 11 laboratories. The screening history for each abnormal smear was obtained from the screening laboratory and compared with the records from the relevant family health services authority (FHSA) database.

RESULTS

Laboratories held complete follow up records in 740 (78.4%) cases; the FHSA records extended this to 910 (96.4%) cases. Poor communication was the main problem; computerisation was not necessary to improve fail-safe procedures.

CONCLUSIONS

Audit of fail-safe procedures is a valuable purchasing tool, identifying weaknesses and strengths, setting and maintaining standards.

Factors relating to smoking and pregnancy in the North Western Region

BACKGROUND

One of the targets for the Health of the nation is to increase the proportion of women smokers who give up smoking at the start of their pregnancy, from a quarter to at least one-third, by the year 2000. This study uses a regional lifestyle survey to look at the characteristics of pregnant women who smoke.

METHODS

The lifestyle survey was based on a structured questionnaire which was sent by post to a systematic random sample of 60,000 adults across the North Western Region. A total of 513 respondents were pregnant; of these, 150 (29 per cent) reported that they smoked. The responses of pregnant smokers and non-smokers were compared to identify differences in age, demographic and social characteristics, mental distress and attitudes to lifestyle variables.

RESULTS

Women in the North Western Region who smoked tended not to give up during pregnancy, but they did tend to smoke less. Smokers were more likely to be under 25 than non-smokers, less likely to be home-owners, and less likely to be living with a husband or partner. There was no difference in mental distress between smokers and ex-smokers, but they both experienced significantly greater mental distress than those who had never smoked. The difference between smokers and ex-smokers was in their type of occupation, housing tenure and whether they were living with a partner, ex-smokers being much more similar to non-smokers.

CONCLUSIONS

More work needs to be done to improve the design of smoking cessation programmes, to make them more culturally appropriate for pregnant women who appear to be socially disadvantaged, have poor housing and lack a stable relationship.

Analysis of F2-isoprostanes as indicators of non-enzymatic lipid peroxidation in vivo by gas chromatography-mass spectrometry: development of a solid-phase extraction procedure

Recently, it has been reported that a series of prostaglandin F2-like compounds (F2-isoprostanes) are produced in vivo during peroxidation of arachidonic acid by a mechanism independent of the cyclooxygenase pathway. Of these, 8-epi-PGF2 alpha is shown to be a potent vasoconstrictor. We describe an improved method for analysing F2-isoprostanes in biological fluids. The method involves solid-phase extraction on an octadecylsilane (C18) and an aminopropyl (NH2) cartridge. After conversion to pentafluorobenzyl ester and trimethylsilyl ether derivatives, F2-isoprostanes are analysed by negative-ion chemical ionization mass spectrometry using tetradeuterated PGF2 alpha as the internal standard. The limit of detection of the assay was 10 pg/ml, with a coefficient of variation ranging from 9.4 to 15.1%. Analysis of plasma samples from healthy volunteers (n = 7) revealed no quantifiable levels of free (unesterified) 8-epi-PGF 2 alpha. However, the plasma samples contained 58 to 166 pg/ml of 8-epi-PGF2 alpha when analyzed for the total (sum of free and esterified) F2-isoprostanes. The main advantages of the method lie in the improved recovery, gas chromatographic separation and speed compared to existing techniques.

Influence of physical, psychological and behavioural factors on consultations for back pain

Over 34,000 questionnaires were used to study occurrence and consultations for back pain in the community. The 12-month period prevalence was 24% and 13% of the sample consulted a doctor. Elderly women were at greatest risk of back pain. The consultation rate increased in both sexes throughout middle age, but declined in men over the age of 55 yr. Back pain was associated with the Goldberg General Health Health Questionnaire score suggesting psychiatric morbidity [odds ratio (OR) = 2.05; confidence interval (CI) 1.89-2.23], obesity (OR = 1.59; CI 1.40-1.79), and cigarette smoking (OR = 1.52; CI 1.36-1.70). Vigorous daily activity was positively associated with back pain in men aged 18-39 yr (OR = 1.37; CI 1.02-1.85), and women aged 18-39 yr (OR = 1.50; CI 1.08-2.09), but was negatively associated with back pain in women aged over 65 yr (OR = 0.35; CI 0.16-0.76). Alcohol consumption was also negatively associated with back pain (OR = 0.72; CI 0.62-0.85). The prevalence of arthritis, constipation and respiratory disorders was increased in those who consulted for back pain corrected for the other variables. Thus back pain was substantially more common in women compared to men over 55 yr. Psychiatric morbidity, cigarette smoking and obesity were associated with back pain at all ages, but the effect of physical exercise appeared to change with age. Further studies are required to explain the sex differences and nature of the associations.

Imaging strategies in the first 12 months after reduction of developmental dislocation of the hip

We have reviewed the records of 32 infants whose developmental dislocation of the hip (DDH) was treated by reduction and immobilization in a plaster cast. We examined 50 CT scans from 22 patients. The postreduction radiological studies led to a change of cast in 10 patients and, in five of them, the subluxation shown on CT scan was not seen in an earlier radiograph. Where reduction has been undertaken at the time of arthrography or in an older child, a plain radiograph may be adequate to confirm the position in the cast. In an infant, CT scans give superior information, have acceptable risks, and should be used in association with radiation protection measures.

General practitioner attitudes to day surgery

BACKGROUND

Day surgery is increasing in importance. Unfortunately, its impact upon health professionals in the community is poorly documented. This paper reports the opinions of general practitioners (GPs) in a North Western Health District.

METHODS

A structured attitude questionnaire was sent to all GPs in Trafford Health District. GPs were asked for their opinions of the relative merits of day and in-patient surgery for patients with similar conditions. Replies were received from 71 GPs, giving a response rate of 65 per cent.

RESULTS

GPs gave only a mixed level of support to the idea of further expansion. This related less to considerations of workload in the Primary Care Team than it did to concerns about readmissions and complications.

CONCLUSION

The further development of day surgery will require a greater sensitivity to the resource and information needs of professionals in the Primary Care Team.