Objectives To examine the effects that variant descriptor labels on cigarette packs have on smokers’ perceptions of those packs and the cigarettes contained within. Method As part of two larger web-based studies (each involved 160 young adult ever-smokers 18–29 years old), respondents were shown a computer image of a plain cigarette pack and sets of related variant descriptors. The sets included terms that varied in terms of descriptors of colours as names, flavour strength, degrees of filter venting, filter types, quality, type of cigarette and numbers. For each set, respondents rated the highest and lowest of two or three of the following four characteristics: quality, strongest or weakest in taste, delivers most or least tar/nicotine, and most or least level of harm. Results There were significant differences on all four ratings. Quality ratings were the least differentiated. Except for colour descriptors, where ‘Gold’ rated high in quality but medium in other ratings, ratings of quality, harm, strength and delivery were all positively associated when rated on the same descriptors. Conclusions Descriptor labels on cigarette packs, can affect smokers’ perceptions of the characteristics of the cigarettes contained within. Therefore, they are a potential means by which product differentiation can occur. In particular, having variants differing in perceived strength while not differing in deliveries of harmful ingredients is particularly problematic. Any packaging policy should take into account the possibility that variant descriptors can mislead smokers into making inappropriate product attributions.,An analysis of congenital malformations, other than neural tube defects, which have contributed to perinatal mortality in Leicestershire is presented for the years 1976 to 1982 inclusive. Chromosomal, single gene, or polygenic inheritance accounted for 67% of cases.,BackgroundAlthough proven measures for reducing injury due to motor vehicle collision and residential fires exist, the number of families properly and consistently using child passenger restraints and smoke alarms remains low. This paper describes the design of the Safety In Seconds (SIS) 2.0 study, which aims to evaluate the impact of a smartphone app on parents' use of child restraints and smoke alarms.MethodsSIS is a multisite randomised controlled trial. Participants are parents of children aged 4–7 years who are visiting the Pediatric Emergency Department or Pediatric Trauma Service. Parents are randomised to receive tailored education about child passenger safety or about fire safety via the SIS smartphone app. A baseline and two follow-up surveys at 3 months and 6 months are conducted. Primary outcomes are: (1) having the correct child restraint for the child's age and size; (2) restraining the child in the back seat of the car; (3) buckling the child up for every ride; (4) having the restraint inspected by a child passenger safety technician; (5) having a working smoke alarm on every level of the home; (6) having hard-wired or lithium battery smoke alarms; (7) having and (8) practising a fire escape plan.DiscussionFinding ways to communicate with parents about child passenger and fire safety continues to be a research priority. This study will contribute to the evidence about how to promote benefits of proper and consistent child restraint and smoke alarm use.Trial registration numberNCT02345941; Pre-results.,Histamine and histamine methyltransferase (HMT) have been measured in gastric mucosa from 110 patients with duodenal ulcer and 62 control subjects. Both antral and fundic mucosa had similar levels of HMT activity despite antral mucosa containing significantly less histamine. Patients with duodenal ulcer had significantly lower levels of fundic mucosal HMT activity and lower concentrations of fundic mucosal histamine than control subjects. An additional finding was that men who were cigarette smokers had significantly lower concentrations of fundic mucosal histamine (but not HMT) than non-smokers and, as there was an excess of cigarette smokers among patients with duodenal ulcer, this may be the explanation for the reduced concentrations of fundic mucosal histamine in these patients.,A simple discriminant function in four variates (area of mill, average number of cigarettes currently smoked per day, a complex of dyspnoea, cough, and wheezing grades, and occupation) was derived to discriminate between non-byssinotic (grade o) and byssinotic (grades I and II) preparers. This function diagnosed 14% of non-byssinotics as byssinotic and 35% of byssinotics as non-byssinotic, giving a total misclassification rate (24·5%) that agreed closely with the theoretically expected rate (26·4%). Similar misclassification rates were found in a randomly selected check sample of preparers. The function did not diagnose accurately preparers with early byssinosis (grade ½); 64% of such workers would have been diagnosed as normal.
Drug and Therapeutics Bulletin (DTB) has moved home. At the end of November 2006, ownership of DTB was transferred from Which? to the BMJ Group. Here, in the first article published under the new banner, we explain the move and its implications.,Fifty-one patients with amaurosis fugax were followed for a mean of 4.9 years from their first attack. Females predominated under the age of 50 years in contrast to men who presented in the older age group. Minor permanent visual sequelae occurred in only three patients, but cerebral vascular symptoms were present at some time in just under half the group. A range of abnormalities was identified on cerebral angiography and some of these correlated with certain clinical findings. Twenty patients were treated by surgery and permanent relief of significant improvement in symptoms occurred in 14. A group of patients who were at greater risk of cerebral vascular complications following angiography and surgery was identified. It is concluded that careful patient selection is necessary before surgery is recommended but that in a significant number of cases with relatively focal atheroma confined to one proximal internal carotid artery an excellent long term result following surgery may be expected.,Hirschsprung disease (HSCR, aganglionic megacolon) represents the main genetic cause of functional intestinal obstruction with an incidence of 1/5000 live births. This developmental disorder is a neurocristopathy and is characterised by the absence of the enteric ganglia along a variable length of the intestine. In the last decades, the development of surgical approaches has importantly decreased mortality and morbidity which allowed the emergence of familial cases. Isolated HSCR appears to be a non-Mendelian malformation with low, sex-dependent penetrance, and variable expression according to the length of the aganglionic segment. While all Mendelian modes of inheritance have been described in syndromic HSCR, isolated HSCR stands as a model for genetic disorders with complex patterns of inheritance. The tyrosine kinase receptor RET is the major gene with both rare coding sequence mutations and/or a frequent variant located in an enhancer element predisposing to the disease. Hitherto, 10 genes and five loci have been found to be involved in HSCR development.
This article explores the ethical challenges of providing Medical Assistance in Dying (MAID) in a paediatric setting. More specifically, we focus on the theoretical questions that came to light when we were asked to develop a policy for responding to MAID requests at our tertiary paediatric institution. We illuminate a central point of conceptual confusion about the nature of MAID that emerges at the level of practice, and explore the various entailments for clinicians and patients that would flow from different understandings. Finally, we consider the ethical challenges of building policy on what is still an extremely controversial social practice. While MAID is currently available to capable patients in Canada who are 18 years or older—a small but important subsection of the population our hospital serves—we write our policy with an eye to the near future when capable young people may gain access to MAID. We propose that an opportunity exists for MAID-providing institutions to reduce social stigma surrounding this practice, but not without potentially serious consequences for practitioners and institutions themselves. Thus, this paper is intended as a road map through the still-emerging legal and ethical landscape of paediatric MAID. We offer a view of the roads taken and considered along the way, and our justifications for travelling the paths we chose. By providing a record of our in-progress thinking, we hope to stimulate wider discussion about the issues and questions encountered in this work.,The transoral approach to the upper cervical spine is an established but little used route, offering excellent access with good wound healing, to lesions of the bodies of the atlas, axis and upper part of the third cervical vertebra. The authors report four cases which demonstrate the value of the procedure.,The present study details the time course and isotype distribution of the immune response to type II collagen in collagen-induced arthritic mice and mice suppressed for collagen-induced arthritis. The serum of arthritic mice was observed to contain significantly higher (p less than 0.005) concentrations of antibodies to type II collagen than that of mice suppressed for arthritis at all times tested. For the arthritic mice anti-type II collagen antibodies ranged from 0.2 +/- 0.2 (SD) to 6.1 +/- 0.7 mg/ml (g/l). Serum values for mice suppressed for arthritis ranged from 0.05 +/- 0.04 to 0.6 +/- 0.04 mg/ml. Analysis of the isotypes of these responses showed an expression of anticollagen molecules restricted to the IgG1 subclass in mice suppressed for collagen arthritis throughout the time course (p less than 0.01). The data indicate that mice suppressed for collagen-induced arthritis can mount a primary and secondary immune response to the arthrogenic stimuli. This response, however, is mainly restricted to the IgG1 subclass of antibodies. This restricted subclass expression of anticollagen antibodies may represent a mechanism of suppression of arthritis in the murine model of collagen-induced arthritis.,When the patient applies for disability benefit in Norway, the general practitioner (GP) is required by the National Insurance Administration (NAV) to confirm that the patient is unfit for work due to disease. Considering the important social role of medical certificates, they have been given surprisingly little attention by the medical critique. They may make essential differences to peoples’ lives, legitimise large social costs and, in addition, the GPs report that issuing certificates can be problematic. This article explores values, attitudes and persuasive language in a selection of medical certificates written by GPs. We direct attention to such texts as significant social actors using a mixed rhetoric including certain values and attitudes. When arguing for granting the patient disability benefit, some GPs emphasised the ‘worthiness’ of the patient by pointing to positive attitudes approved by the national insurance: a will to work and participate, to cooperate and be motivated. Others pointed out the patient’s positive character in terms of universally accepted values, called for the reader’s (the NAV official) sympathy , understanding and helpfulness or appealed to his/her willingness to be realistic and pragmatic and grant disability benefit (DB). The dialogic style varied: some certifiers—although they argued for disability benefit—showed openness to possible opposing or alternative voices by displaying their own uncertainty. Others addressed the reader to share responsibility, demanding or urging for DB. This shifting rhetoric, we believe, mirrors that the GPs see themselves as the patient’s advocate, and that they may find themselves conflicted. We propose further studies within qualitative research to investigate the effect of this rhetoric on the reader, the decision-makers. In addition, to improve the quality and accuracy of these important documents, we suggest that medical schools introduce students to the making of text as a specific skill of medical practice.
Anorectal function has been assessed in 53 patients with Crohn's disease by measurement of resting and squeeze anal canal pressures and the maximum volume tolerated during distension of a balloon in the rectum. Radiographs of the rectum from barium enema examination were also reviewed to assess rectal capacity. Thirty-three patients have had a colectomy and ileorectal anastomosis for Crohn's colitis of whom 13 now have a stoma because they either required a protectomy (n=9) or where closure of a loop ileostomy had not been possible (n=4) because of severe anorectal disease. The maximum tolerated volume was less than 150 ml in 12 of 13 patients who now have a stoma compared with none of the 20 patients who have a functioning anastomosis. Although the correlation between a radiological assessment of rectal capacity and the maximum tolerated volume was poor, a severely contracted rectum was associated with the need for a stoma in six of seven patients compared with only two of 13 patients who did not have radiological signs of a narrow rectum.,THE current economic downturn in agriculture is having knock-on effects on veterinary practices, with the result that some are having to consider very carefully their position in the marketplace. There are a number of alternative ways forward open to practices in this situation, one of which is for two neighbouring practices to merge. In this article, Dixon Gunn explains the process.,ObjectiveTo assess if violent deaths were associated with pay days in Guatemala.DesignInterrupted time series analysis.SettingGuatemalan national autopsy databases.ParticipantsDaily violence-related autopsy data for 22 418 decedents from 2009 to 2012. Data were provided by the Guatemalan National Institute of Forensic Sciences. Multiple pay-day lags and other important days such as holidays were tested.Outcome measuresAbsolute and relative estimates of excess violent deaths on pay days and holidays.ResultsThe occurrence of violent deaths was not associated with pay days. However, a significant association was observed for national holidays, and this association was more pronounced when national holidays and pay days occurred simultaneously. This effect was observed mainly in males, who constituted the vast majority of violent deaths in Guatemala. An estimated 112 (coefficient=3.12; 95% CI 2.15 to 4.08; p<0.01) more male violent deaths occurred on holidays than were expected. An estimated 121 (coefficient=4.64; 95% CI 3.41 to 5.88; p<0.01) more male violent deaths than expected occurred on holidays that coincided with the first 2 days following a pay day.ConclusionsMen in Guatemala experience violent deaths at an elevated rate when pay days coincide with national holidays. Efforts to be better prepared for violence during national holidays and to prevent violent deaths by rescheduling pay days when these days co-occur with national holidays should be considered.,The typical badminton player with an Achilles tendon rupture is 36 years old and, despite limbering up, is injured at the rear line in a sudden forward movement. He resumes work within three months and has a slight lack of dorsiflexion in the ankle as the main complication. Most patients resume badminton within one year, but some finish their sports career, mainly due to fear of a new injury. The investigation discusses predisposing factors and prophylactic measures.
The Clostridium genus contains several species that are important equine pathogens. Clostridia are Gram-positive spore-forming bacteria with differing degrees of aerotolerance. Many Clostridium species are intestinal commensals in healthy horses; however, some are opportunistic pathogens that cause a range of diseases. Clostridial spores are often resistant to disinfectants and can survive in extreme environmental conditions, leading to widespread exposure risk. This article describes the main clostridial diseases affecting horses, discussing differential diagnoses, prevention and treatment.,BackgroundThe Valsalva manoeuvre (VM) is used to treat supraventricular tachycardia (SVT) by inducing a vagal response (drop in HR). There is debate as to the best position in which to carry out the VM and how the strain should be delivered in practice. We aimed to compare vagal responses induced with supine and modified VMs using strains delivered with a standardised manometer or novel Valsalva Assist Device (VAD), a simple device to provide resistance to exhalation.MethodsWe conducted a repeated measures randomised trial of four VMs (two supine VM and two modified VMs), in healthy adult volunteers, with strains delivered using an adapted sphygmomanometer (manometer) or a VAD. Changes in HR, pressure and duration of strain and adverse events were monitored and compared between the techniques and devices. The trial was approved by the University of Exeter Medical School Research ethics committee.Results75 healthy participants aged 19–55 years were recruited over a 4-month period. A mixed-effects linear regression showed the modified VM resulted in a 3.8 beats per min (bpm) greater drop in HR compared with the supine VM (p=0.002, 95% CI 2.2 to 5.4). VM strains produced by the VAD were of a similar pressure but of slightly shorter duration and resulted in a 1.9 bpm smaller drop in HR compared with the manometer (p=0.01, 95% CI 0.4 to 3.4). There were no differences in adverse events.ConclusionsModified VM was associated with a greater drop in HR than a supine VM with no increase in adverse events in healthy volunteers. The VAD can be used to safely generate the recommended VM strain pressure, but produced a smaller drop in HR compared with a manometer and requires modification to enable the recommended strain duration to be achieved consistently.Trial registration numberNCT03298880.,This paper examines the conjunction of pharmacological science and espionage fiction of the post-war era. This paper argues that, during the 1950s, the relatively new science of pharmacology propounded the possibility that illness and human deficiency could be treated in a way that better reflected the post-war zeitgeist. The use of pharmacological medicine, perceived as cleaner and quicker than more ‘bodily’ forms of treatment, represented progress in contemporary medical science. It is argued that this philosophy extended to more overt means of pharmacological application, directly related to the geopolitical concerns of the ‘Cold War’. A growing form of popular literature in this period was the espionage novel. This paper argues that the benefits proffered by pharmacology were incorporated into the fabric of espionage fiction, specifically the James Bond novels of Ian Fleming. Here, it is demonstrated how Fleming used pharmacological knowledge of Benzedrine throughout his novels. His works illustrate a belief that the augmentation of the spy's natural ability with pharmacological science would award decisive advantage in the Cold War conflict played out in spy fiction. However, the relationship between public use of Benzedrine and awareness of its side effects changed during the period of Fleming's publications, moving from a position of casual availability to one of controlled prescription. It is argued that the recognition of the dangers associated with the drug were over-ruled in favour of the benefits its use presented to the state. The continued use of the drug by Bond illustrates how the concerns of the nation are given priority over the health, and life, of the individual.,Brocresine, an aromatic L-amino acid decarboxylase inhibitor with both a peripheral and central action was shown to potentiate the therapeutic effect of levodopa in Parkinson's disease. The search for useful decarboxylase inhibitors therefore need not be limited to agents that do not pass the blood/brain barrier.,Addressing the cultural and religious beliefs around the issue of family planning has been a big challenge for the international development community. The concept of family planning has raised some concerns regarding its acceptability within Muslim populations. While some Muslim states and organisations have adopted a rather cautious approach to the issue, others have gone to the extent of inviting religious leaders to present religiously sound interpretations (fatwa) on the subject. Alongside these deliberations are some alarming statistics on maternal health. The World Health Organization estimates that worldwide 211 million women become pregnant each year and that about two-thirds of them deliver live infants. The remaining one-third of pregnancies end in miscarriage, stillbirth or induced abortion. Some 200 million women in developing countries have an unmet need for effective contraception. These statistics and the ongoing discussion surrounding family planning in the Muslim communities raise legitimate questions. How is family planning perceived within the Muslim community? Does Islam address the issue of family planning? Is it permissible? How should appropriate family planning programmes within Muslim settings be developed and applied? This article seeks to present the ongoing debate on family planning within the Muslim community and offer recommendations to organisations for effective strategy implementation of family planning programmes within Muslim settings. The article provides a brief background on the historical development of family planning in the Muslim community, and outlines Muslim perceptions on this issue. It concludes with recommendations for nongovernmental organisations on how to effectively implement acceptable family planning programmes within Muslim settings.,A preliminary examination of the relationship between the infant mortality of US birth cohorts and their mortality in later life suggested that infant mortality from diarrhoea and enteritis was particularly influential. In the 1917-21 birth cohorts of 17 US Registration States, infant mortality from diarrhoea and enteritis was significantly related to arteriosclerosis heart disease at ages 40-44 and 50-54 in both sexes, and to respiratory cancer at the same ages in men, after controlling for contemporary infant mortality. Hypotheses suggest by these relationships are put forward.,Objective: To identify specific risk factors for concussion severity among ice hockey players wearing full face shields compared with half face shields (visors). Methods: A prospective cohort study was conducted during one varsity hockey season (1997–1998) with 642 male ice hockey players (median age 22 years) from 22 teams participating in the Canadian Inter-University Athletics Union. Half of the teams wore full face shields, and half wore half shields (visors) for every practice and game throughout the season. Team therapists and doctors recorded on structured forms daily injury, participation, and information on face shield use for each athlete. The main outcome measure was any traumatic brain injury requiring assessment or treatment by a team therapist or doctor, categorised by time lost from subsequent participation and compared by type of face shield worn. Results: Players who wore half face shields missed significantly more practices and games per concussion (2.4 times) than players who wore full face shields (4.07 sessions (95% confidence interval (CI) 3.48 to 4.74) v 1.71 sessions (95% CI 1.32 to 2.18) respectively). Significantly more playing time was lost by players wearing half shields during practices and games, and did not depend on whether the athletes were forwards or defence, rookies or veterans, or whether the concussions were new or recurrent. In addition, players who wore half face shields and no mouthguards at the time of concussion missed significantly more playing time (5.57 sessions per concussion; 95% CI 4.40 to 6.95) than players who wore half shields and mouthguards (2.76 sessions per concussion; 95% CI 2.14 to 3.55). Players who wore full face shields and mouthguards at the time of concussion lost no playing time compared with 1.80 sessions lost per concussion (95% CI 1.38 to 2.34) for players wearing full face shields and no mouthguards. Conclusions: The use of a full face shield compared with half face shield by intercollegiate ice hockey players significantly reduced the playing time lost because of concussion, suggesting that concussion severity may be reduced by the use of a full face shield.
Objective Electronic Nicotine Delivery Systems (ENDS) have recently been attracting interest for their potential as a less harmful alternative to smoking, their rising popularity and the regulatory issues they raise. The news media can play an important role in shaping public perceptions of new technologies. It is, therefore, important to understand the ways the news media present ENDS. This paper examines how ENDS are represented in the UK and in the Scottish press. Methods Twelve national UK and Scottish newspapers and the three most popular online news sources were searched between 2007 and 2012. A thematic analysis was conducted to explore how the meanings, uses and users of ENDS are presented, and whether and how this has changed. Results Newspaper coverage of ENDS increased substantially over this period. Five key themes emerged from the analysis: getting around smokefree legislation; risk and uncertainty; healthier choice; celebrity use; price. Conclusions Drawing on the diffusion of innovations theory, we suggest that newspaper constructions of ENDS provide readers with important information about what ENDS are for, how they work, and their relative advantages. These themes, and dominance of more positive meanings, raise a number of issues for tobacco control, including concerns around celebrity use and promotion; the impact of increasing ENDS use on social norms around smoking; their potential to undermine smokefree legislation; and their promotion as effective cessation aids.,It is conceivable that brush border enzyme activities of the intestinal mucosa will change when bacterial toxins are exposed to the intestinal microvillous membranes. The effect of cholera toxin on the activity of intestinal alkaline phosphatase in rats was therefore determined in the intestinal mucosa by the histochemical method as well as in intestinal lymph by using lymph fistulated-rats. Activity of intestinal alkaline phosphatase in the intestinal mucosa and lymphatics changed biphasically after the oral administration of cholera toxin to rats. For the first three hours after the administration of cholera toxin it was depressed; it then increased and at eight hours reached a maximum. These changes in the activity of intestinal alkaline phosphatase were prevented by the administration of chlorpromazine, a known inhibitor of adenylate cyclase activity.