Communicable disease epidemiology and control

by Roger Webber, CAB International, 1997. pound19.95 (xiv+352 pages) ISBN 0 85199 138 6.     

Nurse led versus lay educators support for those with asthma in primary care: a costing study

ABSTRACT: BACKGROUND: Regular review and support for asthma self-management is promoted in guidelines. A randomised controlled trial suggested that unscheduled health care usage was similar when patients were offered self management support by a lay-trainer or practice nurses. METHODS: Following the RCT, a costing study was undertaken using the trial data to account for the cost of delivery of the service under both strategies and the resulting impact on unscheduled healthcare (measure of effectiveness) in this trial. RESULTS: One year data (n = 418) showed that 29% (61/205) of the nurse group required unscheduled healthcare (177 events) compared with 30.5% (65/213) for lay-trainers (178 events).The training costs for the lay-trainers were greater than nurses ([pound sign]36 versus [pound sign]18 respectively per patient, p<0.001), however, the consultation cost for lay-trainers were lower than nurses ([pound sign]6 per patient versus [pound sign]24, p<0.001). If the cost of unscheduled healthcare are accounted for then the costs of nurses is [pound sign]161, and [pound sign]135 for lay-trainers (mean difference [pound sign]25, [95% CI = -[pound sign]97, [pound sign]149, p = 0.681]). The total costs (delivery and unscheduled healthcare) were [pound sign]202 per patient for nurses versus [pound sign]178 for lay-trainers, (mean difference [pound sign]24, [95%CI = -[pound sign]100, [pound sign]147, p = 0.707]). CONCLUSIONS: There were no significant differences in the cost of training and healthcare delivery between nurse and lay trainers, and no significant difference in the cost of unscheduled health care use.     

Application and evaluation of denaturing HPLC for molecular genetic analysis in tuberous sclerosis

Tuberous sclerosis (TSC) is an autosomal dominant disorder characterised by the development of hamartomas in multiple tissues and organs. TSC exhibits locus heterogeneity with genes at 9q34 (TSC1) and 16p13.3 (TSC2) that have 21 and 41 coding exons, respectively. The mutational spectrum at both loci is wide and previous studies have shown that 60%-70% of cases are sporadic and represent new mutations. We have formatted denaturing high performance liquid chromatography (DHPLC) for rapid screening of all coding exons of TSC1 and TSC2. DHPLC analysis detected likely disease-causing mutations in 103 of 150 unrelated cases (68%), compared with 92/150 (61%) and 87/150 (58%) for single-strand conformation polymorphism analysis (SSCP) and conventional heteroduplex analysis (HA), respectively. Capital, consumable and labour costs were determined for each exon screening procedure. Estimated costs per patient sample depended on throughput, particularly for DHPLC, where a high proportion of costs are fixed, and were pounds sterling 257, pound sterling 216 and pound sterling 242 for DHPLC, SSCP and HA, respectively, assuming a throughput of 252 samples per year, or pound sterling 354, pound sterling 233 and pound sterling 259, assuming a throughput of 126 samples per year. DHPLC had the advantages of increased sensitivity and reduced labour costs when compared with more traditional approaches to exon screening but, unless expensive DHPLC equipment is being efficiently utilised for a very high proportion of the time available, overall costs are slightly higher.     

Additives to biological substances. V--The stability of lactose as a carrier for Biological Standards

The stability of freeze-dried lactose has been studied, by accelerated degradation, after being ampouled under the conditions employed for the preparation of International Standards and Reference Preparations and also under less stringent conditions which might facilitate degradation. The possible formation of the reactive product, 5-hydroxymethyl-furfural, has been monitored over a period of 10 years at temperatures up to 56 degrees C. No evidence has been obtained to suggest that the formation of this compound would present a hazard to the stability of standards prepared by the procedures customarily employed.     

The internet for scientists

by Kevin O'Donnell and Larry Winger, Harwood Academic Publishers, 1997. pound14.50 (pbk)/ pound30.00 (hbk) (xi+309 pages) ISBN 90 5702 221 4.     

Venous blood gases and lactates of wild loggerhead sea turtles (Caretta caretta) following two capture techniques

During summer of 2001, venous blood gases were determined in loggerhead sea turtles (Caretta caretta) captured by trawl (n = 16) in coastal waters of South Carolina and Georgia (USA) as part of a sea turtle census program and captured in pound nets (n = 6) in coastal North Carolina (USA) during a study of sea turtle population biology. Trawls were towed for 30 min, so turtles captured were forcibly submerged for < or = 30 min. Pound nets are passive gear in which fish and sea turtles are funneled into a concentrated area and removed periodically. Sea turtles in pound nets are free to surface and to feed at will. Blood was obtained from the dorsal cervical sinus as quickly as possible after landing on the boat (range 2-10 min trawl, 1-2 min pound net) and at 30 min after landing just prior to release. Blood gases including pH, partial pressures of O2 and CO2 (pO2, pCO2), and lactate were measured within 10 min. Instrument measurements for pH, pO2, and pCO2 made at 37 C were corrected to cloacal temperature and HCO3- was calculated from temperature-corrected pH and pCO2. Venous blood pH and bicarbonate were higher, and pO2 and lactate were lower from pound net-captured turtles compared to trawl captured turtles at the initial sampling time. In pound net turtles, pH and bicarbonate declined and lactate increased during 30 min on deck. In trawled sea turtles, venous blood pH increased and pCO2 and pO2 decreased during the 30 min on deck. Both capture systems caused perturbations in blood gas, acid-base, and lactate status, though alterations were greater in trawl captured turtles.     

Nitric oxide in health and disease

by Jill Lincoln, Charles H.V. Hoyle and Geoffrey Burnstock, Cambridge University Press, 1997. pound24.95 (pbk)/ pound70.00 (hbk) (xiv +363 pages) ISBN 0 521 55977 4/0 521 55038 6.     

Host-parasite evolution: general principles and avian models

edited by D.H. Clayton and J. Moore, Oxford University Press, 1997. pound60.00 (hbk)/ pound25.00 (pbk) (xi+473 pages) ISBN 0 19 854893 1/0 19 854892/3.     

An encyclopaedia of sexuality

Primate Sexuality. Comparative Studies of the Prosimians, Monkeys, Apes and Human Beings by Alan F. Dixson, Oxford University Press, 1998. £75.00 hbk, £32.50 pbk (656 pages) ISBN 0 19 850183 8/0 19 850182 X     

House Dust Mites,how they affect asthma,eczema and other allergies

Book Review

House Dust Mites, how they affect asthma, eczema and other allergiesDes Whitrow: Elliot Right Way Books, Kingswood, Surrey (UK), 1995. Paperback, 191 pp. £3.99     

Sedentary behavior, recreational physical activity, and 7-year weight gain among postmenopausal U.S. women

Objective: To assess the relationship among recreational physical activity (PA), non‐occupational sedentary behavior, and 7‐year weight gain among postmenopausal U.S. women 40 to 69 years old. Research Methods and Procedures: In 1992 and 1999, 18,583 healthy female participants from the Cancer Prevention Study II Nutrition Cohort completed questionnaires on anthropometric characteristics and lifestyle factors. The associations between recreational PA [in metabolic equivalent (MET) hours per week] and non‐occupational sedentary behavior (in hours per day) at baseline and risk for 7‐year weight gain (5 to 9 or ≥10 vs. ±4 pounds) were assessed using multivariate logistic regression analysis. Results: Neither PA nor sedentary behavior was associated with a 5‐ to 9‐pound weight gain. Among women who were not overweight at baseline (BMI <25.0), the odds of ≥10‐pound weight gain were 12% lower (odds ratio, 0.88; 95% confidence interval, 0.77 to 0.99) for those in the highest category of recreational PA (≥18 MET h/wk) compared with >0 to <4 MET h/wk; odds were 47% higher (odds ratio, 1.47; 95% confidence interval, 1.21 to 1.79) for non‐overweight women who reported ≥6 h/d of non‐occupational sedentary behavior compared with <3 h/d. Neither PA nor sedentary behavior were associated with risk of ≥10‐pound weight gain weight among women who were overweight at baseline (BMI ≥25.0). Discussion: Both recreational PA and non‐occupational sedentary behavior independently predicted risk of ≥10‐pound weight gain among postmenopausal women who were not overweight at baseline. Public health messages to prevent weight gain among normal‐weight postmenopausal women may need to focus on decreasing time spent in sedentary behaviors and increasing the amount of time spent on PA.     

Diagnosing idiopathic learning disability: a cost-effectiveness analysis of microarray technology in the National Health Service of the United Kingdom

Array based comparative genomic hybridisation (aCGH) is a powerful technique for detecting clinically relevant genome imbalance and can offer 40 to > 1000 times the resolution of karyotyping. Indeed, idiopathic learning disability (ILD) studies suggest that a genome-wide aCGH approach makes 10–15% more diagnoses involving genome imbalance than karyotyping. Despite this, aCGH has yet to be implemented as a routine NHS service. One significant obstacle is the perception that the technology is prohibitively expensive for most standard NHS clinical cytogenetics laboratories. To address this, we investigated the cost-effectiveness of aCGH versus standard cytogenetic analysis for diagnosing idiopathic learning disability (ILD) in the NHS. Cost data from four participating genetics centres were collected and analysed. In a single test comparison, the average cost of aCGH was ￡442 and the average cost of karyotyping was ￡117 with array costs contributing most to the cost difference. This difference was not a key barrier when the context of follow up diagnostic tests was considered. Indeed, in a hypothetical cohort of 100 ILD children, aCGH was found to cost less per diagnosis (￡3,118) than a karyotyping and multi-telomere FISH approach (￡4,957). We conclude that testing for genomic imbalances in ILD using microarray technology is likely to be cost-effective because long-term savings can be made regardless of a positive (diagnosis) or negative result. Earlier diagnoses save costs of additional diagnostic tests. Negative results are cost-effective in minimising follow-up test choice. The use of aCGH in routine clinical practice warrants serious consideration by healthcare providers. Copyright statement The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence (or non exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd, and its Licensees to permit this article (if accepted) to be published in BMJ editions and any other BMJPGL products and to exploit all subsidiary rights, as set out in our licence (bmj.com/advice/copyright.shtml). Authorship The authors included on this paper fulfil the criteria of authorship and no one who fulfils the criteria has been excluded from authorship. The authors made a substantial contribution to the conception, design, analysis and interpretation of data. They were involved in drafting the article or revising it critically for important intellectual content and approving the version to be published. Contributorship Sarah Wordsworth (Guarantor): Planning, conducting and reporting work, interpretation of data, drafting and revising article. James Buchanan: Conducting and reporting work, interpretation of data, revising article. Regina Regan: Completing costing questionnaire, providing protocol details, other costing information, interpretation of data, information about learning disability and genome imbalance and revising article. Val Davison: Completing costing questionnaire, providing protocol details, sharing overall laboratory experience and drafting article. Kim Smith: Completing costing questionnaire, providing protocol details, drafting article. Sara Dyer: Completing costing questionnaire and providing protocol details. Carolyn Campbell: Completing costing questionnaire and providing protocol details. Edward Blair: Critical appraisal of article for clinical content and revising article. Eddy Maher: Completing costing questionnaire, providing protocol details, sharing overall laboratory experience and drafting article. Jenny Taylor: Planning and facilitating work between centres. Drafting and revising article. Samantha JL Knight: Completing costing questionnaire, providing protocol details, other costing information, interpretation of data, providing information about learning disability and genome imbalance, drafting and revising article. Jenny Taylor and Samantha JL Knight contributed equally to the work presented.     

Advances in trematode biology

edited by Bernard Fried and Thaddeus K. Graczyk, CRC Press, 1997. pound88.50 (466 pages) ISBN 0 8493 2645 1.     

Parasitism and the platyhelminthes

by Graeme C. Kearn, Chapman & Hall, 1998. pound115.00 (xii +544 pages) ISBN 0 412 80460 3.     

Vector control: methods for use by individuals and communities

by Jan A. Rozendaal, World Health Organization, 1997. pound85.00 (xii +412 pages) ISBN 92 4 154494 5.     

Parasites and pathogens effects on host hormones and behavior

edited by Nancy E. Beckage, Chapman & Hall, 1997. pound57.00 (338 pages) ISBN 0-412-07401-X.     

Diagnostic medical parasitology

by L.S. Garcia and D.A. Bruckner, ASM Press, 1997. pound60.00 (xv+937 pages) ISBN 1 55581 1167.     

Ronald ross: malariologist and polymath. A biography

by Edwin R. Nye and Mary E. Gibson, Macmillan (UK) and St Martin's Press (USA) 1997. pound48.50 (316 pages) ISBN 0 312 16296 0.     

The eradication of infectious diseases

edited by W.R. Dowdle and D.R. Hopkins, Wiley, 1998. pound60.00 (hbk) (xv +218 pages) ISBN 0 471 98089 7.     

Growing Industry, Growing Problems

Black, Kenneth (ed.) 2001. Environmental impacts of aquaculture. Sheffield Academic Press, Sheffield. 214 pp. U.K. £ 69.00