Effect of a training programme to reduce stress in carers of patients with dementia.

OBJECTIVE--To reduce the psychological stress and improve the skills in coping of people who care for relatives with dementia. DESIGN--Assessment and suitability of carers by questionnaire; assessment of patients and carers in a hospital outpatient clinic; allocation to groups according to date of application to study. Linkage of groups of four carers and programme coordinator by telephone conference calls over 12 months after programmes. Reassessment at three, six, 12, and, for those in the "wait list" group, 18 months. SETTING--The programmes were conducted in the psychiatry unit of a Sydney teaching hospital. SUBJECTS--Eligible patients were less than 80 years old, had mild to moderate dementia, and lived at home with their carer. Of the 96 patient-carer pairs in the study, 33 were in the dementia carers'' programme group, 31 were in the memory retraining group, and 32 were in the wait list group. INTERVENTIONS--Carers in the dementia carers'' programme received training in coping with the difficulties of looking after patients with dementia while the patients had sessions in subjects such as memory retraining. In the memory retraining programme patients were admitted and received the patient component of the carers'' programme while their carers had 10 days'' respite. In the wait list group carers waited six months before undertaking the carers'' programme. MAIN OUTCOME MEASURES--Effect of the programmes on carers'' general health questionnaire scores and the rate of placement of patients in institutions. RESULTS--At 12 months'' follow up the carers'' programme had resulted in significantly lower psychological stress among carers than the memory retraining programme (mean (SD) general health questionnaire scores at 0 months were 6.31 (6.23) and 3.60 (6.25) respectively, and at 12 months were 4.69 (5.58) and 7.40 (9.39); p less than 0.05.) In the wait list group distress scores remained stable, even after the carers and patients had undertaken the carers'' programme. Patients deteriorated over 12 months regardless of group allocation, but at 30 months, allowing for patients who died and could not be included in the analysis, 65% of patients in the carers'' programme group were still living at home compared with 26% in the memory retraining programme group. CONCLUSION--The intensive intervention programme described for carers of patients with dementia can reduce the psychological morbidity of the carer and delay the placement of the patient in an institution without increasing the use of health services by either patient or carer.     

Decrease in the Incidence of Hepatitis in Dialysis Units associated with Prevention Programme

A prospective survey of hepatitis in more than two-thirds of the dialysis units in the United Kingdom since January 1968 shows that after a prevention and control programme was started in 1970 the rising incidence of hepatitis B was halted. The programme has continued, with a sustained decline in the incidence among patients from 4·9% in 1970 to 1·4% in 1972 and among staff from 1·3% in 1970 to 0·4% in 1972.     

External fluorescence retention of calcein‐marked juvenile brown trout Salmo trutta raised in natural and artificial environments

The fluorescence retention and intensity of juvenile brown trout Salmo trutta marked during their first summer were monitored in a hatchery and in four natural streams. A handheld detector was used for direct examination. In the hatchery, three marking treatments (T) were compared: 3·5 min in a 0·5% calcein solution (T0·5‐3·5), 7 min in a 0·5% calcein solution (T0·5‐7) and 3·5 min in a 1% calcein solution (T1‐3·5). The fish were raised indoors for 11 months and then outdoors until 18 months. The fluorescence retention rate was 100% in all treatments at 11 months, although T1‐3·5 showed the highest mean fluorescence intensity, followed by T0·5‐7 and T0·5‐3·5. The fluorescence intensity was not correlated with the final total length (L_T) of the fish in two treatments, although it significantly decreased with increasing L_T in T1‐3·5. At 18 months, <30% of the fish were still slightly fluorescent, suggesting a negative effect of sunlight exposure. In stream studies, the fluorescence intensity did not significantly differ according to final L_T; an overall mean ± s.d . retention rate of 70·7 ± 26·6% was measured at 12 months with a decrease to 48·6 ± 24·6% at 24 months. Significant differences amongst streams and within reaches of the same stream were observed. Because of a significant positive effect of the shading index on the fluorescence intensity, the use of calcein should be restricted to streams unexposed to direct sunlight. Consequently, the marking method would be reliable for 1 year monitoring studies in shaded streams.     

An examination on composition of spermatozoa obtained from pre-operative and post-operative varicocele patients

Varicocele is one of the main and surgically repairable causes of male infertility, which arises from dilatation and torsion of the testicular veins in the plexus pampiniformis. In this study, we examined semen samples from 40 patients diagnosed with varicocele between the ages of 15 and 30 years, according to WHO criteria (pre-operatively, and at 3, 6, and 12 months post-operatively). The mean spermatozoa concentration was found to be 45.25?±?34.83 million/ml pre-operatively, while the mean post-operative concentration was 48.85?±?35.73 million/ml at three months, 51.72?±?32.82 million/ml at six months, and 49.63?±?28.05 million/ml at 12 months (P?>?0.05). The mean rate of A?+?B motile spermatozoa was 35.5?±?14.71% pre-operatively, 42.65?±?16.80% at three months, 43?±?13.52%at six months and 44?±?14.76 percent at 12 months post-operatively (P?<?0.05). The mean Kruger morphology score was 3.15?±?3.0% pre-operatively, and 3.20?±?2.83% at three months, 2.97?±?2.61%at six months and 3.27?±?2.50%at 12 months post-operatively (P?>?0.05). The nucleus, acrosomal cap, mitochondrial structure and microtubules of the tail of the spermatozoa were examined under electron microscopy. The mean DNA fragmentation index (DFI%) of the spermatozoa was 20.57?±?4.60% pre-operatively, and post-operatively at 17.27?±?3.65% at three months, 15.5?±?3.23% at six months and 15.3?±?3.63% at 12 months (P?<?0.001).The findings suggest that despite the increased count and motility, as well as the improved DNA fractures observed post-operatively in the spermatozoa of varicocele patients, the morphology rates remain intact.     

东北黑土有机磷的矿化过程研究

用室内恒温控湿培养法和埋袋法研究了不同时间序列下黑土有机磷的矿化过程.结果表明,无论是实验室培养法还是埋袋法,有机磷含量和矿化速率都逐渐下降,累积矿化率逐渐上升.培养法中,两个处理的矿化速率均在1个月时最大,分别为31.67和38.75 mg·kg^-1·month^-1,6个月时累积矿化率和矿化速率分别为7.9%,13.26 mg·kg^-1·month^-1;9.24%,17.99 mg·kg^-1·month^-1.埋袋法中,5个有机物料处理的矿化速率均在1年时最大,分别为55.67、55.65、49.60、19.71和22.52 mg·kg^-1·month^-1,3年时玉米根和小麦根处理的累积矿化率和矿化速率较高(二者3年的累积矿化率约50%,矿化速率约35 mg·kg^-1·month^-1),而大豆根和草根的处理则较低.同时,两种研究方法均表明,有机磷初始含量影响其矿化率和矿化速率,有机磷初始含量愈高,其矿化率和矿化速率就愈高.     

腰椎间盘突出症阶梯式手术治疗方案的临床疗效和患者心理状况调查

目的:探讨阶梯式手术治疗方案对腰椎间盘突出的临床疗效和患者对临床疗效的心理接受情况。方法:回顾性分析2014年至2016年本院骨科确诊为腰椎间盘突出症的50例患者,经椎间孔镜下行髓核摘除微创手术(Percutaneous transforaminal endoscopic discectomy,PTED),术后1天和3个月采用视觉疼痛模拟评分(VAS)和改良Mac Nab疗效评定、术后3个月采用Oswestry功能障碍指数(ODI)评价手术效果,以及相应调查时间点患者对手术效果心理接受程度调查;对于7例微创手术疗效不佳患者进一步采用传统的开窗髓核摘除术(Fenestration discectomy,FD),采用同样方法评价手术效果和调查患者心理接受情况。结果:50例微创术后1天及术后3个月的VAS评分和ODI指数均显著低于术前,差异具有显著性(P均0.05);改良Mac Nab疗效评定:术后1天优良率为84%,术后3个月为86%;患者对术后疗效心理满意度调查:术后1天,满意并接受为84%,不满意但接受为16%,不满意难接受为0;术后3个月,满意并接受为86%,不满意但接受为14%,不满意难接受为0。对于微创术后效果欠佳7例患者行FD手术,术后1天及3个月的VAS评分和ODI指数均显著低于术前,差异具有显著性(P均0.05);改良Mac Nab疗效评定:术后1天优良率为71%,术后3个月为100%;患者对开窗术后疗效心理满意度调查:术后1天,满意并接受为71%,不满意但接受为0,不满意难接受为29%;术后3个月,满意并接受为100%,不满意但接受为0,不满意难接受为0。结论:腰椎间盘突出症阶梯式手术治疗方案临床效果和患者心理接受情况均值得临床推荐。     

Liver transplantation in patients with alcoholic cirrhosis: selection criteria and rates of survival and relapse.

OBJECTIVE--To evaluate the outcome of liver transplantation in patients with alcoholic cirrhosis with respect to selection criteria, survival, and evidence suggesting a return to harmful drinking. DESIGN--Nine year retrospective study. SETTING--Cambridge and King''s College Hospital liver transplant programme. SUBJECTS--24 Patients (three women, 21 men) with alcoholic cirrhosis. MAIN OUTCOME MEASURES--Survival, rehabilitation, and clinical and laboratory evidence of a return to harmful drinking after transplantation. RESULTS--15 Patients were selected for transplantation because of repeated admission to hospital for the complications of advanced portal hypertension despite abstinence, and six because they had a hepatocellular carcinoma superimposed on alcoholic cirrhosis. Three patients who were not abstinent received transplants. The one year survival rate was 66%, and of the 18 patients surviving at least three months, 17 had been rehabilitated. In three patients laboratory variables and histological examination of the liver suggested a return to drinking, though they did not admit to taking alcohol. These patients represented the only cases in the series that were not abstinent before transplantation. CONCLUSIONS--The survival and rehabilitation of patients who received transplants for alcoholic cirrhosis compared favourably with those of patients who received transplants for cirrhosis of other aetiology. The criteria for selection for liver transplantation in patients with alcoholic cirrhosis should include recurrent complications related to severe portal hypertension despite maximum medical treatment in addition to a minimum period of six months of abstinence before transplantation.     

National Health Service breast screening programme results for 1991-2.

OBJECTIVES--To report the results of the NHS breast screening programme for the year March 1991 to April 1992. DESIGN--A report of statistics was derived from Körner (K62) returns and from the radiology quality assurance programme. MAIN OUTCOME MEASURES--Detection rates for breast cancer and small (< or = 10 mm diameter) invasive cancer, benign biopsy rates, and recall and acceptance rates. RESULTS--The acceptance rate for screening across the United Kingdom was 71.3%. The referral rate for further investigation was 6.2% (regional 4.3-9.0%). The breast cancer detection rate was 6.2 cancers per 1000 women screened (5.1-9.0) and the detection rate of invasive cancers < or = 10 mm was 1.4/1000 (1.0-2.3). 72% of screening programmes reached the target 70% acceptance rate, and 95% of programmes achieved a recall rate of less than 10%. 75% of programmes had a cancer detection rate of more than 5/1000, but only 32% had a detection rate for invasive cancers < or = 10 mm of more than 1.5/1000. CONCLUSIONS--Overall, the results of the screening programme for the year 1991-2 can be regarded as extremely satisfactory, given the size and complexity of the operation.     

Continuous ethanol production by yeast immobilized on to channeled alumina beads

Vertical and near-horizontal (15° angle) packed-bed columns were compared for continuous ethanol fermentation using an alcohol- and glucose-tolerant Saccharomyces cerevisiae strain immobilized on to channeled alumina beads (5·0 × 10⁹ cells g⁻¹ beads). Spaces between beads (1·0–6·5 mm) and angle (15°) of near-horizontal reactor columns (with six ports in each) efficiently removed CO₂ and increased ethanol productivity. Malt-glucose-yeast-extract broth containing 16·7% glucose at 35°C fed at a dilution rate of 3· h⁻¹ to thw two horizontal columns (in series) yielded maximum ethanol productivity of 40·0 g liter⁻¹ h⁻¹. Feedstock flow rate and other factors (temperature, pH, nutrients, and glucose levels) affected productivities. The immobilized-cell system showed operational stability for >3 months without plugging, and could be stored for at least one year with no loss of bioreactor performance. Scanning electron micrographs of the beads revealed large numbers of yeast-cells attached on to internal and external surfaces of beads.     

Loop diathermy excision of the cervical transformation zone in patients with abnormal cervical smears.

OBJECTIVE--To determine the efficacy and morbidity of fine loop diathermy excision of the cervical transformation zone as applied to the management of outpatients with abnormal cervical smears. DESIGN--Prospective programme trial with six month follow up. SETTING--Two hospital based colposcopy clinics. PATIENTS--616 Patients aged 16-60 with abnormal cervical smears. INTERVENTIONS--After colposcopic and cytological assessment excision of the cervical transformation zone by fine loop diathermy under local anaesthesia in the outpatient department. MAIN OUTCOME MEASURES--Time to complete the treatment, immediate morbidity in terms of discomfort and bleeding, and cytological and colposcopic findings at six months. RESULTS--Treatment was completed in a mean of 3.47 minutes (SD 1.99). Immediate morbidity was minimal, and histological specimens were adequate in over 90% of cases. Almost two thirds of patients were treated at their first visit to the clinic. 58 Patients (9.4%) failed to attend for follow up at six months and one had had a hysterectomy. Of the 557 patients who attended for colposcopic and cytological follow up at six months, 506 (91%) were normal cytologically and 19 (3.4%) had histologically confirmed persistence of cervical intraepithelial neoplasia. The overall confirmed failure rate of the technique was 4.4%. CONCLUSION--Loop diathermy excision is an effective treatment with low morbidity and is an appropriate modality for patients with abnormal cervical smears.     

Home based care and standard hospital care for patients with severe mental illness: a randomised controlled trial.

OBJECTIVE--To compare the efficacy of home based care with standard hospital care in treating serious mental illness. DESIGN--Randomised controlled trial. SETTING--South Southwark, London. PATIENTS--189 patients aged 18-64 living in catchment area. 92 were randomised to home based care (daily living programme) and 97 to standard hospital care. At three months'' follow up 68 home care and 60 hospital patients were evaluated. MAIN OUTCOME MEASURES--Use of hospital beds, psychiatric diagnosis, social functioning, patients'' and relatives'' satisfaction, and activity of daily living programme staff. RESULTS--Home care reduced hospital stay by 80% (median stay six days in home care group, 53 days in hospital group) and did not increase the number of admissions compared with hospital care. On clinical and social outcome there was a non-significant trend in favour of home care, but both groups showed big improvements. On the global adjustment scale home care patients improved by 26.8 points and the hospital group by 21.6 points (difference 5.2; 95% confidence interval -1.5 to 12). Other rating scales showed similar trends. Home care patients required a wide range of support in areas such as housing, finance, and work. Only three patients dropped out from the programme. CONCLUSIONS--Home based care may offer some slight advantages over hospital based care for patients with serious mental illness and their relatives. The care is intensive, but the low drop out rate suggests appreciation. Changes to traditional training for mental health workers are required.     

Heart rate as an indicator of metabolic rate and activity in adult Atlantic salmon, Salmo salar

Telemetered heart rate (f_H) was examined as an indicator of activity and oxygen consumption rate (VO₂) in adult, cultivated, Atlantic salmon, Salmo salar L. Heart rate was measured during sustained swimming in a flume for six fish at 10° C [mean weight, 1114 g; mean fork length (f. l.), 50·6 cm] and seven fish at 15° C (mean weight, 1119 g; mean f. l., 50·7 cm) at speeds of up to 2·2 body lengths/s. Semi–logarithmic relationships between heart rate and swimming speed were obtained at both temperatures. Spontaneously swimming fish in still water exhibited characteristic heart rate increases associated with activity. Heart rate and Vo₂ were monitored simultaneously in a 575–1 circular respirometer for six fish (three male, three female) at 4° C (mean weight, 1804 g; mean F. L., 62· cm) and six fish (three male, three female) at 10° C (mean weight, 2045 g; mean f. l., 63·2 cm) during spontaneous but unquantified activity. Linear regressions were obtained by transforming data for both f_H and Vo₂ to log values. At each temperature, slopes of the regressions between f_H and Vo₂ for individual fishes were not significantly different, but in some cases elevations were. All differences in elevation were between male and female fish. There were no significant differences in regression slope or elevation for fish of the same sex at the two temperatures and so regressions were calculated for the sexes, pooling data from 4 and 10° C. There was no significant difference in the mean ± S. D. Vo₂ between the sexes at 4° C (male, 66·0 ± 59·6 mgO₂ kg^?1 h^?1; female, 88·0 ± 60·1 mgO₂ kg^?1 h^?1) or 10° C (male, 166·2 ± 115·4 mgO₂ kg^?1 h^?1; female, 169·2 ± 111–1 mgO₂ kg^?1h^?1). Resting Vo₂ (x?± s. d.) at 4°C was 36·7 ± 8.4 mgO₂ kg^?1 h^?1, and 10° C was 72·8 ± 11·9 mgO₂ kg^?1 h^?1. Maximum Vo₂ (x?± S. D.) at 4° C was 250·6 ± 40·2 mgO₂ kg^?1 h^?1, and at 10° C was 423·6 ± 25·2 mgO₂ kg^?1 h^?1. Heart rate appears to be a useful indicator of metabolic rate over the temperature range examined, for the cultivated fish studied, but it is possible that the relationship for wild fish may differ.     

Successful rehabilitation in conversion paralysis.

A rehabilitation programme for patients with conversion paralysis has been introduced in which they are offered physical rehabilitation. During an eight month period between October 1984 and May 1985 six patients who had been diagnosed as dependent on wheelchairs owing to conversion paralysis for a mean of 3 years (range 1-6 years) were entered into the inpatient neurorehabilitation programme. All six patients were able to walk within a mean of 41 days (range 10-70 days), and then relinquished a variety of aids and allowances as a result of their regained mobility. They continued to be independent at outpatient review for a mean of 10 months (range 8-15 months). Successful rehabilitation from wheelchair dependency can be achieved by a cost effective, prolonged, inpatient neurorehabilitation programme.     

Growth and maturation of the redlip parrotfish Scarus rubroviolaceus

This study presents age‐based life‐history information for the red lip parrotfish Scarus rubroviolaceus based on a 5 year sampling programme from the commercial fishery of American Samoa. Females reached sexual maturity at 31·9 cm fork length (L_F) and 2·6 years and sex change occurred at 42·3 cm L_F, although not all females change sex through their ontogeny. The maximum observed age was 14 years and c. 65% of the fishery harvest was above the median L_F at sex change.     

Atlantic sturgeon Acipenser oxyrinchus surfacing behaviour

Atlantic sturgeon Acipenser oxyrinchus surfacing behaviour was investigated in Minas Basin (45° 20′ N; 64° 00′ W) and the Bay of Fundy with pop‐up satellite archival tags (MiniPAT) measuring physical variables (pressure, temperature, light ) . Of six tags deployed during June and July, five provided pop‐up locations and two were recovered after c. 4 months. Analysis of recovered archival data revealed that the frequency of surfacing events was highest (78·9%) when A. oxyrinchus were in Minas Basin at depths <10 m. Surfacing frequency decreased substantially when fish migrated into greater depths of the Bay of Fundy (>40 m). The tidal cycle in Minas Basin had a significant relationship to surfacing frequency, with the most surfacing events (49·5%) occurring on the flood tide, from mid‐ to high‐tide. Surfacing events ranged from 0–12 a day and the maximum number occurred between 2300 and 0300 hours. Maximum surfacing ascent speeds ranged from 0·50 to 4·17 m s^?1 and maximum descent speeds ranged from 0·17 to 3·17 m s^?1. Buoyancy control, by gulping air to inflate the gas bladder, is proposed as the main reason for surfacing behaviour in A. oxyrinchus.     

Empirically derived maximal acceptable wait time for surgery to treat adolescent idiopathic scoliosis

Background

Prioritizing patients using empirically derived access targets can help to ensure high-quality care. Adolescent scoliosis can worsen while patients wait for treatment, increasing the risk of adverse events. Our objective was to determine an empirically derived access target for scoliosis surgery and to compare this with consensus-based targets

Methods

Two-hundred sixteen sequential patients receiving surgery for adolescent idiopathic scoliosis were included in the study. The main outcome was need for additional surgery. Logistic regression modeling was used to evaluate the relation between surgical wait times and adverse events and χ² analysis was used as the primary analysis for the main outcome.

Results

Of the 88 patients who waited longer than six months for surgery, 13 (14.8%) needed additional surgery due to progression of curvature versus 1.6% (2 of 128 patients) who waited less than six months for surgery (χ² analysis, p = 0.0001). Patients who waited longer than six months for surgery had greater progression of curvature, longer surgeries and longer stays in hospital. These patients also had less surgical correction than patients who waited less than six months for surgery (Wilcoxon–Mann–Whitney test, p = 0.011). All patients requiring additional surgeries waited longer than three months for their initial surgery. A receiver–operator characteristic curve also suggested a three-month wait as an access target. The adjusted odds ratio for an adverse event for each additional 90 days of waiting from time of consent was 1.81 (95% confidence interval 1.34–2.44). The adjusted odds ratio increased with skeletal immaturity and with the size of the spinal curvature at the time of consent.

Interpretation

A prolonged wait for surgery increased the risk of additional surgical procedures and other adverse events. An empirically derived access target of three months for surgery to treat adolescent idiopathic scoliosis could potentially eliminate the need for additional surgery by reducing progression of curvature. This is a shorter access target than the six months determined by expert consensus.Adolescent idiopathic scoliosis effects just over 2% of females aged 12–14 years.^1–3 Although only 10% of patients require surgery, spinal instrumentation and fusion for adolescent idiopathic scoliosis is the most common procedure done in pediatric orthopaedics.⁴ Patients who wait too long for scoliosis surgery may require additional surgery such as anterior release to achieve satisfactory correction of the spinal curvature. These patients may also need longer surgeries and may be at increased risk of complications such as increased blood loss, neurologic deficits or inadequate correction of the curvature.^5–14 Furthermore, as seen in other studies of wait times, patients and families can feel anxiety and prolonged suffering while waiting for treatment, which can negatively impact the quality of care.^15–19 Programs such as the Canadian Pediatric Surgical Wait Times Project have determined a maximal acceptable wait time for adolescent scoliosis through expert consensus (similar to how other surgical wait time targets have been determined).²⁰ Surprisingly, there has been little or no attention given to developing evidence-based access targets or maximal acceptable wait times for most treatments.²¹ The purpose of this study was to determine the maximal acceptable wait time for surgical correction of adolescent idiopathic scoliosis using an empirically based approach to minimize the possibility of adverse events related to progression of curvature.     

Treatment of thin stillage by Aspergillus oryzae and its effect on alcoholic fermentation in syrup liquid

The microbial degradation of thin stillage for environment-friendly treatment has been studied extensively in recent years, and useful compounds in the treated-thin stillage are expected to be utilized in the subsequent fermentation. In this study, an Aspergillus oryzae H18, suitable for growing in thin stillage, was isolated from soil and served to degrade the organic matter in thin stillage, with the increase in pH (from 3·75 to 4·8) and decrease in chemical oxygen demand (COD, 81·3% removal rate). The effect of thin stillage as backset water after degradation of the strain H18 on alcohol production in syrup liquid was investigated. Compared with zero addition of thin stillage, the alcohol yield in mixed syrup liquid increased by 8·6% when the concentration of treated-thin stillage was 20%. After the addition of nutrients at proper concentration (0·5% urea, 1% molasses, 0·25% NaCl, 0·2% NaH₂PO₄, 0·3% MgSO₄ and 0·25% CaCl₂) in thin stillage, the alcohol yield in yeast fermentation was increased by 32·7% when mixed syrup liquid (with 40% thin stillage treated by H18) was employed, in comparison to control group without thin stillage addition. Meanwhile, the fermentation time was shortened, and alcohol production rate was enhanced.     

An association between a lymphocyte antigen in sheep and the response to vaccination against the parasite Trichostrongylus colubriformis

Lymphocyte antigens were tested in sheep which had been selected for responsiveness to vaccination against the intestinal nematode Trichostrongylus colubriformis. These sheep had been bred in an assortative mating programme which produced offspring designated as either “high responders” or “low responders”, with highly heritable resistance or susceptibility.Ovine lymphocyte antigen (OLA) typing antisera were obtained from parous ewes in the course of matings which produced the high and low responder flocks. A particular antigen (SY1) was found to be present in high frequency on the lymphocytes of high responder (72·2%) and in lower frequency (21·9%) on the lymphocytes of low responder rams. In ewes, the frequency for high responders was 65·7% and for low responders it was 33·5%. A similar association between the SY1 antigen and low faecal egg count was found in random-bred sheep which had been vaccinated with irradiated larvae and challenged with normal larvae. The conclusion was drawn that this lymphocyte antigen was likely to be part of the sheep major histocompatibility complex which influenced the immune response of sheep to vaccination against the parasite.     

Evaluation of a patient education manual.

A randomised controlled trial has shown that introducing a health education booklet describing the management of six common symptoms resulted in fewer consultations for the symptoms described by families receiving this booklet compared with a control group. A sample of the mothers in each group was subsequently followed up by an interview, at which a questionnaire was administered. This was designed to measure the mother''s knowledge of the management of the symptoms described. The booklet did not lead to any increase in knowledge in the mothers receiving it. The questionnaire did, however, show that 76% of the mother had consulted the booklet at some time in the year of the study and 28% had consulted it in the three months before interview. The important result was a fall in the new request for care for the symptoms described in the booklet. This may be interpreted as indicating that what patients need to respond appropriately to common symptoms of illness is a simple reference manual rather than an educational programme designed to increase their knowledge about the management of illness.