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Objective: To discover the importance of social sources of tobacco to young people as opposed to commercial sources; to describe the peer market for cigarettes in schools and the consequences for young people of their involvement in it. Study design: Cross sectional questionnaire survey, one-to-one interviews, and focus groups. Setting: Seven schools in Birmingham, UK. Subjects: All students in two randomly selected classes from each school completed the questionnaire, and never smokers, occasional smokers, and regular smokers were interviewed. Results: Two thirds of occasional smokers and one quarter of regular smokers obtained cigarettes socially, mostly for free. A few smokers regularly bought their cigarettes from others. Among friendship groups, both smokers and non-smokers were involved in the exchange of cigarettes, often for money, which is a common activity. A few young people use the selling of cigarettes to fund their own smoking. Some young people, smokers and non-smokers, are involved in semi-commercial selling of cigarettes. All school students ore aware of where to purchase cigarettes from non-friends, which is only used "in emergency" because of the high price. One school had a strong punishment policy for students caught with cigarettes. In this school, more people bought singles from the peer market and the price was higher. Conclusions: The passing and selling of cigarettes in school is a common activity, which from the young persons perspective, ensures that all share cross counter purchases. A few people are prepared to use the peer market for monetary gain and it appears to be responsive to external conditions. The peer market might mean that efforts to control illegal sales of cigarettes are not as effective as hoped. INSET: What this paper adds.. [ABSTRACT FROM AUTHOR]

The article investigates the potential value of neonatal BCG vaccination in protecting children against tuberculosis meningitis by researchers from Birmingham, England. A review of previous studies indicate widely ranging suggestions. A meta-analysis performed in 1993 sought to differentiate between different sites of disease and the protective effect of BCG. However, later studies aimed to quantify the efficacy of BCG and the duration of protective immunity produced more substantial results.

Objective: To compare the outcomes of home-based (using the Heart Manual) and centre-based cardiac rehabilitation programmes. Design: Randomised controlled trial and parallel economic evaluation. Setting: Predominantly inner-city, multi-ethnic population in the West Midlands, England. Patients: 525 patients referred to four hospitals for cardiac rehabilitation following myocardial infarction or coronary revascularisation. Interventions: A home-based cardiac rehabilitation programme compared with centre-based programmes. Main outcome measures: Smoking cessation, blood pressure (systolic blood pressure (SBP), diastolic blood pressure (DBP)), total cholesterol (TC) and high-density lipoprotein (HDL)-cholesterol, psychological status (HADS anxiety and depression) and exercise capacity (incremental shuttle walking test, ISWT) measured at 12 months. Health service resource use, quality of life utility and costs were quantified. Results: There were no significant differences in the main outcomes when the home-based was compared with the centre-based programme at 12 months. Adjusted mean difference (95% Cl) for SBP was 1.94 mm Hg (-1.1 to 5.0); DBP 0.42 mm Hg (-1.25 to 2.1); TC 0.1 mmol/l (-0.05 to 0.24); HADS anxiety -0.02 (-0.69 to 0.65); HADS depression -0.35 (-0.95 to 0.25); distance on ISVVT -21.5 m (-48.3 to 5.2). The relative risk of being a smoker in the home arm was 0.90. The cost per patient to the NHS was significantly higher in the home arm at £198, (95% Cl 189 to 208) compared to £157 (95% Cl 139 to 175) in the centre-based arm. However when the patients' cost of travel was included, these differences were no longer significant. Conclusions A home-based cardiac rehabilitation programme does not produce inferior outcomes when compared to traditional centre-based programmes as provided in the United Kingdom. [ABSTRACT FROM AUTHOR]

Objective: To assess the frequency, nature and understanding of abbreviations in medical records. Design: Audit of abbreviation use and meaning in paediatric handover sheets and medical notes compared to two standards, the Trust lntranet Medical Dictionary (TID) and Mosby's Medical Dictionary (MMD). A selection of abbreviations was shown to healthcare professionals to examine interpretation of abbreviations. Setting: Large inner-city district general hospital, Birmingham, UK. Main outcome measures: Frequency, nature and understanding of abbreviations in paediatric medical records. Results: On 25 handover sheets a total of 2286 abbreviations were used, with 221 different abbreviations; the standards recognised 14% (TID) and 20% (MMD) of these abbreviations. In 168 sets of medical notes a total of 3668 abbreviations were used, with 479 different abbreviations; the standards recognised 15% (TID) and 17% (MMDI. Some words were shortened in different forms, for example, normal (N, NI, NAD) and some abbreviations had multiple interpretations that differed from those intended, for example, TOF (tetralogy of Fallot, tracheo-oesophageal fistula). When presented with a selection of abbreviations, paediatric doctors recognized 56-94% and other healthcare professionals recognised 3 1-63%. Conclusion: Abbreviation use was widespread in paediatric note keeping. There was no systematic approach to this and difficulties in interpretation were demonstrated. The use of standardised abbreviations to avoid confusion is suggested. [ABSTRACT FROM AUTHOR]

In the December 2001 issue of the journal "Medical Humanities," a small notice announcing a meeting in the Birmingham, England-based University of Birmingham Medical School was carried out, at which a new body, the Association for Medical Humanities in Great Britain and Ireland, was to be launched. This was a small but important step in the development of the medical humanities as a field of study in these shores, and it took forward the work of a more exploratory body, the Council for Medical Humanities, which the Nuffield Trust had sponsored over the preceding two or three years. That meeting, as subsequently reported, attracted around fifty participants from around Britain, representing many disciplines and levels of seniority within clinical health care as well as academic subjects both from the humanities and from those comprising, or related to, medicine. The association was duly launched as envisaged, and its constitution was established with the remit of promoting the medical humanities in education, health care and research.

This article dwells upon the author's idea of promoting medical humanities in undergraduate medical education. Researcher R. Arnott's experience at the University of Birmingham Medical School, reflects reported medical humanities developments in the undergraduate curriculum, in that they are well received by medical students but with the exception of medical ethics they are virtually all non-core courses. Arnott's disappointment at the slowness of medical humanities' integration into the medical curriculum will be shared, however, by many medical educators in the field. The subsequent coup degrace, however, is either the criticism that medicine is a science and therefore the humanities have no place in medical education, or it is the related criticism that there is no evidence for the effectiveness of the humanities in medical education, or both.