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Loss of arm function is a common problem after stroke. Robot-assisted training might improve arm function and activities of daily living. We compared the clinical effectiveness of robot-assisted training using the MIT-Manus robotic gym with an enhanced upper limb therapy (EULT) programme based on repetitive functional task practice and with usual care.

Abstract Objective To evaluate the effectiveness of combinations of three methods to promote physical activity. Design Randomised controlled trial. Baseline assessment with post-intervention follow up at 12 weeks and 1 [...]

Recent epidemiological and clinical research is changing our thinking on primary biliary cirrhosis, a chronic cholestatic liver disease probably of autoimmune origin. Until the early 1970s primary biliary cirrhosis was [...]

BackgroundHigh blood pressure (BP) during acute stroke is associated with poorer stroke outcome. Trials of treatments to lower BP have not resulted in improved outcome, but this may be because treatment commenced too late. Emergency medical service staff (paramedics) are uniquely placed to administer early treatment; however, experience of prehospital randomised controlled trials (RCTs) is very limited.MethodsWe conducted a pilot RCT to determine the feasibility of a definitive prehospital BP-lowering RCT in acute stroke. Paramedics were trained to identify, consent and deliver a first dose of lisinopril or placebo to adults with suspected stroke and hypertension while responding to the emergency call. Further treatment continued in hospital. Study eligibility, recruitment rate, completeness of receipt of study medication and clinical data (eg, BP) were collected to inform the design of a definitive RCT.ResultsIn 14 months, 14 participants (median age=73 years, median National Institute of Health Stroke Scale=4) were recruited and received the prehospital dose of medication. Median time from stroke onset (as assessed by paramedic) to treatment was 70 min. Four participants completed 7 days of study treatment. Of ambulance transported suspected stroke patients, 1% were both study eligible and attended by a PIL-FAST paramedic.ConclusionsIt is possible to conduct a paramedic initiated double-blind RCT of a treatment for acute stroke. However, to perform a definitive RCT in a reasonable timescale, a large number of trained paramedics across several ambulance services would be needed to recruit the number of patients likely to be required.Clinical trial registrationhttp://www.clinicaltrials.gov. Unique identifier: NCT01066572.

Research on the potential impact of air pollution on the health of adults and children has grown rapidly over the last decade. Recent studies have suggested that air pollution could also be associated with adverse effects on the developing fetus. This systematic review evaluates the current level of epidemiologic evidence on the association between ambient particulate air pollution and fetal health outcomes. We also suggest further research questions.

Recurrent throat problems in children are common and have an impact on the family. The appropriateness of surgery will depend on both clinical and social factors.

We conducted a study to assess the association between the acute respiratory health of children and the levels of particulates in communities near and away from active opencast coal mines. The study enrolled children aged 1–11 years from the general population of five socioeconomically matched pairs of nonurban communities in northern England. Diaries of respiratory events were collected for 1405 children, and information was collected on the consultations of 2442 children with family/general practitioners over the 6-week study periods during 1996–1997, with concurrent monitoring of particulate levels. The associations found between daily PM10levels and respiratory symptoms were frequently small and positive and sometimes varied between communities. The magnitude of these associations were in line with those from previous studies, even though daily particulate levels were low, and the children were drawn from the general population, rather than from the population with respiratory problems. The associations among asthma reliever use, consultations with general practitioners, and daily particulate levels were of a similar strength but estimated less precisely. The strength of association between all respiratory health measures and particulate levels was similar in communities near and away from opencast coal mining sites.

Objectives: To investigate the benefit of carotid endarterectomy relative to medical treatment, by comparing the outcome for different groups of patients following transient ischaemic attacks.Methods: A Markov model was used to describe the survival and quality of life of patients treated for a transient ischaemic attack. The benefit is measured in terms of quality adjusted life months (QALMs). The outcome was estimated using a computer simulation with parameters based on published studies on the probability of events following treatment. The benefit of carotid endarterectomy was explored using a baseline set of parameters and a sensitivity analysis.Results: The baseline scenario of a 65-year-old male patient with the model factors set at an intermediate level showed a benefit for surgery of 3 QALMs compared with medical treatment alone. The sensitivity analysis showed that the most favourable combination of factors had a benefit of 13.4 QALMs and the least favourable a loss of 2 QALMs. Of all 128 factor combinations, 79.9% showed a benefit for surgery, 5.5% showed equal benefit, and 15.6% showed a benefit for medical treatment.Conclusions: Computer simulations have the potential for deriving estimates of benefit for different patient groups from the results of clinical trials. Combined with reliable information on costs, the technique could also demonstrate variations in cost-effectiveness for these groups. For patients following a transient ischaemic attack, the results from this simulation and limited cost information suggest that carotid endarterectomy is unlikely to be a cost-effective intervention in the UK for many patient groups despite a reduction in the risk of stroke.

Young people are vulnerable to the effects of alcohol consumption. Adverse effects from alcohol manifest in a range of short-term and long-term physical and psychosocial factors, including neurological issues, cognitive impairment, and risk-taking behaviours. The aim of the SIPS JR-HIGH, a multicentre randomised controlled trial (RCT), is to assess the effectiveness and cost-effectiveness of alcohol screening and brief intervention to reduce risky drinking in young people aged 14–15 years in the English high-school setting.

Logit Modelling: Practical ApplicationsA. Demaris, 1992 Newbury Park, Sage vi + 88 pp., £6.50 ISBN 0 8039 4377 6

Computer‐interactive Data AnalysisA. D. Lunn and D. R. McNeil, 1991 Chichester, Wiley xiv + 374 pp. and 2 diskettes, £45 ISBN 0 471 93114 4

Linear Statistical Models: An Applied Approach2nd edn B. L. Bowerman & R. T. O'Connel, 1990 Boston, MA, PWS‐Kent Publishing Company xvi + 1024 pp., £18·95 ISBN 0 534 91796 8

Logistic Regression: A Self Learning TextD. G. Kleinbaum, 1994 New York, Springer viii + 282 pp., £34.50 ISBN 0 387 94142 8

BackgroundEarly and heavy drinking by young adolescents is linked to intellectual impairment, increased risk of injury, mental health issues, unprotected or regretted sexual experience, violence, and sometimes accidental death. Our aim was to assess the feasibility of delivering brief alcohol intervention in a school setting with adolescents aged 14–15 years; and to examine the acceptability of study measures to staff, young people, and parents, including take-up and follow-up rates.

Statistics: A Spectator SportRichard M. Jaeger, 1990, 2nd edn Newbury Park, CA, Sage xii + 402 pp., £15.75 ISBN 0 8039 3421 1

Essential StatisticsD. G. Rees, 1989, 2nd edn London, Chapman and Hall xiv + 251 pp., £9.95 ISBN 0 412 32030 4

Background Given its limited availability, it is worth while to explore the relationship between the non-availability of assisted conception and psychological morbidity among subfertile women, to see if those denied the procedure experience poorer health. Methods A non-randomized group comparison study was carried out in Bradford Health Authority, England. Sixty-six women who had reached the point at which assisted conception was deemed appropriate, but for whom such treatments were not available, were compared with 49 parous women, and 73 newly diagnosed subfertile women.The General Wellbeing Index (GWI) was used to measure their psychological wellbeing. Results Cases and subfertile controls have similar levels of wellbeing, whereas parous controls have significantly higher average levels than cases. This pattern is seen in the simple unadjusted comparison and also when adjustments are made for the distributions of age, life event score and social class. Conclusions Subfertile women experience poorer psychological health than similar parous women. Subfertile women, for whom assisted conception is an appropriate but unavailable treatment option, appear to have similar psychological health to those who are being investigated and treated by other means.