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Objective: Evaluation of the impact on diet of the school fruit and vegetable scheme (SFVS). Design: Non-randomised controlled trial. Setting: Infant and primary schools in the north of England. Participants: 3703 children aged four to six years (reception, year 1, and year 2). Intervention: One portion of fruit or vegetable provided per child on each school day between February and December 2004. Main outcome measures: Fruit and vegetables consumed and intake of nutrients. Results: The SFVS was associated with an increase in fruit intake across reception and year 1 pupils of 0.4 portions (95% confidence interval, 0.2 to 0.5) and 0.6 portions (0.4 to 0.9), respectively, at three months, which fell to 0.2 (0.1 to 0.4) and 0.3 (0.1 to 0.6) at seven months. In year 2 it was associated with an increase of 0.5 portions (0.2 to 0.7) of fruit at three months, which fell to baseline values at seven months when these children were no longer eligible for the scheme. Overall, at seven months there were no changes in vegetable consumption, no associations between the SFVS and energy, fat, or salt intake, and small changes in carotene and vitamin C intake. Conclusions: The SFVS promoted an increase in fruit intake after three months. At seven months the effect remained significant but reduced, and it returned to baseline in year 2 when pupils were no longer part of the scheme. There was a small impact on the intake of some nutrients across the children surveyed. [ABSTRACT FROM AUTHOR]

This paper compares the socio-demographic characteristics of patients with gonorrhoea with a control group of other attendees to an inner-London genitourinary medicine (GUM) clinic. Between 16 May and 21 December 1994 inclusive there were 312 culture-confirmed heterosexually-acquired cases of Neisseria gonorrheae treated in our clinic: 192 (61.54%) men and 120 (38.46%) women. There were significant differences between the population of cases and controls. Both male (z = -5.36, P < 0.001) and female (z = -6.6, P < 0.001) cases were younger than controls. Cases were more likely to be black African-Caribbean than were controls and these differences were more marked in men (chi 2 = 47.85, P < 0.001). Cases were also more likely to reside in south London postal districts than were controls (chi 2 = 24.98, P < 0.001). The implications of these findings for targeted health interventions are discussed and we suggest avenues for further work. [ABSTRACT FROM AUTHOR]

The article discusses a study on fosfomycin susceptibility in extended-spectrum β-lactamase (ESBL)-producing Escherichia coli with resistance to third-generation cephalosporins conducted in Nottingham, England from September to December 2009. The disadvantages of using mecillinam to treat community-acquired urinary tract infection (UTI) in elderly patients are cited. It is concluded that fosfomycin is an effective oral option because of the low rate of resistance to fosfomycin among E. coli.

Background: There is a lack of validated tools to assess potential disease progression and hospitalisation decisions in patients presenting to the emergency department (ED) with a suspected infection. This study aimed to identify suitable blood biomarkers (MR-proADM, PCT, lactate and CRP) or clinical scores (SIRS, SOFA, qSOFA, NEWS and CRB-65) to fulfil this unmet clinical need., Methods: An observational derivation patient cohort validated by an independent secondary analysis across nine EDs. Logistic and Cox regression, area under the receiver operating characteristic (AUROC) and Kaplan-Meier curves were used to assess performance. Disease progression was identified using a composite endpoint of 28-day mortality, ICU admission and hospitalisation > 10 days., Results: One thousand one hundred seventy-five derivation and 896 validation patients were analysed with respective 28-day mortality rates of 7.1% and 5.0%, and hospitalisation rates of 77.9% and 76.2%. MR-proADM showed greatest accuracy in predicting 28-day mortality and hospitalisation requirement across both cohorts. Patient subgroups with high MR-proADM concentrations (≥ 1.54 nmol/L) and low biomarker (PCT < 0.25 ng/mL, lactate < 2.0 mmol/L or CRP < 67 mg/L) or clinical score (SOFA < 2 points, qSOFA < 2 points, NEWS < 4 points or CRB-65 < 2 points) values were characterised by a significantly longer length of hospitalisation (p < 0.001), rate of ICU admission (p < 0.001), elevated mortality risk (e.g. SOFA, qSOFA and NEWS HR [95%CI], 45.5 [10.0-207.6], 23.4 [11.1-49.3] and 32.6 [9.4-113.6], respectively) and a greater number of disease progression events (p < 0.001), compared to similar subgroups with low MR-proADM concentrations (< 1.54 nmol/L). Increased out-patient treatment across both cohorts could be facilitated using a derivation-derived MR-proADM cut-off of < 0.87 nmol/L (15.0% and 16.6%), with decreased readmission rates and no mortalities., Conclusions: In patients presenting to the ED with a suspected infection, the blood biomarker MR-proADM could most accurately identify the likelihood of further disease progression. Incorporation into an early sepsis management protocol may therefore aid rapid decision-making in order to either initiate, escalate or intensify early treatment strategies, or identify patients suitable for safe out-patient treatment.

Early detection of long term conditions is predicated on assumptions that lifestyle changes and medications can be used to reduce or manage the risk of condition progression. However, ambiguity remains about the nature and place of diagnostic disclosure to people in newly recognised or asymptomatic 'pre' conditions such as early stage chronic kidney disease (CKD). The disclosure of a diagnosis is relevant to instigating strategies which rely on actively engaging patients as self-managers of their own care. Whilst primary care routinely records a diagnosis of early stage CKD, little is known about how patients learn about the fact that they have CKD or how they respond to this. This study aimed to explore patients' experiences of disclosure of CKD in primary care settings. A nested qualitative study of participants recruited to a trial of an intervention for CKD patients in Greater Manchester, UK was undertaken. A purposive sample of 26 patients, with a mean age of 72 years (range 59-89, median 71), were interviewed during 2012. Interview transcripts were analysed using constant comparative techniques. Narrative accounts reflected limited or partial disclosure of CKD; often cast in vague terms as "nothing to worry about". How patients described themselves in terms of participation and their tendencies towards 'active' or 'passive' involvement in consultations emerged as important components of narratives around disclosure. The findings illuminate the ways in which diagnosis is oriented in a context where it is possible to meet the requirements for remuneration under a pay for performance system of primary care, whilst apparently not disclosing a label or a diagnosis to patients. This challenges the presumptions inherent in wider health policy objectives that are increasingly built on the notion of responsible patients and the ethos of the active support of self-management for pre-conditions., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Two cases of severe falciparum malaria contracted in the United Kingdom occurred in residents of Sussex, living 10 and 15 km from Gatwick airport. One patient was the landlord of a public house much frequented by aircrew, and the other was the wife of a worker at the airport, who travelled close to the public house on the probable date she contracted her infection. Transmission was most probably due to the bite of an infected imported tropical anopheline mosquito transported in a vehicle from the aircraft to the site of transmission during the very hot and humid weather of July 1983. Prevention of further cases depends on increased diligence in "blocks-away" destruction of insects in aircraft flying from endemic areas, but there is a need for more study of acceptable alternative ways of delivering the insecticide. This "airport malaria" is well recognised on the continent, and physicians should be aware of its existence in those who have not travelled abroad but live or work near international airports.

A multiple-choice questionnaire was completed by 100 parents of children attending ear, nose and throat out-patients to assess their ENT knowledge. This highlighted areas of poor understanding, and was followed by the production of information leaflets and a pictorial display.

The mortality experience of 5971 members of the British Diabetic Association (BDA) was followed-up for between five and eight years to mid-1973. Overall, 1207 deaths occurred compared with 778 expected from the mortality of the population of England and Wales in 1972. This excess of deaths was due almost entirely to diabetes mellitus and ischaemic heart disease. Deaths from cancer (128) were significantly fewer than expected (168), mainly because of a deficit in the number of deaths from cancers related to smoking (cancers of the buccal cavity and pharynx, oesophagus, respiratory system, and bladder). There was also a lower than expected mortality from chronic bronchitis and emphysema. Data on saccharin consumption by BDA members showed that more than half of them used saccharin tablets daily, with an overall daily intake of three to six tablets, depending on age and sex. Information on a small sample of survivors from the mortality study suggested that about 23% of them would have taken saccharin daily for 10 years or more and 10% for 25 years or more by the end of the follow-up. It was concluded that these relatively high levels of saccharin intake had not increased the risk of cancer in general among BDA members.

Information from 422 cases of child mistreatment in Toronto was gathered from the files of a child welfare agency and a children's hospital. These data were compared to patterns reported in previous studies and clinical writings on child mistreatment to investigate similarities and differences in families whose children have been abused in Canada, England, and the United States. Findings from the present study were similar to others in many respects. The differences were primarily in the area of lower incidences of such problems as perinatal difficulties in the children and intellectual limitations and social isolation in the parents; however, there was a higher incidence of single-parent families. The results suggest that clinicians should bear in mind that child mistreatment cannot be ruled out on the grounds that no serious problems have been noted for the child or the family.

The use of recognised carcinogens in the rubber industry before 1950 led to the introduction of screening progammes offering urinary cytology to workers who had been exposed. Publicity given to the introduction of these programmes and to individual claims for compensation have increased medical practitioners' awareness of a relationship between work and the industry and the subsequent development of bladder cancer. In this study 27 rubber workers and 88 controls registered in 1966 and 1967 with bladder cancer have been followed. A comparison of their death-rates and of the relative frequency of bladder cancer recorded on the death certificates should indicate whether cytological screening or doctors' awareness might explain a recent rise in the bladder-cancer death-rate in this industry. Since the proportions of rubber workers and controls who died before 1976 were similar (74% and 73% respectively) and bladder cancer was mentioned with similar frequence on their death certificates (80% and 83% respectively) neither screening nor doctor's awareness would appear to have an important influence.

The lognormal parametric statistical model can provide, for groups of carcinoma cervix patients, good estimates of long-term survival fractions several years earlier than would otherwise be possible. The present paper extends this model work to head and neck cancer by using a minimum chi-squared test for goodness of fit (P greater than 0-05), to study the distribution of survival times of patients who died with their cancer present. Some 12,000 case histories were available from 7 hospital registries, 4 regional cancer registries and one national registry (the OPCS). All histories were followed up for at least 10 years subsequent to treatment and could be grouped into one of 8 cancer sites: antrum, floor of mouth, larynx, nasopharynx, pyriform fossa, post cricoid, tonsil and tongue. The theoretical distributions investigated were the lognormal, negative exponential and skew exponential. The results showed that the lognormal provided the best overall fit to the data, although the range of optimum values for the lognormal parameter, S, differed with cancer site. The optimum range did, however, usually include the value S=0-45. These results will now permit the second stage of validation of the lognormal model to proceed for head and neck cancers.

It has been suggested in a number of recent reports that there is a possible relationship between parental occupation and malignant disease in children. A proportional mortality analysis relating deaths among children in England and Wales in 1959-63 and 1970-72 to occupation of father as stated on the child's death certificate has not shown any convincing evidence for such associations. Earlier papers published on the subject are reviewed. Although there is some slight evidence for associations between childhood tumours and certain parental occupations there is little consistency between the results reported by different authors. A previously reported association between higher social class and deaths from neoplasms was found also in this study. The explanation for this finding is unknown, and it remains possible that it is an artefact.

711 women were identified who in 1939 were married to men who died with cancer of the penis in England and Wales during the period 1964 to 1973. The records of women were traced through the National Health Service Central Register and, by January 1975, 378 (53%) were found to have died. Expected numbers of deaths from all causes, all cancers and from some specific cancers were calculated assuming the women to have the same mortality rates as the general population of England and Wales. The total number of deaths (378) was close to the number expected (366-8) but there was a slight excess of deaths from cancer (89 against 76.5 expected). Of the individual sites examined only cancer of the cervix showed a statistically significant excess (11 deaths against 3.9 expected, P = 0.002). This finding is similar to those reported in two other studies of the wives of men with cancer of the penis. On the basis of these studies it is suggested that some cases of cancer of the cervix and cancer of the penis may have a common aetiology. Other epidemiological characteristics of the two diseases do not show a marked similarity.