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Background: Quantifying subtalar joint kinematics during locomotion is a major challenge but is critical to understanding foot function. The difficulty of modeling the subtalar joint is demonstrated by the plethora of three-dimensional multisegment foot models lacking specific consideration of the subtalar joint. Scientific attempts to develop an adequate method of quantifying subtalar joint kinematics should include investigation of the movement of skin-mounted markers. This study reports on a single-subject investigation into this topic., Methods: Radiopaque markers were attached to the skin overlying the medial and lateral malleoli and the medial and lateral talar heads of a single subject. Frontal, sagittal, and transverse plane radiographs were taken with the foot in the fully pronated and fully supinated positions. Parallax corrected measurements were taken of the displacement of the markers from the bony landmarks. Measurements were also taken of the effect of these displacements on angular calculations., Results: Skin movement at the four anatomical locations was not uniform, with displacements varying from 0.61 to 22.18 mm. Movement of the malleolar markers was found to be less than that of the talar head markers. The distortion of angular measurements caused by movement of the skin markers relative to the bony landmarks was found to be only 1° in the sagittal and transverse planes and 5° in the frontal plane., Conclusions: For this subject, skin-mounted markers could be used to assess subtalar joint motion. Further studies are necessary to investigate the implications of these findings to the wider population.

The NHS community services in my local area are offering free health checks. My invitation letter offered me a choice - I could take the enclosed form to my GP, get another form and go to a phlebotomy clinic, then wait 2 weeks and go back to my GP for the blood test result and the health check; or alternatively, I could go to my local pharmacy, have a blood test and assessment, all in one visit. I thought 'no contest, I am going to the pharmacy for my health check!'

The contribution of Florence Nightingale and Mary Seacole was immense. Their similarities and differences are described in this article.

The author describes the management of depression in older people with visual impairment. The concept of depression is defined, and the main classifications are outlined. The signs and symptoms of depression are presented and approaches to treatment are discussed. The role of the nurse in managing depression in older people with sight loss is discussed.

Background: The considerable variation in subtalar joint structure and function shown by studies indicates the importance of developing a noninvasive in vivo technique for assessing subtalar joint movement. This article reports the in vitro testing of the CODA MPX30, an active infrared marker motion analysis system. This work represents the first stage in the development of a noninvasive in vivo method for measuring subtalar joint motion during walking., Methods: The in vitro repeatability of the CODA MPX30 system's measurements of marker position, simple and intermarker set angles, was tested. Angular orientations of markers representing the position of the talus and the calcaneus were measured using a purpose-designed marker placement model., Results: Marker location measurements were shown to vary by less than 1.0 mm in all of the planes. The measurement of a 90° angle was also found to be repeatable in all of the planes, although measurements made in the yz plane were shown to be consistently inaccurate (mean, 92.47°). Estimation of segmental orientation was found to be repeatable. Estimations of marker set orientations were shown to increase in variability after a coordinate transform was performed (maximum SD, 1.14°)., Conclusions: The CODA MPX30 was shown to produce repeatable estimations of marker position. Levels of variation in segmental orientation estimates were shown to increase subsequent to coordinate transforms. The combination of the CODA MPX30 and an appropriate marker placement model offers the basis of an in vivo measurement strategy of subtalar joint movement, an important development in the understanding of the function of the joint during gait.

The most common diseases encountered by health professionals are those associated with skin disorders. There are thousands of skin diseases, accurate diagnosis of which is critical to appropriate management and patient outcomes. Diseases of the skin are the most common group of occupational health problems that lead to absence from work in the general population. Eczema describes a variety of inflammatory skin disorders; it is a chronic, widespread, non-infective inflammatory condition that causes severe pruritus, erythema and scaling. The condition can impact at any age; generally it occurs during infancy or early childhood. The cause of atopic eczema is complex and not fully understood. This article describes the pathophysiology associated with eczema focusing upon atopic eczema. Signs and symptoms are described; methods of diagnosis and treatment options are outlined. The most up-to-date clinical evidence is used to inform the community nurse. The active involvement of the informed patient in their therapy is critical to success and this is advocated. The role of the nurse is central to enhancing health and wellbeing of people with atopic eczema.

Background: In 2004 an estimated 17.1 million people died from cardiovascular diseases (CVDs) worldwide, representing 29% of all global deaths. According to the American Heart Association, heart disease and stroke are the main cause of death and disability among people with type 2 diabetes. Additional safe and effective approaches are needed for the prevention and management of CVDs which may include nutritional supplements., Objective: To identify the potential of bromelain (a food supplement) on the risk factors associated with CVDs., Search Strategy: An electronic and manual search was conducted during November 2009 to March 2010. The databases searched included: Ovid MEDLINE; All EBM Reviews-Cochrane Database of Systematic Reviews (Cochrane DSR), American College of Physicians (ACP) Journal Club, Database of Abstracts of Reviews of Effects (DARE), Cochrane Central Register of Controlled Trials (CCTR), Cochrane Methodology Register (CMR), Health Technology Assessment (HTA) and National Health Service Economic Evaluation Database (NHSEED); Allied and Complementary Medicine (AMED); British Nursing Index and Archive; EMBASE; Health Management Information Consortium (HMIC); Science Direct and Electronic Thesis Online Services (ETHOS). Only papers in the English language were included., Inclusion Criteria: Randomised controlled trials (RCTs), human studies, animal studies and experimental studies related to bromelain for CVDs., Data Extraction and Analysis: The quality assessment of all the selected studies was conducted by the authors. Data from 3 animal trials and 3 human trials were included in the review. Data collected included: type of trial, drug dosage, duration, outcome measures, characteristics of bromelain used, significance of results and conclusion., Results: Out of 223 papers retrieved, 6 papers met the inclusion criteria and could be included in the review. These comprised of 3 animal and 3 human trials, each of which investigated the use of bromelain for CVDs. Results suggested that bromelain could be used for treating acute thrombophlebitis, as it decreases aggregation of blood platelets, has a cardio-protective effect, ameliorates rejection-induced arterial wall remodelling, prevents thrombin-induced human platelet aggregation as well as reduces thrombus formation., Conclusion: No substantive study of bromelain and clinical CVDs has been carried out in human populations. Only a few studies on bromelain and CVDs were published from 1948 to 2010. This may be an area worthy to be explored in future CVDs research.

Recently I attended an event aimed at raising awareness about the increased risk of stroke among people with sickle cell disease.

The herpes zoster virus is a common neurocutaneous infection. When the eye is involved, the virus is referred to as herpes zoster ophthalmicus. This article discusses the role of the nurse in managing the care of patients with herpes zoster ophthalmicus. It provides an overview of the condition and its associated pathophysiology. The article examines risk factors, clinical features, diagnosis, treatment, complications and prevention. It also discusses the care required to support patients during their treatment and subsequent rehabilitation.

All prisoners should be entitled to the same standards of health care as the general population. This is the principle of equivalence. Inmates who are physically or mentally ill, addicted to substances, or disabled should receive equivalent care to what is expected of the NHS. There are a number of variations and inequalities in the health services that prisoners receive across the UK. A number of prisons have no policies in place for HIV, hepatitis C or sexual health. The prevalence of HIV is significantly higher in the prison population than it is in the wider community. This article considers and outlines the important principle of equivalence and the needs of the prison population in relation to HIV infection and other blood-borne virus infections. Methods used to minimize risk are described and the importance of development, implementation and evaluation of harm minimization strategies are discussed. The term 'prison' in this article is used to identify all places of detention in England and the term 'prisoner' is used to describe all adults who are held in such places. Prison services and healthcare provision in other UK countries are also outlined.

Cancer affects more men than women; evidence shows that men are almost 40%more likely than women to die from cancer (Men's Health Forum, 2009). The three cancers that only affect men are penile, prostate and testicular cancers, with prostate cancer being the most common of all cancers in men. This article provides an overview of the health of men in the UK from a male cancer perspective. It suggests that gender is a significant determinant of health status, and that the nurse must take this into account when providing health services and when planning and devising strategy and policy. There are complexities and inter-relationships between gender and social class, ethnicity, disability, sexuality and age that are associated with male health. Ways in which the challenges faced by men and ways in which men access health services are discussed. Further research is needed to address this important healthcare issue.

Urinary tract infections are a well-known hazard associated with the use of indwelling urethral catheters in older people in hospital. These infections can have serious consequences for older people, including an increased risk of death in hospital. This consequence can be minimised by ensuring that all nurses and other healthcare workers consistently incorporate evidence-based guideline recommendations into their routine practice. The background to these infections is explained and the recommendations for minimising risk and enhancing patient safety are described.

Objective: The purpose of this study was to determine the effect of a new physiotherapy concept on bone density, muscle force and motor function in bilateral spastic cerebral palsy children., Methods: In a retrospective data analysis 78 children were analysed. The concept included whole body vibration, physiotherapy, resistance training and treadmill training. The concept is structured in two in-patient stays and two periods of three months home-based vibration training. Outcome measures were dual-energy x-ray absorption (DXA), Leonardo Tilt Table and a modified Gross Motor Function Measure before and after six months of training., Results: Percent changes were highly significant for bone mineral density, -content, muscle mass and significant for angle of verticalisation, muscle force and modified Gross Motor Function Measure after six months training., Conclusions: The new physiotherapy concept had a significant effect on bone mineral density, muscle force and gross motor function in bilateral spastic cerebral palsy children. This implicates an amelioration in all International Classification of Functioning, Disability and Health levels. The study serves as a basis for future research on evidence based paediatric physiotherapy taking into account developmental implications.

The intra-aortic balloon pump (IABP) is the most widely used cardiac assist device, whose main benefits are augmentation of coronary flow and reduction of left-ventricular afterload. The aim of this study is to investigate the pressure and flow-volume distribution associated with balloon inflation. We hypothesize that in order to displace fluid on both sides of the balloon, a pressure locus must be present along the balloon during inflation. In vitro experiments were performed in two positions, horizontal and angled, using four balloon sizes: 25, 34, 40, and 50 cc. Along and on both sides of each balloon, we measured pressure, flow rate, and calculated flow velocity, volume displacement, wave intensity and energy. A pressure locus was found at the center of each balloon and the average flow volume displaced toward the tip at the horizontal position was about 57% of the balloon volume. In the angled position, the location of the pressure locus was less obvious and average volume displacement toward the top end of the balloon was reduced to 45%. These results confirm the existence of a pressure locus at the center of each of the balloons we tested. Because a clear reduction in flow volume was observed at the angled position, these results may have clinical implications as most patients using IABP in the intensive care units are nursed in semirecumbent position.

The CHO320 cell line, engineered to produce human interferon gamma was investigated with regard to its susceptibility to oxidative stress. Batch cultures of the cells grown in a bench-top bioreactor exhibited no marked response to changes in oxygen concentration between 6% and 14% whereas cell growth and recombinant protein production were inhibited by increasing the oxygen to 20%. High concentrations of hydrogen peroxide (in excess of 200 microM) were required to inhibit growth of the CHO320 cells whereas concentrations of 50 microns and 100 microM had no effect on recombinant protein production. Buthionine sulphoximine (50 microM and 100 microM) completely depleted the cells of glutathione within 24 h; however, no quantitative effect on recombinant protein production was seen. It is concluded that the CHO320 cells are, possibly as a consequence of the long selection process they have undergone, very resistant to oxidative stress.

This study investigates variations in motor neuron disease (MND) mortality rates between the counties of England and Wales from 1981 to 1989, and their relationship with gamma-ray dose rates, indoor radon gas concentrations and enhanced general life expectancy. A strong correlation was confirmed between age-adjusted rates of MND mortality and life expectancy. Weaker, but statistically significant, associations were observed between indoor radon gas concentrations, terrestrial gamma radiation and marginal variations in MND mortality. Life expectancy and radon gas concentrations were positively associated with MND mortality rates whilst gamma radiation was negatively associated. The negative correlation of gamma radiation with MND mortality may be understood with reference to its negative effects on overall population life expectancy. Radon gas concentrations seemingly account for a small elevation in MND mortality, amounting to at most 4% of total deaths. Further research is required to investigate this association.

Mortality rates from motor neuron disease (MND) in Spain were analysed for the years 1960-1989, a period in which 3,530 deaths were recorded from the disease and during which the crude annual mortality rate ranged between 0.35 and 0.95 deaths per 100,000 persons. Whilst the crude mortality rate fell by 54% during the decade 1960-1969, there was a net increase of 26% over the entire period. The influence of three sets of variables-the increasing mean age of the population, changing environmental factors, and changing competition between diseases-upon mortality rates were investigated through Gompertzian analysis of crude and age-adjusted mortality rates. The increased mean age of the population contributed significantly to the overall rise in mortality from MND over the whole period, a feature that has previously been demonstrated to occur in the majority of industrialised countries. The unusual pattern of a decline and subsequent rise in mortality appears to be due to the influence of changing environmental factors on a sub-population susceptible to the disease.

Motor neuron disease (MND) is a progressive and invariably fatal disease affecting the nuclei of the pyramidal tract and anterior horn cells. Despite intensive research into environmental agents associated with the onset or course of the disease, there is no single factor that can be confidently linked over time with regional, national or international variations in mortality rates. However, unusual variations in MND mortality rate in Japan from 1950-1990 were found to correlate highly significantly with variations in radioactive fallout released by atmospheric weapons testing in the Pacific. This association could be explained by the ingestion of alpha-emitting radionuclides acting upon a pre-existing susceptible subpopulation, a hypothesis which is consistent with recent research on the epidemiology and pathology of MND. However, it is likely that radiation is only one of many factors that act singly or in combination to accelerate the condition in subpopulations susceptible to MND.

Nursing plays an influential role in the socialization of disease and illness, that is, how they become integrated within the social context of people living together in the community of human society. Generally, it may be argued that physicians adopt the ideology that disease is fixed within a framework of a medical model, which frequently ignores how an individual feels when sick and what effects the sickness will have on an individual's perception of everyday life. Nurses, on the other hand, adopt a more flexible approach in their care, which is based on recognizing that the body responds dynamically during the experience of sickness. This paper sets out to explore why nursing has evolved with the concept of an illness model as opposed to a disease model, which so often underpins the approach adopted by physicians. Traditionally, the care of the young, sick and infirm was delegated to women and set within the realms of domesticity. Today, as in the past, many aspects of the nursing role involve polluting aspects that result from sickness. These are skillfully, subtly and tactilely managed by nurses in order to protect themselves and create an environment of permission in which the sufferer's sickness is contained and managed. Over the past couple of decades, innovations in nursing have recognized the effects of disease and illness on the individual within their own social context, and attempts have been made through the evolvement of the nursing process to focus on an individual's sickness as a lived-body experience.(ABSTRACT TRUNCATED AT 250 WORDS)

Recent studies of mortality from motor neurone disease (MND) in Sweden have demonstrated rising levels of mortality from the disease, especially amongst older age groups. Case-control investigations have suggested that certain environmental factors are significantly related to variations in mortality from the disease, and are associated with a probable individual susceptibility to MND. This study applies an innovative epidemiological technique to longitudinal and cohort analysis of Swedish mortality from MND during the period 1961 to 1990. Survival modelling shows that a subpopulation susceptible to MND exists in Sweden, as has been demonstrated in other countries. The increased life expectancy of the Swedish population since 1961 has resulted in more of that susceptible population living to the ages at which MND is expressed, explaining the majority of the increase in mortality from the disease. However, environmental factors may play a role in accelerating the course of MND and may affect the timing of death within the susceptible sub-population.

Gompertzian analysis is a statistical technique which has been successfully applied to the analysis of amyotrophic lateral sclerosis (ALS) mortality in England and Wales, Japan and the United States. This paper analyses the consistent trend of rising ALS mortality in France over the years 1968-1990, a period during which crude mortality rose from 400 deaths in 1968 to 950 deaths in 1990. The findings indicate that age-specific mortality rates have risen at ages older than 54 years for men and 53 years for women and decreased slightly at younger ages. The evolving ALS mortality pattern is attributable to changing inter-disease competition resulting from the increased life expectancy of the French population, rather than to changing environmental aetiopathogenic factors or to substantial artefact effects.

Mortality from amyotrophic lateral sclerosis (ALS) in Norway has increased substantially over the last two or three decades, as it has in other Western nations. The reasons for this general increase are not clear, but the rise has been attributed to increasing exposure to a broad range of environmental agents. Our previous research has indicated that another explanation for the substantial rise in ALS mortality is more likely to be valid. In particular, the mortality rate curve for ALS is consistent with deaths being confined to an inherently susceptible subpopulation. The size of susceptible subpopulations and mortality rates within them have been shown to be consistent in England and Wales, Japan and the United States. The same methods have been used to analyse Norwegian mortality data. The analysis demonstrates that the rise in ALS mortality is real and that the cause of the increase is almost entirely attributable to the increasing life expectancy of the Norwegian population. Increased life expectancy, a consequence of decreasing general mortality, allows ALS susceptible individuals to survive to the ages at which ALS is expressed. As in other national populations, it is expected that mortality from the disease will continue to increase with continuing increases in life expectancy.

Gompertzian analyses of mortality data have recently been undertaken for a number of individual conditions (Riggs JE. Mech Ageing Dev 1990; 55: 207-220 [1]; Neilson S et al. Mech Ageing Dev 1992; 64: 201-216 [2]; Neilson S et al. Acta Neurol Scand 1993; 87: 184-191 [3]). Such analyses are in principle of particular epidemiological value in circumstances where demographic change is occurring and where the balance between mortality from different conditions is subject to change. However, the extent to which a Gompertzian relationship between age and mortality holds for particular conditions has been subject to debate. In this analysis it is demonstrated that even some conditions which do not superficially hold to a Gompertz relationship do in fact do so, if such conditions are considered to be restricted to small, inherently susceptible subpopulations. By analysing mortality from a range of neurological conditions within the context of general mortality in England and Wales, conditions with different aetiologies such as Huntington's chorea, amyotrophic lateral sclerosis and multiple sclerosis can be shown to have a Gompertzian mortality rate distribution. Such analyses are of substantial value in indicating how demographic change affects the balance of mortality between conditions, as well as directing interest to revised aetiological possibilities.

Recent studies have demonstrated a worldwide rise in mortality from motor neurone disease (MND). However, in Japan mortality appears to have fallen significantly since the late 1960s, especially amongst women. Studies of the cause of both the worldwide rise, and the unique decline in MND mortality in Japan, have largely failed to substantiate the role of any single factor, or group of factors in these phenomena. Modelling the relationship between age and mortality using gompertzian analysis has already shown that the rise in MND mortality in England and Wales, and the United States, is mainly the result of increased longevity and decreasing competition from other causes of death amongst a susceptible subpopulation. Employing the same techniques on Japanese mortality data from 1950 to 1990 demonstrates that an unusual and accelerated increase of mortality occurred in the 1950s and 1960s, probably caused by an earlier unknown but extremely potent environmental agent or agents. This premature depletion of the susceptible subpopulation resulted subsequently in a lower than expected mortality rate. Mortality is now rising slowly to expected levels as the size of the susceptible subpopulation recovers to reach the ages at which MND is normally expressed. Further substantial rises in mortality are anticipated in future decades.

Amyotrophic lateral sclerosis (ALS), known as motor neurone disease (MND) in Britain, poses special problems in rehabilitation by virtue of its nature, trajectory and the age of patients with the disease. Many practical difficulties of ALS are well known, but there has been little research on the psychological parameters of the disease. This study of 181 ALS patients, from a national register in England and Wales, indicates that, contrary to some previous research, psychological distress (measured by the General Health Questionnaire) is widespread among patients at all stages of the disease. Severity of functional impairment is significantly related to psychological distress, but explains only a small part of the variance. Rehabilitation in relation to ALS must take account of the high incidence of psychological difficulties, as well as the considerable functional problems associated with the disease.

Many conventional epidemiological analyses of the distribution and aetiology of disease employ standardised mortality ratios (SMRs) as a basis upon which to evaluate comparative studies of disease in populations. However SMRs, whilst constructed to control for age and sex, are not capable of incorporating other variables such as life expectancy which has been demonstrated to be of crucial importance in understanding the changing relationships between mortality from different causes. The development of a Gompertz mortality ratio (GMR) and its application to recent mortality from amyotrophic lateral sclerosis (ALS) in the Counties of England and Wales illustrates the value of substituting GMRs for SMRs in the analysis of competitive relationships between conditions, especially those associated with enhanced life expectancy.

Recent advances using somatic cell genetic approaches have provided a convincing body of evidence that the senescence of mammalian cells in culture is controlled by a small group of genes, one or more of which are functionally deleted in the process of immortalization. Microcell-mediated mono-chromosomal transfer methods should permit precise mapping of these genes to specific chromosomal regions. Cloning of senescence genes, using either conventional 'positional cloning' techniques or retroviral insertion mutagenesis, is now a realistic possibility. The leap in our understanding of the molecular genetic events driving the alternative cellular states of limited proliferative capacity and immortality, which such advances should precipitate, will finally permit the question of the role of cell immortalization in cancer to be addressed, and may open the door to the design of new modes of cancer therapy. In addition, the precise mechanism underlying the wide difference in transformability between human and rodent cells, which should also emerge from these investigations, is likely to make a significant contribution towards resolving the key issue of the relevance of rodent tumour induction assays in assessing the potential carcinogenicity of environmental chemicals.

Mortality statistics in amyotrophic lateral sclerosis (ALS), which is more commonly and generally termed motoneurone disease (MND) in the United Kingdom, have been shown to reflect the incidence of previously diagnosed cases of the disease in a more complete way than in other conditions [1,2]. An analysis of changing patterns of mortality may therefore be a particularly appropriate way of tracing the underlying trends in the disease and is in principle a useful way of investigating the relationship between environmental and genetically controlled factors in the genesis of the condition. The majority of analyses so far have concentrated on the crude rise in reported mortality rates evident in recent decades in a number of countries [2-5], on the uneven geographical distribution [6,7] and on the complex range of plausible causes for these reported rises. Debates have centred on whether the increases represent 'real' or 'artifactual' changes, with no apparent resolution of the issue [8,3]. Recently Riggs [9] proposed a novel way of analysing this issue by using a Gompertzian model and provided evidence of the existence of an inherently susceptible subset of the US population. Riggs indicated that while the rise in ALS mortality is real, it is for the most part the result of an increase in the size of this inherently susceptible sub-population due to greater longevity. In order to examine the wider applicability of a Gompertzian model to ALS the technique has been replicated with the mortality rates for England and Wales for the 27-year period from 1963 to 1989. The technique has been developed and extended to produce an estimate of the size of the inherently susceptible sub-population (both male and female) over the entire period.

The incidence of coronary heart disease (CHD) can be reduced by preventive measures. We know what it costs to treat CHD, but lack even the most rudimentary estimates of what it might cost to reduce the incidence by means of population wide strategies of prevention. American and Australian experience shows that such strategies achieve results. Even in Britain, where official spending on prevention is relatively small, health publicity has succeeded in bringing about marked reductions in the household consumption of animal fats and in cigarette smoking. Yet we know virtually nothing about the cost of bringing about a given reduction in CHD mortality by preventive measures. Estimates of such costs would be useful in persuading public authorities to spend more on prevention.

Confidentiality has been argued to be a cornerstone both of medical and social research encounters, particularly because of the protection it offers for patients and informants. In practice the idea of confidentiality is fractured. Professional interests in the organisation of medical work, and concerns for the collective interest amongst social researchers may lead to individual confidentiality being undermined. In addition discrepancies in the ethical positions and practices of social researchers and those in biomedicine may produce further problems for the maintenance of confidentiality.

Personal accounts of illness have always proved difficult to analyse. Using the distinction between personal narratives of illness, social careers of sickness and physical courses of disease this paper argues that such narratives provide an important and complementary means of understanding changes in health status. In developing a broad typology of such narratives it is argued that they can be considered as thermatically organised life stories. Personal accounts of the lives of people with multiple sclerosis are subject to narrative analysis, and the value of such perspectives is stressed in giving access to the personal world of illness.

The criteria which may be employed by chronically ill people in their decision about whether to continue with therapy were investigated in the context of a clinical trial of hyperbaric oxygen therapy for multiple sclerosis. An open-ended question about reasons for continuing or discontinuing treatment obtained data from 48 trial participants on completion of the trial and six months later. Physical factors were the most commonly cited reasons for continuing treatment; stabilization of the condition was mentioned as well as improvement. Lack of effectiveness was more commonly given as a reason to stop therapy six months after the trial. Social and practical reasons were also cited as reasons for discontinuing therapy and there was implicit evidence of a high level of social support enabling patients to continue therapy. Most problems appeared to have surfaced by the end of the trial. Epistemological reasons provided rationales for the decisions taken and referred particularly to the time required to make an informed judgement about the effectiveness of treatment. Personal experience and knowledge of the effects of hyperbaric oxygen on others were more significant to the decision than anticipation of the trial's formal results. The participants in the trial were sophisticated and responsible decision-makers even though their judgements would not always have coincided with medical opinion.

Oxygen-derived free radicals have been implicated as contributors to inflammatory disorders and it has been suggested that certain anti-inflammatory drugs act by scavenging free radicals. In this paper we have studied the free radical scavenging activity of two such experimental anti-inflammatory drugs MK-447 and ONO-3144. Using the technique of pulse radiolysis we have been able to obtain rate constants for the reactions of these compounds with specific free radicals including OH and O2-. We have also investigated the antioxidant capacity of these compounds using rat liver microsomal lipid peroxidation systems. It is suggested that this approach yielding quantitative data concerning defined free radical species will lead to a better understanding of the role of radical scavenging in anti-inflammatory activity.

Problems with case ascertainment in epidemiological research on multiple sclerosis (MS) make it necessary to use indirect sources. However, there is a lack of information about the characteristics of cases drawn from different sources and thus little basis on which sampling frames for large scale surveys may be constructed. The characteristics of a population drawn from the membership of Action for Research into Multiple Sclerosis (ARMS) were compared with those of 10 other British MS populations reported between 1980 and 1987. Demographic variables examined were geographical location, nationality, ethnicity, sex ratio and age. Diagnostic status, age at diagnosis and duration since diagnosis were considered together with data on the comparative populations based on date of onset. On all the variables investigated the ARMS population fell close to or within the range shown by the comparative populations. The relative youth of the ARMS population and its bias towards a high proportion of females were differences in keeping with existing knowledge about the membership of mutual support organisations. A population drawn from such an organisation may usefully complement other MS research populations provided that the likely biases in each are understood.

This paper is a review of strategies that patients use to manage their symptoms in chronic conditions, with particular reference to multiple sclerosis. It emphasizes the complex and socially conditioned process through which symptoms come to be recognized and managed by patients. This process is compared and contrasted with that of medical recognition of symptoms. A range of patient-based strategies and their implications is then discussed.

A brief review is presented of the methods of measuring lattice parameters and strain using diffraction techniques. The presence of strain leads to broadening of diffraction maxima, which is normally separable from any broadening caused by size. The special advantages of the convergent beam electron diffraction (CBED) technique is the local nature from which the data are derived. Examples of the use of CBED techniques in measuring lattice parameters and strain are given from studies of precipitation (including misfit measurements) and from investigations of partially recrystallised microstructures. These examples are used to illustrate the advantages and limitations of the CBED technique.

Although the hemodynamic advantages of rate-responsive (RR) pacing are well established, the symptomatic benefits remain controversial and the effects on the quality of life have not been assessed. Sixteen patients with RR pacemakers and a mean age of 56 (range 22-77) years were involved in a double-blind crossover study to assess their exercise capacity (treadmill testing), symptomatology, and quality of life (structured questionnaires). Pacemakers were implanted because of symptomatic heart block or sick sinus syndrome. Ventricular demand pacemakers were randomly programmed into the constant rate (VVI) or RR pacing modes for four-week study periods. All patients exercised longer in the RR mode than in the VVI mode (570 +/- 29 vs. 437 +/- 17 s, p less than 0.001). Statistically significant improvements in "shortness of breath" and "energy during daily activities" as measured by a 10-point scale were reported in the RR pacing mode by the patients and were also observed by their close relatives. Symptoms such as "chest pain" and "palpitations" were not worsened during RR pacing. Nondisease-specific "quality of life" was studied in 11 patients using the Nottingham Health Profile which showed a trend for an improved quality of life in five of the six dimensions of perceived health, although none of the changes were statistically significant. This study suggests that RR pacing should be recommended in selected patients on symptomatic grounds.

Inclusion of subjective measures in clinical trials has raised questions concerning the basis on which their results may be compared with medical findings. Central problems relate to the status of such measures as indicators of 'real' change and to appropriate methods of assessing their significance. These issues were explored in a controlled trial of hyperbaric oxygen therapy (HBO) for multiple sclerosis (MS). Subjective measures were incorporated on the basis of an explicit view of their status vis à vis medical assessments. The General Health Questionnaire (GHQ) and Nottingham Health Profile (NHP) were investigated with respect to their usefulness as indicators of the significance of reported benefit. While neither measure appeared sensitive to the kinds of significance involved, the NHP in particular might have a role in identifying orders of effectiveness which remain untapped by more commonly employed measures of perceived improvement.