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NEW SCHEDULE EASES CLASSIFICATION

Rheumatologists in Southampton have devised an examination schedule sufficiently reproducible for community epidemiological research into soft tissue musculoskeletal disorders of the neck and upper limb. The lack of an agreed diagnostic classification system has held back previous research into these disorders. The repeatability for eliciting items in a physical examination was assessed and was generally good for each of the specific diagnoses (median κ coefficient of 0.66). The Southampton examination schedule could potentially be used as a diagnostic classification system in the community. (

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R Carter

SLE PHENOTYPE IDENTIFIED

German immunologists have identified a typical clinical and serological phenotype of systemic lupas erythematosus (SLE) that has a high risk of poor outcome. Survival rate of SLE patients has increased in the past 40 years but mortality still remains about three times as high as in relevant controls. White German patients with SLE were followed up from 1985 to 1999 and five year survival was 96.6%. Common reasons for death were cardiovascular (37%) and infectious diseases (29%). The most important risk factors identified for poor outcome are male sex, advancing age, low creatinine clearance, nephritis, heart disease, and CNS disease. Identification of patients with severe outcome of SLE may be aided by these data, leading to the use of optimum therapeutic regimens, including the use of early aggressive immunosuppressive drugs. (

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R Carter

EDUCATION AND EYE CARE IN AUSTRALIA

Undercorrected refractive error is a common condition in older people and has a significant impact on their independence. A population based survey explored several demographic, social and eye related variables associated with the condition and researchers measured visual acuity and checked for refractive errors in 3654 Australians. They found that undercorrected refractive error was present in 814 people, and that factors such as increasing age, hyperopia, social disadvantage, and isolation were associated with a higher prevalence of the condition. The findings suggest the need to target education and eye care services. (

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J Villanueva

GENERALISE WITH CAUTION IN GUIDELINES

Predicting risk for coronary heart disease (CHD) can be useful for healthcare professionals, as well as a source of critical information for individual patients. The Diverse Populations Collaborative Group used data from 16 observational studies to gauge the relation between CHD mortality and age and the four major risk factors. The researchers then examined variations of risk functions in three contexts (ordering risk, magnitude of relative risk, and estimation of absolute risk) and whether there was a common risk function that could predict CHD death among the different samples. They found a quantitative heterogeneity of the risk factor-CHD relation among the population groups. The study shows that expert panels should be careful in generalising from one population to another when making clinical guidelines. (

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J Villanueva

RETINAL CHANGES AND BLOOD PRESSURE

It has been known for some long that retinal microvascular changes are associated with hypertension, but whether these changes reflect current or longstanding raised blood pressure was not clear. A recent study has found that some changes actually reflect blood pressure at the time of retinal photography while others represent cumulative arteriolar damage from longstanding hypertension. Additionally, the results showed that patients with untreated or poorly controlled hypertension are more liable to have retinal microvascular abnormalities. (

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B Morris

SMOKING CESSATION STRATEGIES AGAIN

Smoking rates and attributable illnesses are higher among low income and minority populations. There is strong support for training primary care providers in smoking cessation interventions and implementing the four As (ask, advise, assist, and arrange follow up). Performance rates for ask and advise rose from 30% to 44% after training sessions delivered cessation guidelines and tobacco counselling skill building. There were no significant increases for advise, assist, and arrange. The study also found that implementation of ask and advise tobacco interventions is less likely in obstetrics and gynaecology visits. The authors feel that smoking cessation requires sustained efforts with multiple strategies. (

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S Nayee

NEW GUIDELINES IDENTIFY MORE PATIENTS

Traditionally myocardial infarction (MI) has been defined by a combination of symptoms, raised cardiac enzyme activities, and ECG changes. Recently, the advent of the more sensitive and specific cardiac troponins has led to redefining MI. Researchers tried to compare the two definitions of MI in a sample group of 80 patients admitted for suspected ischemic chest pain and found that more patients were diagnosed with MI using the new criteria compared with the conventional. The authors conclude that adopting the new guidelines will identify twice as many patients with MI than with current clinical practice. (

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B Morris

ELDERLY AMERICANS AT RISK TO CARS AND FALLS

Among Americans aged 65 and older, motor vehicle crashes and falls are the leading cause of injury deaths with significant disparities by sex, race, and ethnicity. US census data were used to calculate the death rates for men and women by race and ethnicity. Motor related deaths for men were 79%–90% higher than for women regardless of race and higher among people of colour (except Asian men) with American Indians faring the worst. Fall related deaths were higher among white men and women and almost twice the rate for all the other races combined. The authors hope that prevention strategies can be better targeted by identifying high risk groups. (

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S Nayee

ASTHMA, WHEEZE, AND ATOPY

A recent paper suggests that the role of atopy in the aetiology of asthma may have been overemphasised. The 1995–6 Health Survey of England asked if subjects had experienced wheezing in the past year and if they were diagnosed asthmatics, while serum IgE and house dust mite specific IgE were also measured. Of those with wheeze and raised house dust mite IgE levels, 41.8% were not diagnosed asthmatics and women and young people are more likely than current smokers to be diagnosed with asthma. The authors suggest that other aetiological factors such as genetics and diet in non-IgE mediated asthma should be considered. (

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S Kochhar

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