A randomised, controlled, triple-blind trial of the efficacy of homeopathic treatment for chronic fatigue syndrome.

OBJECTIVE: There is no management regime for chronic fatigue syndrome (CFS) that has been found to be universally beneficial and no treatment can be considered a "cure". Patients with CFS may use complementary and alternative medicine (CAM). Our aim was to evaluate homeopathic treatment in reducing subjective symptoms of CFS. METHOD: Using a triple-blind design (patient and homeopath blind to group assignment and data analyst blind to group until after initial analyses to reduce the possibility of bias due to data analyst), we randomly assigned patients to homeopathic medicine or identical placebo. One hundred and three patients meeting the Oxford criteria for CFS were recruited from two specialist hospital out patient departments. Patients had monthly consultations with a professional homeopath for 6 months. Main outcome measures were scores on the subscales of the Multidimensional Fatigue Inventory (MFI) and proportions of each group attaining clinically significant improvements on each subscale. Secondary outcome measures were the Fatigue Impact Scale (FIS) and the Functional Limitations Profile (FLP). Ninety-two patients completed treatment in the trial (47 homeopathic treatment, 45 placebo). Eighty-six patients returned fully or partially completed posttreatment outcome measures (41 homeopathic treatment group who completed treatment, 2 homeopathic treatment group who did not complete treatment, 38 placebo group who completed treatment, and 5 placebo group who did not complete treatment). RESULTS: Seventeen of 103 patients withdrew from treatment or were lost to follow-up. Patients in the homeopathic medicine group showed significantly more improvement on the MFI general fatigue subscale (one of the primary outcome measures) and the FLP physical subscale but not on other subscales. Although group differences were not statistically significant on four out of the five MFI subscales (the primary outcome measures), more people in the homeopathic medicine group showed clinically significant improvement. More people in the homeopathic medicine group showed clinical improvement on all primary outcomes (relative risk=2.75, P=.09). CONCLUSIONS: There is weak but equivocal evidence that the effects of homeopathic medicine are superior to placebo. Results also suggest that there may be nonspecific benefits from the homeopathic consultation. Further studies are needed to determine whether these differences hold in larger samples.

United Kingdom and Republic of Ireland renal physicians' experiences of patients undergoing renal transplants abroad: a questionnaire-based cross-sectional survey.

BACKGROUND: Due to ongoing poor availability of organs, increasingly patients from developed countries are reported to be travelling abroad for renal transplants. We aimed to assess the extent and characteristics of this trend across the UK and Republic of Ireland. METHODS: A questionnaire-based cross-sectional survey; 397 renal consultants from 33 hospitals with renal units across the UK and the Republic of Ireland were contacted through email and 62 replied (16%). RESULTS: Fifty-seven out of 62 (93%) renal consultants managed transplant patients, and of these 36/57 (63%) had managed at least one patient who had undergone a transplant abroad. The most popular reason reported for doing this was being on the UK or Republic of Ireland transplant list but seeking a shorter wait. Respondents reported commencement by overseas doctors of appropriate routine post-transplant prophylaxis with the following medications in all cases they had encountered as follows: co-trimoxazole 12%, isoniazid 3%, anti-fungals 0%, and Cytomegalovirus prophylaxis or treatment 0%. Fourty-four percent of renal consultants reported having some prior warning of a patient undergoing a renal transplant abroad. CONCLUSIONS: Renal transplant tourism has become widely established in the UK and the Republic of Ireland, and care for these patients is often suboptimal. Furthermore, the opportunity exists for pre-transplant counselling.

Undergraduate teaching on biological weapons and bioterrorism at medical schools in the UK and the Republic of Ireland: results of a cross-sectional study.

OBJECTIVE: To determine if individual undergraduate schools of medicine in the UK and the Republic of Ireland provide any teaching to medical students about biological weapons, bioterrorism, chemical weapons and weaponised radiation, if they perceive them to be relevant issues and if they figure them in their future plans. DESIGN: A cross-sectional study utilising an internet-based questionnaire sent to key figures responsible for leading on the planning and delivery of undergraduate medical teaching at all schools of medicine in the UK and Ireland. SETTING: All identified undergraduate schools of medicine in the UK and Ireland between August 2012 and December 2012. OUTCOME MEASURES: Numerical data and free text feedback about relevant aspects of undergraduate teaching. RESULTS: Of the 38 medical schools approached, 34 (28 in UK, 6 in Ireland) completed the questionnaire (89.47%). 4 (all in UK) chose not to complete it. 6/34 (17.65%) included some specific teaching on biological weapons and bioterrorism. 7/34 (20.59%) had staff with bioterrorism expertise (mainly in microbiological and syndromic aspects). 4/34 (11.76%) had plans to introduce some specific teaching on bioterrorism. Free text responses revealed that some felt that because key bodies (eg, UK's General Medical Council) did not request teaching on bioterrorism, then it should not be included, while others regarded this field of study as a postgraduate subject and not appropriate for undergraduates, or argued that the curriculum was too congested already. 4/34 (11.76%) included some specific teaching on chemical weapons, and 3/34 (8.82%) on weaponised radiation. CONCLUSIONS: This study provides evidence that at the present time there is little teaching at the undergraduate level in the UK and Ireland on the subjects of biological weapons and bioterrorism, chemical weapons and weaponised radiation and signals that this situation is unlikely to change unless there were to be high-level policy guidance.

Hepatitis B: report of prevalence and access to healthcare among Chinese residents in Sheffield UK.

UNLABELLED: Overall prevalence of hepatitis B (HBV) in the UK is low. However, among migrants from endemic areas, prevalence has been shown to be high. Furthermore, timely diagnosis and/or referral are required prevent serious health consequences through early institution of treatment. METHODS: We identified locations that would be familiar to Chinese members of the community with the objective of facilitating testing. Dried blood spot samples were collected from 229 Chinese subjects and tested for HBV and also for hepatitis C virus (HCV) infection--offering complete chronic viral hepatitis screening. RESULTS: HBsAg was positive in 20/229 (8.7%) participants, (10 F, 10 M). Five women and one man were aware of their condition, but only one man and none of the women were under specialist care. The average length of residence in the UK for positive patients was 15 years (range 2-40). Evidence of HBV past infection, HBcAb(+)/HBsAg(-), was seen in 28/229 participants (12.2%). HCV antibody testing produced negative results in all participants. The methodology of testing was well accepted, 139/144 (95%) responded to a feedback questionnaire declaring no discomfort and 100% finding the information session useful. CONCLUSION: This model of outreach testing is helpful for addressing health inequalities afflicting the UK's Chinese community.

Tolerance to cannabinoid-induced behaviors in mice treated chronically with ethanol.

RATIONALE: Chronic ethanol (EtOH) treatment decreases the motor-impairing effects of cannabinoids and downregulates the cannabinoid type 1 (CB1) receptor. However, these studies have been limited to measures of ataxia and analysis of CB1 expression from whole-brain or hippocampal preparations. OBJECTIVE: To more fully assess the interactions between ethanol and cannabinoids, a tetrad of four well-characterized cannabinoid-induced behaviors (hypolocomotion, antinociception, hypothermia, and catalepsy) was measured in mice following EtOH treatment. Additionally, immunoblotting assessed CB1 protein in tissue from nine brain regions associated with these behaviors and the addiction neurocircuitry. MATERIALS AND METHODS: Male C57Bl/6J mice were administered EtOH (0, 2, or 4 g/kg; intraperitoneally (i.p.)) twice daily for 10 days. Tetrad behaviors induced by the CB1 agonist WIN 55212-2 (3 mg/kg, i.p.) were measured in subjects 1 or 10 days following the last EtOH injection. In a separate group of animals, tissue was collected at the same time points for immunoblot analysis. RESULTS: EtOH-treated mice were less sensitive to the hypothermic, hypolocomotive, and antinociceptive effects of WIN, and this effect reversed to control levels over a 10-day abstinence period. EtOH treatment did not affect WIN-induced catalepsy. CB1 protein expression was significantly altered in several brain areas including the hypothalamus, periaqueductal gray, ventral tegmental area, and cerebellum. CONCLUSIONS: These results show that chronic EtOH treatment significantly affects the behavioral sensitivity to cannabinoid drugs and alters CB1 expression in several brain regions. Furthermore, these effects are selective as some behaviors and brain regions display an altered response while others do not.