An evaluation of clinical governance in the public health departments of the West Midlands Region.

STUDY OBJECTIVES: (1) To evaluate the development of clinical governance within public health departments. (2) To assess two models for examining clinical governance in public health departments. DESIGN: Semi-structured interviews carried out during the annual visits of the regional director of public health to the health authority public health departments. SETTING: West Midland Region, England. PARTICIPANTS: Directors of public health plus other members of public health departments. MAIN RESULTS: These visits demonstrated that there is already a substantial amount of clinical governance activity taking place in the region's public health departments. There was also a need to reclassify many routinely occurring activities and include them under the clinical governance heading. CONCLUSIONS: The two models both proved useful for examining clinical governance in public health departments, however combining them into a matrix provided the best results. This matrix will still be useful after the reorganisation of the NHS and could be used to assess any public health department in the world. The West Midland public health departments find the visits valuable as they provide a source of external peer review of their activities. The public health departments have ownership of the process.

Improving physical self-perception in adolescent boys from disadvantaged schools: psychological outcomes from the Physical Activity Leaders randomized controlled trial.

OBJECTIVES: To evaluate the effect of a school-based obesity prevention programme on physical self-perception and key physical-activity related cognitions in adolescent boys from disadvantaged secondary schools. A secondary objective was to determine if any psychological changes were associated with improved weight status. METHODS: Participants (n = 100, age = 14.3[0.6]) were randomized to the PALS (Physical Activity Leaders) intervention (n = 50) or a control group (n = 50) and assessed at baseline, 3- and 6-month follow up. Measures included BMI, BMI z-score and % body fat (bioelectrical impedance analysis). Students also completed the Children's Physical Self-Perception Profile and a physical activity-related cognitions questionnaire. The findings include secondary data analyses. RESULTS: Relative to the controls, the PALS group significantly increased their physical self worth (p = .01), perceived physical condition (p = .02), resistance training self efficacy (p < .001) and their use of physical activity behavioural strategies (p = .02). CONCLUSIONS: A school-based obesity prevention programme that targeted leadership skills improved psychological health in the physical domain in adolescent boys from disadvantaged schools.

Mast cell production of IL-4 and TNF may be required for protective and pathological responses in gastrointestinal helminth infection.

Expulsion of the gastrointestinal nematode Trichinella spiralis is associated with Th2 responses and intestinal inflammation, which correlate with a marked mast cell (MC) response. To address the role of MC-derived cytokines in the induction of protective responses, WBB6F1-KitW/KitW-v (W/W(v)) mice were reconstituted with wild-type, tumor necrosis factor (TNF)-alpha(-/-), or interleukin (IL)-4(-/-) bone marrow (BM) prior to infection with T. spiralis. W/W(v) mice reconstituted with TNF-alpha(-/-) or IL-4(-/-) BM expelled the parasite less efficiently and showed diminished enteropathy, whereas protective responses were normal in W/W(v) mice reconstituted with wild-type BM and were accompanied by intestinal pathology. MC responses were reduced in W/W(v) mice reconstituted with IL-4(-/-) BM and to a lesser extent when reconstituted with TNF-alpha(-/-). These results suggest that MC-derived IL-4 and TNF may regulate the induction of protective Th2 responses and intestinal inflammation associated with the expulsion of T. spiralis. Significantly, these studies suggest a role for MC-derived cytokines as autocrine growth factors.

Dose of digoxin prescribed in the UK compared with France and the USA.

BACKGROUND: Two trials in patients with heart failure showed that some patients grew worse if digoxin was withdrawn. The median daily dose of digoxin in these trials was 375 micrograms. We suspected that doses used in the UK were much lower. METHODS: We studied the prescription of digoxin to 119 patients who were discharged from St George's Hospital, London, UK, in April and May, 1994. We calculated the appropriate digoxin prescription dose by Jelliffe's formula. Appropriate doses were put into a scale of six levels: 62.5 micrograms, 125 micrograms, 187.5 micrograms, 250 micrograms, 375 micrograms, or 500 micrograms. We compared our findings with information from a database of prescription records. These records, gathered during 1993-94, came from the UK (1085 prescriptions). France (1148), and the USA (2303). FINDINGS: In the St George's Hospital series, the median daily dose of digoxin was 125 micrograms (mean 170 [SD 80] micrograms). The dose was significantly higher in patients who had heart failure than those who did not, by a mean of 40 micrograms. Among the 100 patients for whom appropriate dose was calculated, the dose was as predicted in 28, one level too low in 34, two or more levels too low in 32, and one level too high in six. There was no difference between St George's Hospital and UK practice as a whole (p > 0.05), but the dosage was significantly higher in the USA and France than in the UK (p < 0.001 for both) and significantly higher in France than in the USA (p < 0.001). INTERPRETATION: Differences in dosage may be correlated to the range of tablet strengths available in each country in our analysis. Underdosing can be detected with certainty only if plasma digoxin concentration is measured. However, our study provides strong circumstantial evidence that many patients in the UK are receiving too little digoxin.