Predictors of re-employment and quality of life in NHS staff one year after early retirement because of ill health; a national prospective study.

AIMS: To measure changes in health related quality of life and employment status of NHS staff one year after early retirement because of ill health, and to identify predictors of re-employment. METHODS: A national cohort of 1317 NHS staff taking early retirement because of ill health in 1998 was recruited. Postal questionnaires were used to assess their quality of life (SF-36) and employment status 12 months after retirement. RESULTS: A total of 1143 (87%) ill health retirees responded; 152 (13%) retirees were working at one year, mostly part-time, and 22% of them were re-employed by the NHS. Independent predictors of re-employment were: living in England rather than Wales and occupation of doctor. There was an increased likelihood of re-employment with reducing age and increasing quality of life at baseline. Retirees' quality of life improved from baseline to one year after ill health retirement, but at one year still remained lower than the general population. Improvements in physical and mental component scores were greater in those working at one year compared with those not working. CONCLUSION: Reducing ill health retirement is likely to be of benefit to the individual, the NHS, and the economy. Results suggest that such a reduction may be possible and the identified predictors of re-employment may help in this process.

Antioxidants and reactive oxygen species in follicular fluid of women undergoing IVF: relationship to outcome.

BACKGROUND: The role of free radicals and reactive oxygen species (ROS) in female reproductive function is still unclear. The present study was designed to investigate their relationship with ovulation, fertilization and conception. METHODS: Follicular aspirates obtained from women undergoing IVF following controlled ovarian stimulation were evaluated using the ferric reducing antioxidant power (FRAP) assay for baseline total antioxidant capacity (TAC). Both the baseline TAC and the decline in TAC over 72 h (two-point assay) were used as markers of oxygen radical activity. RESULTS: A total of 303 follicular aspirates from 63 women were analysed. Two hundred and eighteen (71.9%) yielded oocytes, 169 (77.5%) of these fertilized and 134 (79.3%) of these embryos survived until the time of embryo transfer. Baseline TAC was no different in follicular fluid whether the follicle contained an oocyte or not, but was significantly higher in fluid from follicles whose oocyte successfully fertilized and significantly lower in fluid from follicles where the resultant embryo survived to transfer. The decline in TAC was lower when the oocytes fertilized and higher in association with embryo viability, but the differences were not statistically significant. CONCLUSIONS: These results provide further evidence that ROS play a role in female reproductive function.

Ovarian epithelial dysplasia in relation to ovulation induction and nulliparity.

OBJECTIVE: The goal of this study was to assess the relationship between ovulation induction, nulliparity, and ovarian epithelial dysplasia. METHODS: This retrospective cohort study was performed in one teaching and one district general hospital in London. The subjects, 83 women who had undergone hysterectomy and bilateral oophorectomy and whose ovaries were reported as "normal," were divided into three groups: ovulation induction (13), nulliparity (20), and fertile controls (50). These ovaries were independently reviewed by two pathologists who assigned a score of 0, 1, or 2 to nine epithelial cytological and architectural features. The main outcome measure was the total dysplasia score, which was used to quantify the degree of ovarian epithelial abnormality in the three groups. RESULTS: The mean dysplasia score was significantly higher in the women who had undergone ovulation induction than in the fertile controls (7.92 vs 5.70, P = 0.012). The magnitude of the difference between the ovulation induction group and controls remained similar after adjusting for age, parity, and duration of oral contraceptive use (2.17, 95% CI: -0.11-4.44). However, the statistical significance of this difference was reduced (P = 0.062). We did not find any evidence of a difference in dysplasia score between nulliparous women and controls, neither before (P = 0.85) nor after adjusting for age and duration of oral contraceptive use (P = 0.87). CONCLUSIONS: These results suggest a possible association between ovarian epithelial dysplasia and ovulation induction therapy, in accord with previous reports of increased risk of ovarian cancer in women with a history of fertility treatment. The higher dysplasia score could be attributable to the drugs used to induce ovulation or to a genetic susceptibility to ovarian cancer.

Investigation of ethnic neutropenia by assessment of bone marrow colony-forming cells.

Healthy individuals with African ancestry have lower neutrophil counts than Caucasians. It has previously been postulated that this was consequent on either a diminished bone marrow granulocyte reserve or an altered distribution of neutrophils between the circulating and marginated granulocyte pools. Recent indirect evidence supports the former hypothesis. In this study we have compared the number of granulocyte plus granulocyte-macrophage colony-forming units (CFUs) in the bone marrow of healthy African and Afro-Caribbean subjects with the number of CFUs in the bone marrow of healthy age and sex-matched Caucasians. We found the group with African ancestry to have significantly fewer CFUs than the Caucasian group. There was no evidence of any qualitative difference between the CFUs of the two ethnic groups: they showed similar sensitivity to granulocyte-monocyte colony stimulating factor and similar enhancement of growth when cultured with a larger range of cytokines. These observations suggest that ethnic neutropenia observed in those with African ancestry is likely to result from reduced numbers of bone marrow progenitor cells in comparison with numbers present in Caucasians.

Clinical outcomes, quality of life, and costs in the North Thames Dialysis Study of elderly people on dialysis: a prospective cohort study.

BACKGROUND: Evidence-based health policy is urgently needed to meet the increasing demand for health services among elderly people, particularly for expensive technologies such as renal-replacement therapy. Age has been used to ration dialysis, although not always explicitly, despite the lack of rigorous empirical evidence about how elderly people fare on dialysis. We undertook a comprehensive assessment of outcomes in patients 70 years or over. METHODS: We did a 12-month prospective cohort study of outcomes in 221 patients with end-stage renal failure aged 70 years or over recruited from four hospital-based renal units. We assessed 1-year survival in 125 incident patients (70-86 years) and disease burden (hospital admissions, quality of life, costs) in 174 prevalent patients (70-93 years). FINDINGS: 1-year survival rates were: 71% overall; 80%, 69%, and 54% in patients 70-74 years, 75-79 years, and 80 years and older, respectively (p=0.008); and 88%, 71%, and 64% in patients with no, one, or two or more comorbid conditions, respectively (p=0.056). Cox regression analyses showed that mortality was significantly associated with age 80 years and older (relative risk 2.79 [95% CI 1.28-6.93]) and peripheral vascular disease (2.83 [1.29-6.17]), but not with diabetes, ischaemic heart disease, cerebrovascular disease, chronic obstructive airways disease, sex, or treatment method. In terms of disease burden, hospital admissions represent a low proportion of costs and was not required by a third of patients, mental quality of life in elderly dialysis patients was similar to that of elderly people in the general population, and the average annual cost per patient of 20802 (US$31200) (68% dialysis treatment, 1% transport, 19% inpatient hospital admissions, 12% medications) was within the range of other life-extending interventions. INTERPRETATION: Our results suggest that age alone should not be used as a barrier to referral and treatment and emphasise the need to consider the benefits of dialysis in elderly people. Indicators of the ability to benefit from treatment, rather than chronological age, should be used to develop policies that ensure equal access to care for all.

Internal carotid-artery response to 5% carbon dioxide in women with polycystic ovaries.

Although polycystic ovary syndrome is associated with hypertension, hyperlipidaemia, and insulin resistance, mortality from cerebrovascular disease is not increased. We previously reported lower downstream resistance in the internal carotid artery in women with polycystic ovary syndrome. This study was designed to assess vascular reactivity by measuring the response to inhalation of 5% carbon dioxide. We studied 34 young women with polycystic ovary syndrome, 15 with symptomless polycystic ovaries, and 18 controls.

Internal carotid artery haemodynamics in women with polycystic ovaries.

Although polycystic ovarian syndrome (PCOS) is associated with risk factors for cerebrovascular disease, the available evidence does not demonstrate increased stroke mortality, and it has been suggested that some protective mechanisms must be operating in these women. Haemodynamic changes have been demonstrated in the pelvic vessels and aorta in this syndrome, but there have been no studies of the cerebral circulation. Since insulin resistance is a central feature of PCOS, it is of interest that cerebral blood flow may be altered in diabetic subjects. The present study was designed to assess internal carotid artery haemodynamics in women with PCOS, asymptomatic women with polycystic ovaries (PCO women) and healthy controls. Mean internal carotid pulsatility index, measured using pulsed Doppler ultrasound under standardized conditions, was significantly lower in 35 PCOS and 15 PCO women than in the 18 controls. This was also shown on multiple regression analyses. Peak systolic velocity did not differ between groups. In view of the difficulty of interpreting pulsatility index in low-impedance vascular beds, the 'back' pressure was calculated and found to be lower in women with polycystic ovaries. This is the first demonstration of lower pulsatility index and back pressure (suggestive of reduced vascular tone) in the cerebral circulation of these women, independent of blood pressure, insulin resistance and other endocrine or metabolic factors. Changes in internal carotid haemodynamics may offset the risk of cerebrovascular disease commonly associated with polycystic ovaries.

Nephrology and renal replacement therapy in Romania.

BACKGROUND: In the context of the transformation of the Health Systems of Central and Eastern European countries, the role of professional associations is increasing, especially as regards data collection, analysis, and implementation of programmes for development of nephrology and renal replacement therapy (RRT). METHODS: The Romanian Renal Registry sent questionnaires to the heads of Haemodialysis and Nephrology Centres. The need for renal replacement therapy was deduced from the annual incidence (127 patients p.m.p.) of chronic renal failure. RESULTS: Although the rates of increase in the numbers of Nephrology Departments (+82%), HD Centres (+142%), and total number of patients alive on RRT (+196%) from 1991 to 1995 were higher than the European mean, only 27-30% of the incident patients (459 of 1000-1200 patients) could be provided with RRT. Sixty-two percent of the need for RRT in the age group 25-44 years was met, while only 20% of children (age < 15 years) and people over 55 years requiring RRT received this treatment. Primary renal diseases in patients on RRT were glomerulonephritis (49%) or interstitial nephropathies (23%); diabetic nephropathies, nephroangiosclerosis and systemic diseases were rare (4, 2, and 1% respectively). Most of the CRF patients (88%) were treated by HD. Renal transplantation and peritoneal dialysis were seldom performed (8 and 4%). The cost of HD treatment in Romania (87 USD) is low, even though dialyser reuse is not common practice. CONCLUSIONS: The increase in renal replacement therapy in Romania was mainly due to the expansion of the number of haemodialysis centres. Although a significant progress was realized, only one-third of the patients needing RRT could be treated in Romania in 1995.

[Single-dose administration in the treatment with penicillin G (PG) and metronidazole (Me) in primary pulmonary abscesses (a preliminary study)]. / Administrarea în priza unica a tratamentului cu penicilina G (PG) si metronidazol (Me) în abcesele pulmonare primitive (studiu preliminar).

The anaerobic bacteria play the main role in the etiology of the lung abscesses (Finegold, 1989). From this reason, the administration of the association PG and Me (endovenously or per os) gives a high healing rate in our country; 90.5%. The objective of this work was to study the influence of the drug-administration rhythm on the therapeutical results. The drugs were given once daily, several times daily, or in a combination of those 2 modalities. A lot of 38 patients hospitalized between 1.01.94-31.12.95 in the Institute of Pneumophthisiology, was divided in 3 groups: U (11 cases--28.9%), treated with PG: 5-10 mill and Me: 1.5-2 g in one endovenous perfusion, daily: M (18 cases--47.3%), treated with PG: 5-10 mill, one endovenous perfusion daily and Me: 1.5-2 g, 2-4 times daily: F (9 cases--23.8%), treated with both PG: 5-10 mill and Me: 1.5-2 g, 2-4 times daily. Cases with lung abscess and advanced neoplasia, hepato-renal or cardio-pulmonary insufficiencies, were excluded. The hospitalization period was 15-77 days, with an average of 38.3 +/- 26. The proportion of the therapeutical successes, estimated as the disparition of the clinical suppurative symptomatology and the reduction > or = 90% of the lesions and cavity surfaces on the chest X-ray, was for the group U: 90.9% (10 from 11 cases), for M: 94.4% (17 from 18 cases) and for F: 88.9% (8 from 9 cases), the difference being statistical non-significant.

[Clinico-functional changes during inhalational corticotherapy (beclomethasone dipropionate) in children with severe forms of bronchial asthma]. / Modificari clinico-functionale sub corticoterapie inhalatorie (beclometazona dipropionat) la copii cu forme severe de astm bronsic.

In 14 children with corticoid-dependent severe forms of bronchial asthma, inhaled corticotherapy with beclomethasone dipropionate (BDP) was administered for 6 months. Pulmonary functional investigations were performed before, at 1 as well as 6 months from treatment start. Functional pulmonary tests included lung volume and flow measurements. The results showed a remarkable improvement of the mean percentage values of tested functional parameters, and even a significant percentage of normalization concerning the same parameters (excepting MEF50) after 6 months of treatment.