Significant Increase In Uptake Research Articles

A study to evaluate the acceptability, feasibility and impact of packaged interventions (“Diarrhea Pack”) for prevention and treatment of childhood diarrhea in rural Pakistan

BackgroundDiarrhea remains one of the leading public health issues in developing countries and is a major contributor in morbidity and mortality in children under five years of age. Interventions such as ORS, Zinc, water purification and improved hygiene and sanitation can significantly reduce the diarrhea burden but their coverage remains low and has not been tested as packaged intervention before. This study attempts to evaluate the package of evidence based interventions in a “Diarrhea Pack” through first level health care providers at domiciliary level in community based settings. This study sought to evaluate the acceptability, feasibility and impact of diarrhea Pack on diarrhea burden.MethodsA cluster randomized design was used to evaluate the objectives of the project a union council was considered as a cluster for analysis, a total of eight clusters, four in intervention and four in control were included in the study. We conducted a baseline survey in all clusters followed by the delivery of diarrhea Pack in intervention clusters through community health workers at domiciliary level and through sales promoters to health care providers and pharmacies. Four quarterly surveillance rounds were conducted to evaluate the impact of diarrhea pack in all clusters by an independent team of Field workers.ResultsBoth the intervention and control clusters were similar at the baseline but as the study progress we found a significant increase in uptake of ORS and Zinc along with the reduction in antibiotic use, diarrhea burden and hospitalization in intervention clusters when compared with the control clusters. We found that the Diarrhea Pack was well accepted with all of its components in the community.ConclusionThe intervention was well accepted and had a productive impact on the uptake of ORS and zinc and reduction in the use of antibiotics. It is feasible to deliver interventions such as diarrhea pack through community health workers in community settings. The intervention has the potential to be scaled up at national level.

Using formative evaluation to improve uptake of a web-based tool to support antimicrobial stewardship

Web-based decision support tools have rationalized prescribing of antimicrobials in healthcare settings. Clinicians' acceptance of decision support tools is one of the important factors that determine successful implementation of such tools. This study evaluated the impact of a formative evaluation on the uptake of a web-based antibiotic computerized decision support system (CDSS) by clinicians at a university teaching hospital. Semi-structured qualitative interviews were conducted with junior and senior doctors and pharmacists. Interviews were transcribed verbatim and reviewed to identify barriers surrounding clinicians' use of the antibiotic CDSS. Recommendations were made to the development team of the studied system regarding system modifications and the implementation strategy. An automated log of the clinicians' use of antibiotic CDSS was generated before and after the formative evaluation. Interviews of 42 clinicians identified several barriers related to contents and implementation strategy of the antibiotic CDSS. Important differences were observed between senior and junior doctors about various aspects of the antibiotic restriction strategy and applicability of antibiotic CDSS in specialized clinical areas. Recommendations from the formative evaluation study resulted in significant modifications to the contents and implementation strategy of the antibiotic CDSS. A significant increase in uptake of the antibiotic CDSS by clinicians was observed following the formative evaluation. The formative evaluation approach during the implementation period of the studied antibiotic CDSS increased clinicians' uptake of the system. Formative evaluation may be recommended as a routine strategy to implement future CDSS and related clinical computing applications in hospital settings.

24-epibrassinolide restores nitrogen metabolism of pigeon pea under saline stress.

BackgroundSeveral studies have shown that brassinosteroids attenuate the effects of salt stress. However, nothing is known about their effects on amino acid transport, nor the effects of these hormones on nitrate uptake under saline conditions. This study set out to determine the effects of 24-epibrassinolide, at concentrations of 10-7 M and 0.5 × 10-9 M, and clotrimazole (inhibitor of brassinosteroid synthesis), at 10-4 M, on nitrate uptake and metabolism in plants of C. cajan (L.) Millsp, cultivar C11, growing under salinity. The following aspects were analyzed: levels of proteins, amino acids, nitrate, nitrate reductase of roots and the composition of xylem sap amino acids.ResultsSalinity reduced the proportion of N-transport amino acids ASN (the major component), GLU, ASP and GLN. The effect of the hormone in reducing the adverse effects of salt was related to the reestablishment (totally or partially) of the proportions of GLU, ASN and GLN, transported in the xylem and to the small but significant increase in uptake of nitrate. Increased nitrate uptake, induced by 24- epibrassinolide, was associated with a higher activity of nitrate reductase together with greater levels of free amino acids and soluble proteins in roots of plants cultivated under saline conditions.ConclusionThe decline in several components of nitrogen metabolism, induced by salt, was attenuated by 24-epibrassinolide application and accentuated by clotrimazole, indicating the importance of brassinosteroid synthesis for plants growing under salinity.Electronic supplementary materialThe online version of this article (doi:10.1186/1999-3110-54-9) contains supplementary material, which is available to authorized users.

Validation of 18F-FDG PET at Conventional and Delayed Intervals for the Discrimination of High-Grade From Low-Grade Gliomas

The aim of this study was to validate 18F-FDG PET imaging for differentiating high-grade gliomas (HGGs) from low-grade gliomas (LGGs). Twenty-one patients with gliomas undergoing a stereotactic biopsy underwent PET scanning at conventional and delayed intervals, diagnostic and stereotactic MR examinations. To calculate the uptake at the biopsy site, a 2-mm voxel was selected. Uptake in this voxel was expressed as a percentage of the average uptake per voxel in the normal brain. The difference in uptake between HGG and LGG at conventional and late intervals and the difference in uptake difference between HGG and LGG at both intervals were analyzed using t tests as well as a mixed-model analysis of variance. At conventional intervals, uptake in LGG was 67% of that in the normal brain. Between early and late intervals, a significant decrease in uptake of 11% (±2.5%) was noted (P = 0.001). Uptake in HGG at conventional intervals was 138% of that in the normal brain. Between early and late intervals, a significant increase in uptake of 43% (±11%) was noted (P = 0.005). The difference in uptake between HGG and LGG was significant both at conventional and delayed intervals (P < 0.001). Moreover, the difference in uptake between both groups was significantly greater (31%) at delayed than at conventional intervals (2%) (P < 0.001). The results of this correlative study between tumor grade and 18F-FDG uptake both determined at the stereotactic biopsy site indicate that PET, particularly at delayed intervals, is valid for discriminating LGG from HGG.

The Efflux Inhibitor Phenylalanine-Arginine Beta-Naphthylamide (PAβN) Permeabilizes the Outer Membrane of Gram-Negative Bacteria

Active efflux of antimicrobial agents is a primary mechanism by which bacterial pathogens can become multidrug resistant. The combined use of efflux pump inhibitors (EPIs) with pump substrates is under exploration to overcome efflux-mediated multidrug resistance. Phenylalanine-arginine β-naphthylamide (PAβN) is a well-studied EPI that is routinely combined with fluoroquinolone antibiotics, but few studies have assessed its utility in combination with β-lactam antibiotics. The initial goal of this study was to assess the efficacy of β-lactams in combination with PAβN against the opportunistic pathogen, Pseudomonas aeruginosa. PAβN reduced the minimal inhibitory concentrations (MICs) of several β-lactam antibiotics against P. aeruginosa; however, the susceptibility changes were not due entirely to efflux inhibition. Upon PAβN treatment, intracellular levels of the chromosomally-encoded AmpC β-lactamase that inactivates β-lactam antibiotics were significantly reduced and AmpC levels in supernatants correspondingly increased, potentially due to permeabilization of the outer membrane. PAβN treatment caused a significant increase in uptake of 8-anilino-1-naphthylenesulfonic acid, a fluorescent hydrophobic probe, and sensitized P. aeruginosa to bulky antibiotics (e.g. vancomycin) that are normally incapable of crossing the outer membrane, as well as to detergent-like bile salts. Supplementation of growth media with magnesium to stabilize the outer membrane increased MICs in the presence of PAβN and restored resistance to vancomycin. Thus, PAβN permeabilizes bacterial membranes in a concentration-dependent manner at levels below those typically used in combination studies, and this additional mode of action should be considered when using PAβN as a control for efflux studies.

Heavy metal influence on BDE-47 uptake in the human KERTr keratinocyte cell line

Significant correlations between concentrations of PBDEs and heavy metals were observed in the human body. However, there is a lack of evidence on the linkage between the uptake of heavy metals and PBDEs. This study is the first report on the BDE-47 uptake profile in a human cell line. Hg and As exposures to KERTr (human skin derived keratinocyte) did not significantly (p > 0.05) affect the uptake of BDE47, whereas Pb and Cd significantly (p < 0.05) affected the uptake of BDE-47 in KERTr. The change in Km was minor after exposure to all heavy metals. The maximum transport rate (Vmax) after exposure to Pb (Vmax: 5.23 ± 0.49) and As (Vmax: 4.95 ± 0.60) was significantly increased when compared with the background of the KERTr cell line (Vmax: 4.07 ± 0.35). Real-time RT-PCR indicated that OATP-B, OATP-D, and OATP-E were expressed in the KERTr cell line. The upregulation or downregulation of OATP B and D genes were minor after exposure to heavy metals, but the OATP E gene was upregulated by three to fourfold in KERTr cell line after exposure to Pb an Cd, which may explain the significant increase of uptake of BDE-47 in KERTr after exposures to Pb and Cd. This study indicated that the uptake effects should be considered when performing risk assessment of human exposure to PBDEs and heavy metal.

Interventions to increase the uptake of cardiac rehabilitation: Systematic review

Cardiac rehabilitation (CR) can significantly reduce mortality and morbidity, yet many patients fail to attend. Aim: Evaluation of interventions designed to increase participation in CR with a secondary focus on under-represented groups. Methods: Systematic review of six electronic databases including randomised controlled trials. Results: Six studies were identified, four of which reported a significant increase in uptake. Two of these interventions used psychological theory-based letters, the third a liaison nurse, and the fourth used a social worker to encourage attendance. The other two studies used peer support or peer support in combination with a nurse. The latter targeted older, unpartnered adults and the study using social worker support targeted blue-collar workers. These were the only two studies addressing potentially under-represented groups. A lack of evidence in that area became apparent. Conclusion: Conclusions must be limited due to the small number of studies. While the effect of peer support is unclear, the impact of additional health-care professional support appears promising. The low cost and risk of adapting invitation letters in line with psychological theory and the considerable health gain of increased participation suggest that CR clinicians should not wait before investigating this method.

A Randomized Controlled Trial to Evaluate the Effectiveness of a Board Game on Patients' Knowledge Uptake of HIV and Sexually Transmitted Diseases at the Infectious Diseases Institute, Kampala, Uganda

As the number of HIV infections continues to rise, the search for effective health education strategies must intensify. A new educational board game was developed to increase HIV peoples' attention and knowledge to HIV and sexually transmitted infections (STIs) information. The object of this study was to assess the effect of this educational board game on the uptake of knowledge. A randomized controlled trial where patients attending the Infectious Diseases Clinic, Kampala, Uganda were randomized to either play the board game (intervention arm) or to attend a health talk (standard of care arm). Participants' knowledge was assessed before and after the education sessions through a questionnaire. One hundred eighty HIV-positive participants were enrolled, 90 for each study arm. The pretest scores were similar for each arm. There was a statistically significant increase in uptake of knowledge of HIV and STIs in both study arms. Compared with patients in the standard of care arm, participants randomized to the intervention arm had higher uptake of knowledge (4.7 points, 95% confidence interval: 3.9 to 5.4) than the controls (1.5 points, 95% confidence interval: 0.9 to 2.1) with a difference in knowledge uptake between arms of 3.2 points (P < 0.001). Additionally, both participants and facilitators preferred the board game to the health talk as education method. The educational game significantly resulted in higher uptake of knowledge of HIV and STIs. Further evaluation of the impact of this educational game on behavioral change in the short and long term is warranted.

A Putative P-Type ATPase Required for Virulence and Resistance to Haem Toxicity in Listeria monocytogenes

Regulation of iron homeostasis in many pathogens is principally mediated by the ferric uptake regulator, Fur. Since acquisition of iron from the host is essential for the intracellular pathogen Listeria monocytogenes, we predicted the existence of Fur-regulated systems that support infection. We examined the contribution of nine Fur-regulated loci to the pathogenicity of L. monocytogenes in a murine model of infection. While mutating the majority of the genes failed to affect virulence, three mutants exhibited a significantly compromised virulence potential. Most striking was the role of the membrane protein we designate FrvA (Fur regulated virulence factor A; encoded by frvA [lmo0641]), which is absolutely required for the systemic phase of infection in mice and also for virulence in an alternative infection model, the Wax Moth Galleria mellonella. Further analysis of the ΔfrvA mutant revealed poor growth in iron deficient media and inhibition of growth by micromolar concentrations of haem or haemoglobin, a phenotype which may contribute to the attenuated growth of this mutant during infection. Uptake studies indicated that the ΔfrvA mutant is unaffected in the uptake of ferric citrate but demonstrates a significant increase in uptake of haem and haemin. The data suggest a potential role for FrvA as a haem exporter that functions, at least in part, to protect the cell against the potential toxicity of free haem.

Evaluating the effectiveness of GP endorsement on increasing participation in the NHS Bowel Cancer Screening Programme in England: study protocol for a randomized controlled trial

BackgroundThe success and cost-effectiveness of bowel cancer screening depends on achieving and maintaining high screening uptake rates. The involvement of GPs in screening has been found to improve patient compliance. Therefore, the endorsement of screening by GPs may increase uptake rates amongst non-responders.Methods/DesignA two-armed randomised controlled trial will evaluate the effectiveness of a GP endorsed reminder in improving patient participation in the NHS Bowel Cancer Screening Programme (NHSBCSP). Up to 30 general practices in the West Midlands with a screening uptake rate of less than 50% will be recruited and patients identified from the patient lists of these practices. Eligible patients will be those aged 60 to 74, who have previously been invited to participate in bowel screening but who have been recorded by the Midlands and North West Bowel Cancer Screening Hub as non-responders. Approximately 4,380 people will be randomised in equal numbers to either the intervention (GP letter and duplicate FOBt kit) or control (no additional contact) arms of the trial.The primary outcome measure will be the difference in the uptake rate of FOBt screening for bowel cancer between the intervention and control groups at 13 weeks after the GP endorsed reminder and duplicate FOBt kit are sent. Secondary outcome measures will be subgroup analyses of uptake according to gender, age and deprivation quartile, and the validation of methods for collecting GP, NHSBCSP and patient costs associated with the intervention. Qualitative work (30 to 40 semi-structured interviews) will be undertaken with individuals in the intervention arm who return a FOBt kit, to investigate the relative importance of the duplicate FOBt kit, reminder to participate, and GP endorsement of that reminder in contributing to individuals' decisions to participate in screening.DiscussionImplementing feasible, acceptable and cost-effective strategies to improve screening uptake amongst non-responders to invitations to participate is fundamentally important for the success of screening programmes. If this feasibility study demonstrates a significant increase in uptake of FOBt screening in individuals receiving the intervention, a definitive, appropriately powered future trial will be designed.Trial registration numberISRCTN: ISRCTN86784060

Introduction of first trimester combined test increases uptake of Down's syndrome screening

ObjectiveTo describe any trends in the uptake of antenatal screening for Down's syndrome since the addition of the earlier first trimester combined test. Study designAll antenatal screening tests for Down's syndrome were carried out and their results were recorded by the Clinical Biochemistry Department at the Hull Royal Infirmary (HRI) and reviewed against the antenatal booking data held at the Women and Children's Hospital at HRI. The uptake of antenatal Down's syndrome screening for 5 different age groups of women across a four-year-period from 2007 to 2010 was analysed. ResultsThere was a significant increase in uptake of antenatal screening for Down's syndrome from 43.9% to 56.5% after the introduction of the combined test in 2010. This increase was apparent in all age groups. There was no change in the proportion of women opting for an invasive test following a positive screening test. ConclusionAddition of the earlier first trimester combined test has increased uptake of antenatal screening for Down's syndrome in women of all ages. This is most likely due to the advantages this test gives women such as earlier decision making, earlier further invasive diagnostic testing and earlier termination, if necessary.

Cellular uptake and mutagenic potential of metal oxide nanoparticles in bacterial cells

Extensive production and consumption of nanomaterials such as ZnO and TiO 2 has increased their release and disposal into the environment. The accumulation of nanoparticles (NPs) in ecosystem is likely to pose threat to non-specific targets such as bacteria. The present study explored the effect of ZnO and TiO 2 NPs in a model bacterium, Salmonella typhimurium. The uptake of ZnO and TiO 2 bare NPs in nano range without agglomeration was observed in S. typhimurium. TEM analysis demonstrated the internalization and uniform distribution of NPs inside the cells. Flow cytometry data also demonstrates that both ZnO and TiO 2 NPs were significantly internalized in the S. typhimurium cells in a concentration dependent manner. A significant increase in uptake was observed in the S. typhimurium treated even with 8 and 80 ng mL −1 of ZnO and TiO 2 NPs with S9 after 60 min, possibly the formation of micelles or protein coat facilitated entry of NPs. These NPs exhibited weak mutagenic potential in S. typhimurium strains TA98, TA1537 and Escherichia coli (WP2uvrA) of Ames test underscoring the possible carcinogenic potential similar to certain mutagenic chemicals. Our study reiterates the need for re-evaluating environmental toxicity of ZnO and TiO 2 NPs presumably considered safe in environment.

Transepithelial transport of PEGylated anionic poly(amidoamine) dendrimers: Implications for oral drug delivery

The purpose of this work was to assess the impact of PEGylation on transepithelial transport of anionic poly(amidoamine) dendrimers. Cytotoxicity, uptake and transport across Caco-2 cells of PEGylated G3.5 and G4.5 PAMAM dendrimers were studied. Methoxy polyethylene glycol (750 Da) was conjugated to carboxylic acid-terminated PAMAM dendrimers at feed ratios of 1, 2 and 4 PEG per dendrimer. Compared to the control, PEGylation of anionic dendrimers did not significantly alter cytotoxicity up to a concentration of 0.1 mM. PEGylation of G3.5 dendrimers significantly decreased cellular uptake and transepithelial transport while PEGylation of G4.5 dendrimers led to a significant increase in uptake, but also a significant decrease in transport. Dendrimer PEGylation reduced the opening of tight junctions as evidenced by confocal microscopy techniques. Modulation of the tight junctional complex correlated well with changes in PEGylated dendrimer transport and suggests that anionic dendrimers are transported primarily through the paracellular route. PEGylated dendrimers show promise in oral delivery applications where increased functionality for drug conjugation and release is desired.

Activation of Protein Kinase Cζ Increases OAT1 (SLC22A6)- and OAT3 (SLC22A8)-mediated Transport

Organic anion transporters (OATs) play a pivotal role in the clearance of small organic anions by the kidney, yet little is known about how their activity is regulated. A yeast two-hybrid assay was used to identify putative OAT3-associated proteins in the kidney. Atypical protein kinase Czeta (PKCzeta) was shown to bind to OAT3. Binding was confirmed in immunoprecipitation assays. The OAT3/PKCzeta interaction was investigated in rodent renal cortical slices from fasted animals. Insulin, an upstream activator of PKCzeta, increased both OAT3-mediated uptake of estrone sulfate (ES) and PKCzeta activity. Both effects were abolished by a PKCzeta-specific pseudosubstrate inhibitor. Increased ES transport was not observed in renal slices from OAT3-null mice. Transport of the shared OAT1/OAT3 substrate, rho-aminohippurate, behaved similarly, except that stimulation was reduced, not abolished, in the OAT3-null mice. This suggested that OAT1 activity was also modified by PKCzeta, subsequently confirmed using an OAT1-specific substrate, adefovir. Inhibition of PKCzeta also blocked the increase in ES uptake seen in response to epidermal growth factor and to activation of protein kinase A. Thus, PKCzeta acted downstream of the epidermal growth factor to protein kinase A signaling pathway. Activation of transport was accompanied by an increase in V(max) and was blocked by microtubule disruption, indicating that activation may result from trafficking of OAT3 into the plasma membrane. These data demonstrate that PKCzeta activation up-regulates OAT1 and OAT3 function, and that protein-protein interactions play a central role controlling these two important renal drug transporters.

The effect of posters and displays on the use of alcohol gel

Introduction: Hand cleansing with alcohol gel is important in reducing health care associated infection (HCAI). HCAI affects 8% of acute hospital admissions in the UK costing the NHS an estimated ®1 billion per annum1. The aim of this study was to determine the effect of posters and placement of alcohol dispensers on use of alcohol dispensers by staff and visitors passing through hospital foyers. Method: We noted the use of alcohol gel for hand cleansing in pedestrians entering through the hospital foyers. Three scenarios were noted: ■ Display 1. Poster and gel dispenser in the centre of the foyer. ■ Display 2. Poster and gel dispenser on the wall of the foyer. ■ Display 3. No poster with a gel dispenser on the wall of the foyer. Results: For display 1 uptake of alcohol gel was 38.4%, for display 2 it was 8.6% and for display 3 it was 2.7%. There was a significant increase in uptake of alcohol hand cleansing when a display was used (p &gt; 0.001). Regarding gender, males were better users of alcohol hand gel overall. Employment group: the highest use was amongst female visitors with display 1 (51.6%). Displays had least influence on male doctors (44% with display 1, 10% with display 3). Conclusion: We recommend the use of prominently placed posters and gel dispensers in hospital foyers.

Recombinant surfactant protein-D selectively increases apoptosis in eosinophils of allergic asthmatics and enhances uptake of apoptotic eosinophils by macrophages

Pulmonary surfactant protein-D (SP-D) is a multifunctional, pattern recognition molecule involved in resistance to allergen challenge and pulmonary inflammation. In view of therapeutic effects of exogenous SP-D or recombinant fragment of human surfactant protein-D (rhSP-D) (composed of eight Gly-X-Y collagen repeat sequences, homotrimeric neck and lectin domains) in murine models of lung allergy and hypereosinophilic SP-D gene-deficient mice, we investigated the possibility of a direct interaction of purified rhSP-D with human eosinophils derived from allergic patients and healthy donors. rhSP-D showed a sugar- and calcium-dependent binding to human eosinophils, suggesting involvement of its carbohydrate recognition domain. While eosinophils from allergic patients showed a significant increase in apoptosis, oxidative burst and CD69 expression in presence of rhSP-D, eosinophils from healthy donors showed no significant change. However, these eosinophils from healthy donors when primed with IL-5 exhibited increase in apoptosis on incubation with rhSP-D. Apoptosis mediated by rhSP-D in primed eosinophils was not affected by the antioxidant, N-acetyl-L-cysteine. There was a manifold increase in binding of rhSP-D to apoptotic eosinophils than the normal eosinophils and rhSP-D induced a significant increase in uptake of apoptotic eosinophils by J774A.1 macrophage cells. The study suggests that rhSP-D mediated preferential increase of apoptosis of primed eosinophils while not affecting the normal eosinophils and increased phagocytosis of apoptotic eosinophils may be important mechanisms of rhSP-D and plausibly SP-D-mediated resolution of allergic eosinophilic inflammation in vivo.

Optimization of tumor-selective targeting by basic fibroblast growth factor-binding peptide grafted PEGylated liposomes

We have previously shown that the peptide, KRTGQYKLC (bFGF), is recognized by fibroblast growth factor (FGF) receptor (FGFR) via binding to basic FGF (bFGF), and is capable of being used for drug delivery to tumors highly expressing FGFR and bFGF. However, although the binding and uptake of the liposomes (bFGFp-liposomes) modified by the peptide increased in the presence of bFGF, the modification induced non-specific uptake. To overcome this problem, here, we prepared bFGFp-liposomes including mPEG-DSPE. The 5 and 10% mPEG 5000/ and 10% mPEG 3000/bFGFp-liposomes reduced most of the interaction with erythrocytes and the uptake by macrophages, suggesting the sustained blood circulation of bFGFp grafted PEGylated liposomes. Furthermore, 10% mPEG 3000/bFGFp-liposomes produced a significant increase in uptake in NIH3T3, A549, and B16BL6 cells with the expression of FGFR following pre-incubation with bFGF, but no increase in CHO-K1 cells lacking FGFR expression. Taken together, these results lead us to believe that bFGFp grafted PEGylated liposomes possess the functions of both PEGylated stealth liposomes and the tumor-targeting liposomes. This strategy could be applied to the development of novel tumor-selective drug delivery systems.

Quality of care in diabetic patients attending routine primary care clinics compared with those attending GP specialist clinics

To determine the impact on clinical outcomes of specialist diabetes clinics compared with routine primary care clinics. Observational study measuring clinical performance (process/outcome measures) in the primary care sector. A cohort of patients attending specialist diabetes clinics was compared with a control cohort of patients attending routine primary care clinics. Patients seen in specialist diabetes clinics had a significantly higher HbA1c than patients in routine primary care clinics (mean difference 0.58%; P < 0.001) but there was no significant difference in rate of improvement with visits compared with primary care clinics. In contrast, patients seen in the routine primary care clinics had significantly higher cholesterol levels (mean difference 0.24 mmol/l; P < 0.001) compared with patients in specialist diabetes clinics and their improvement was significantly greater over time (mean difference 0.14 mmol/l per visit compared with 0.10 mmol/l; P < 0.006). Patients in routine primary care clinics also had significantly higher diastolic blood pressure (mean difference 1.6 mmHg; P < 0.007) but there was no difference in improvement with time compared with specialist diabetes clinics. Uptake of podiatry and retinal screening was significantly lower in patients attending routine primary care clinics, but this difference disappeared with time, with significant increases in uptake in the primary care clinic group. Weight increased in both groups significantly with time, but more so in the specialist clinic patients (mean increase 0.18 kg per visit more compared with routine clinic primary care patients; P < 0.001). This study provides evidence that the provision of primary care services for patients with diabetes, whether traditional general practitioner clinics or diabetes clinics run by general practitioners with special interests, is effective in reducing HbA1c, cholesterol and blood pressure. However, the same provision of care was unable to prevent increasing weight or creatinine over time. No evidence was found that patients in specialist clinics do better than patients in routine primary care clinics.

Effect of Immobilizing Substances and Salinity on Heavy Metals Availability to Wheat Grown on Sewage Sludge-Contaminated Soil

The objective of the investigation was to evaluate the effect of immobilizing substances and NaCl salinity on the availability of heavy metals: Zn, Cd, Cu, Ni, and Pb to wheat (Triticum aestivum L.). In greenhouse pot experiment, a sewage sludge amended soil was treated with the following immobilizing substances: three clay minerals (Na-bentonite, Ca-bentonite and zeolite), iron oxides (goethite and hematite), and phosphate fertilizers (superphosphate and Novaphos). The pots were planted with wheat and were irrigated either with deionized or saline water containing 1600 mg L−1 NaCl. Wheat was harvested two times for shoot metal concentrations and biomass measurements. Metal species in soil solution were estimated using the software MINEQL+. The addition of metal immobilizing substances to the soil significantly decreased metal availability to wheat. The largest reduction in metal bioavailability was found for bentonites. The irrigation with saline water (1600 mg L−1 NaCl) resulted in a significant increase in metal chloride species (MCl+ and MCl2 0). The highest metal complexation with Cl occurred for Cd, which was about 53% of its total soil solution concentration. The total concentration of Cd (CdT) in soil solution increased by 1.6–2.8-fold due to saline water. The NaCl salinity caused a significant increase in uptake and shoot concentration of Cd for two harvests and small but significant increase in shoot Pb concentration for the second harvest. It was concluded that the use of bentonites is the most promising for the reduction of heavy metal availability to plants. Saline water containing 1600 mg L− 1 NaCl increased the availability of Cd and Pb to wheat and decreased the efficiency of bentonites to immobilize soluble Cd.

Effectiveness of incentive payments to family physicians in improving uptake of influenza vaccine in extreme high-risk patients under the age of 65 years

Background: In 2000, the United Kingdom government recommended universal vaccination for all those 65 years and older and those younger with chronic conditions. The UK's separate administrative health regions adopted this policy, but introduced different funding strategies to improve uptake. England, while offering family doctors a payment for each high-risk individual aged 65 and over, offered no additional payments for targeting the young. In contrast, Wales offered its doctors additional payments regardless of age. This study set out to examine whether these incentive payments resulted in an increased uptake amongst extreme high-risk patients under the age of 65 years. Method: Medical outpatient departments in 13 large hospital sites in Wales were used as a sampling frame and matched for size, socio-economic and demographic characteristics of the populations they serve with hospitals in England. Nurses in charge of the outpatient department were asked to fill out a questionnaire for the first 10 patients who arrived at the general medicine outpatient department during the first week of March 2002. In total, 190 attendees in England and 222 in Wales were recruited. Results: The patients recruited in the two regions were similar in terms of age, sex and chronic disease condition status. No significant difference was found in the uptake rates between patients attending in England and Wales. Overall uptake in both regions was in excess of 80% of patients with chronic health problems and no attendees outside of the recommended groups were vaccinated. No significant difference existed between the uptake rates for the individual chronic disease morbidities either within or between regions. Conclusions: This study found that overall a change in national policy resulted in a dramatic increase in vaccine uptake both overall and within the extreme high-risk groups. Introducing incentives into the influenza vaccine national programme resulted in a general significant increase in uptake in those recommended for vaccination, whereas specific payments for targeting younger individuals resulted in no additional benefit.