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Based on established physiological mechanisms, the paper presents a detailed computer model, which supports the hypothesis that temporal lobe epilepsy may be caused by failure of glutamate reuptake from the extracellular space. The elevated glutamate concentration causes an increased activation of NMDA receptors in pyramidal neurons, which in turn leads to neuronal dynamics that is qualitatively identical to epileptiform activity. We identify by chaos analysis a surprising possibility that muscarinergic receptors can help the system out of a chaotic regime.

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BACKGROUND: In 1998, ICPC-2 was published as a book. In the process of translating the book, and preparing an electronic version of chapter 10 (the actual classification), ICPC-2 proved to contain many errors and inconsistencies. Particularly, major problems were identified in the conversion between ICPC-2 and ICD-10, which could lead to major errors when used in electronic patient records. OBJECTIVES: We prepared an electronic version of chapter 10 of ICPC-2, ICPC-2-E, with all necessary corrections, to be published on the Oxford University Press web site as a part of this article. METHODS: Errors and inconsistencies were redressed, including particularly those in the con-version structure with all consequences on the level of inclusion and exclusion criteria, through a process of careful checking. RESULTS AND CONCLUSION: ICPC-2-E, the electronic version of chapter 10 of ICPC-2, is specifically to be used in an electronic patient record and for research purposes. It is to be used together with the first nine chapters of ICPC-2, since the book is indispensable to make a correct use of ICPC.

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OBJECTIVE: To study the reliability of the COOP/WONCA charts when completed by patients who contacted their general practitioner (GP) with psychosocial health problems. DESIGN: Test-retest study. Three measures: on day 0, day 1 and day 14. Comparisons were made between measures on day 0 and day 1 (1-day test) and measures on day 1 and day 14 (13-day test). Patients reported separately if change in their health had occurred between the measurements. SETTING: General practice, Denmark. MATERIAL: 54 1-day test chart sets and 54 13-day test chart sets. METHOD: Cohen's weighted kappa was used to assess reproducibility. In the group of patients who reported health change in the 13-day test we used clinically significant changes in the individual items to assess the charts' sensitivity to changes. RESULTS: The items "overall health", "feelings", and "social activities" showed high reproducibility for patients without reported health change between the tests, and good sensitivity to reflect the reported changes for patients with change. CONCLUSION: The COOP/WONCA health status measures: "overall health", "feelings", and "social activities" are, combined with "change in health", reliable for assessing primary care patients with psychosocial health problems.

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Clinical skills, like questioning and examining a patient, are developed gradually throughout the years of medical training. Basic skills should be mastered on graduation, but the teaching of skills in most medical schools is not systematic. We evaluated a pilot teaching project in a general practice (GP) skills laboratory. Students were randomised to an intervention group and a control group. Teaching was performed in small groups of one GP instructor and six students and consisted of four weekly three-hour sessions. For the control group, teaching was delayed until after evaluation. Evaluation of practical skills and communication skills was made with the students in random order by GP evaluators who did not know about the randomisation procedure. Each skill was scored as satisfactory or not satisfactory for each of five procedural elements. 56 fourth-year medical students volunteered. Evaluation was performed for 19 (68%) students in the training group and 18 (64%) in the control group. The training group performed better on practical skills, average score 9.7 (95% confidence interval 7.4 to 12.1) vs. 5.5 (3.2 to 7.8), (p = 0.01). There was no significant difference for communication skills, 7.7 (5.6 to 9.8) vs. 6.7 (4.6 to 8.7). Teaching clinical skills in a general practice skills laboratory is feasible. Practical skills may improve rapidly, at least for short-time performance, while our brief teaching in communication skills was not proved to be effective.

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OBJECTIVE: To examine whether a Current Health scale produces reliable and valid measures of self perceived health status. DESIGN: Examination of reliability, based on internal consistency (Cronbach's alpha coefficient). Examination of validity focusing on convergent and discriminant validity. SUBJECTS: 2263 male and female heads of households who participated in The Danish Health Study 1982-83. The survey used items pertaining to health status from Rand's Health Insurance Study. RESULTS: The scale has acceptable properties and is preferable to a single item measure of general health status. It can be used in general practice.

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OBJECTIVE: To examine to which extent 9 items pertaining to health perception fulfil the Likert criteria for adding the scores for each item to make up a Current Health scale. The term "scaling" denotes the process of constructing a scale from questionnaire items. DESIGN: Examination of convergent and discriminant validity of items, groupings of items, item variance, and information content of each item. SUBJECTS: 2,263 male and female heads of households who participated in The Danish Health Study 1982-83. The survey used items pertaining to health status from Rand's Health Insurance Study. RESULTS: The Likert criteria for constructing a scale of the nine items are fulfilled except for one item. The lack of fulfillment for this item can eventually be attributed to the translation.

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Self-care is interpreted from a health economic point of view. Various approaches are presented. It is stressed that the decision-oriented approach used by other health service researchers is an integral part of the economic approach to the topic as is the idea of a continuum of care, from self-care to professional care. A new approach is taken to the modeling of self-care, in that self-care becomes part of a four-part demand for care model. This makes it possible to model the demand for care for three different groups separately: 1--persons with zero episodes; 2--persons with pure illness episodes and illness episodes with self-care; 3--persons with episodes involving professional care or professional care combined with self-care. Another contribution is due to the so-called episodic approach to the demand for care. The natural counting units are illness and treatment episodes, i.e. instead of counting for instance number of times a general practitioner is consulted we ought to count the number of episodes involving professional care, self-care or both types of care. The episodic approach seems to be well suited for work with self-care. The empirical part is based on a unique Danish panel study using health diaries returned weekly. Data from 27 of the 52 reporting weeks are used, involving more than 14,000 episodes distributed across about 2800 persons belonging to about 1000 households. The use of health diaries seems to be very well suited to the study of self-care in that less salient events and activities than professional care are picked up far better in prospective health diary studies than in retrospective questionnaire based surveys. Descriptive and regression (logistic and ordinary) results are presented.

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This paper analyses the question whether minor trauma should be treated in hospital or general practice. It shows what kind of data are necessary and that this data can be obtained from different countries, with basic similarities in their health care system. In a period of tight budgets there is a tendency to focus on a narrow economic analysis. This article, however, shows the complexity of the simple question of where minor trauma should be treated and stresses other important aspects which should supplement an economic analysis. These aspects are illustrated with data from different investigations in Denmark and the United Kingdom.

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