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The long, asymmetric and specialised architecture of neuronal processes necessitates a properly regulated transport network of molecular motors and cytoskeletal tracks. This allows appropriate distribution of cargo for correct formation and activity of the synapse, and thus normal neuronal communication. This communication is impaired in psychiatric disease, and ongoing studies have proposed that Disrupted in schizophrenia 1 (DISC1) is an important genetic risk factor for these disorders. The mechanisms by which DISC1 dysfunction might increase propensity to psychiatric disease are not completely understood; however, an emerging theme is that DISC1 can function as a key regulator of neuronal intracellular trafficking. Transport of a wide range of potential cargoes - including mRNAs, neurotransmitter receptors, vesicles and mitochondria - can be modulated by DISC1, and therefore is susceptible to DISC1 dysfunction. This theme highlights the importance of understanding precisely how DISC1 can regulate intracellular trafficking, and suggests that a novel approach to the treatment of psychiatric disorders could be provided by targeting this protein and the trafficking machinery with which it interacts.

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A large outbreak of Salmonella enterica serotype Newport infection occurred in Northern Ireland during September and October 2004. Typing of isolates from patients confirmed that this strain was indistinguishable from that in concurrent outbreaks in regions of England, in Scotland and in the Isle of Man. A total of 130 cases were distributed unequally across local government district areas in Northern Ireland. The epidemic curve suggested a continued exposure over about 4 weeks. A matched case-control study of 23 cases and 39 controls found a statistically significant association with a history of having eaten lettuce in a meal outside the home and being a case (odds ratio 23.7, 95% confidence interval 1.4-404.3). This exposure was reported by 57% of cases. Although over 300 food samples were tested, none yielded any Salmonella spp. Complexity and limited traceability in salad vegetable distribution hindered further investigation of the ultimate source of the outbreak.

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Rapid detection of MRSA may be important for the control of MRSA spread in hospitals. The aim of this investigation was to compare the use of a rapid polymerase chain reaction (PCR) screening method with standard culture for the detection of meticillin-resistant Staphylococcus aureus (MRSA) colonisation and to determine its impact on the incidence of MRSA in two hospital wards. During the first phase of the investigation (four months), patients in a surgical ward were screened using the rapid PCR technique and patients in a medical/cardiology ward were screened with standard culture methods. During the second phase of the investigation (four months), MRSA screening methods were switched between the two wards. An audit of infection control practices on each ward was made at the end of each phase in order to check whether any changes had occurred that might influence the risks of MRSA transmission. Use of the rapid PCR method significantly reduced the median time between swabs being taken, to the results being telephoned to the wards (excluding weekends), from 47 to 21 h (P<0.001). However, comparison of MRSA incidence during use of PCR (20/1000 bed-days) and culture methods (22.1/1000 bed-days) revealed no significant difference in incidence on the surgical ward (P=0.69). Regarding the medical/cardiology ward, analysis of data was complicated by an increase in the detection of MRSA during the PCR phase (P<0.05). The study demonstrated that rapid PCR can significantly reduce the turnaround times but reducing the time between swabs being taken to results being telephoned to the ward is still not sufficient to limit the transmission of MRSA.

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An outbreak of mumps occurred in the Mid-Ulster area of Northern Ireland between 1st November 1999 and 31st August 2000, with 729 cases notified. Salivary test results were obtained for 430 (59%) reported cases, of which 332 (77%) were positive for mumps IgM antibody. Three hundred and sixteen (95.2%) of these confirmed cases were in the age range 9 to 19. One hundred and eighty-four (55.4%) confirmed cases had received one dose of MMR (measles, mumps and rubella) vaccine, but only 3 (0.9%) confirmed cases had received 2 doses of MMR. The low incidence of mumps among children who had received two doses of MMR illustrates the importance of the second dose of MMR for full protection.

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To determine whether fatty marrow conversion of the proximal femoral metaphysis is related to osteonecrosis of the femoral head using a marrow conversion index ([signal intensity of the proximal femoral metaphysis/signal intensity of the greater trochanter] x 100 in T1 weighted magnetic resonance images), a case control study was conducted on 42 osteonecrotic hips in 28 patients. The 28 patients (42 osteonecrotic hips) were matched with 84 control patients (84 normal hips) for gender, age (5-year range), and time of presentation (1-year range). The marrow conversion index was measured in each hip studied. The index was 90.2% (standard deviation, 8.2%) in osteonecrotic hips and 75.1% (standard deviation, 9.1%) in matched controls. By conditional logistic regression, a 5% increase in the index was associated with 3.6 times increase of the odds ratio of osteonecrosis and a 10% increase with a 12.9 times increase of the odds ratio. The marrow conversion index, which reflects the ratio of fatty marrow conversion of the proximal femoral metaphysis to that of the greater trochanter measured on T1 weighted magnetic resonance images, is increased in osteonecrotic hips.

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The number of whooping cough notifications has declined in recent years, as vaccine coverage has recovered from the low levels seen in the 1970s and 1980s. Notification of infectious disease is often incomplete, and this study aimed to estimate the extent to which whooping cough is undernotified. We included all cases of whooping cough occurring in the North West Region between 1 April 1994 and 31 December 1996, identified by notification, hospital admission data, or laboratory reports. By combining the three sources, 1239 cases were identified, 69.6% of which were notified. The notification rate was 29.6% (131/442) for cases admitted to hospital and 45.6% (78/170) for laboratory reported cases. Completeness of notification was estimated to be 35.7% (863/2420; 95% confidence interval 30.3-43.4%) using the capture-recapture method. The study confirms that notification of whooping cough is incomplete and suggests that two thirds of cases are not notified.

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OBJECTIVES: The aim of this study was to assess patient satisfaction with the geriatric services of a district general hospital and to examine whether there was a difference in satisfaction between patients in hospital and those who had been recently discharged. METHODS: A structured and validated patient satisfaction questionnaire was administered before discharge to hospitalised patients with a mental test score of 8 or more. It was also administered to a group of patients in the community who had been discharged from hospital not more than 72 hours earlier. The questionnaire was designed to assess seven separate areas, and contained 51 statements with which patients were asked to agree or disagree. Statistical analysis was by the Mann-Whitney U test and p < 0.05 was taken as significant. A total of 134 elderly patients (> 72 years) were surveyed over a four-month period. RESULTS: Satisfaction with the hospital geriatric service was high in both groups of patients. However, patient satisfaction differed between the two groups in three areas: interpersonal aspects; access, availability and convenience of the health services; and financial aspects.

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The aim of the study was to evaluate the follow-up of sporadic cases of suspected food-borne illness by either a postal questionnaire or a personal visit by environmental health staff. This was achieved by comparing the practice in two authority areas within the West Pennine Health Authority in the north west of England. We included all identified cases of suspected food poisoning, campylobacteriosis, cryptosporidiosis, salmonellosis and dysentery occurring in the district between 1 July and 30 September 1996. The main outcome measures were: (1) the proportion of all cases which were successfully followed-up by each method; (2) the timeliness of follow-ups; (3) qualitative estimation by environmental health staff of the data obtained. Visiting by environmental health staff was successful in obtaining information from 76.3% (106/139) of cases, while the postal questionnaires elicited a 52% (50/96) response rate. We found that 70.5% of visits occurred within one week of notification. Although 69.8% (67/96) of questionnaires were issued within one week of notification, only 16% of replies to the questionnaire were received within this period. The information provided on the returned questionnaires was found by environmental health staff to be generally as useful as that obtained by visiting.

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We have estimated the completeness of tuberculosis notification in Bolton health district by combining notification data with information from prescriptions issued by general practitioners and hospital admission data. From 1 January 1991 to 31 December 1993, 307 cases of tuberculosis were notified in Bolton. Thirty-four cases were identified using general practitioners' prescriptions: 27 of these had been notified between January 1991 and December 1993, and seven had not been notified during this period. Although prescriptions may be used as a marker for tuberculosis, they would not be an adequate alternative to notification of cases. One hundred and forty-eight cases of tuberculosis were identified between 1 October 1992 and 30 September 1993 by combining data from the three sources: 138 cases had been notified (93.2%), 28 identified from prescriptions (23.0%), and 54 identified from hospital data (36.5%).

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A self-administered postal questionnaire was sent to 216 Bolton shopkeepers to examine their knowledge and attitudes about children's smoking. The response rate was 76%. A majority of respondents (57%) were in favour of banning cigarette advertising; this option was supported by significantly more women (73%) than men (46%), (p < 0.05). There was widespread recognition of the harmful consequences of children's smoking (97%), although the highly addictive nature of cigarettes was not as widely acknowledged (41%). Many of the shopkeepers perceived children's smoking as a normal part of growing up (49%); this view was held more frequently by shopkeepers who had smoked during their own childhood (62%). Challenging shopkeepers' acceptance of children's smoking as a normal part of growing up, and increasing their awareness about the highly addictive nature of cigarettes, may reduce their willingness to sell cigarettes to children.

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Prostaglandin manipulation has been shown to improve pulmonary dysfunction in animal models of acute respiratory distress syndrome. Using our previously reported porcine model of Pseudomonas-induced respiratory failure, we examined the therapeutic effects of a vasodilating prostaglandin, PGE1, and a reversible cyclooxygenase inhibitor, ibuprofen. Forty-two animals were randomized to seven groups: I--ibuprofen; II--PGE1; III--ibuprofen + PGE1; IV--Pseudomonas + ibuprofen; V--Pseudomonas + PGE1; VI--Pseudomonas + ibuprofen + PGE1; VII--Pseudomonas. Ibuprofen significantly improved pulmonary vasoconstriction, pulmonary hypertension, and hypoxemia, as well as increased survival slightly. PGE1 had no effect on pulmonary dysfunction, but prevented the rise in systemic vascular resistance that occurred in untreated, infected animals and animals treated with ibuprofen alone. Combination therapy improved stroke volume index, a measure of nonpulmonary organ function.

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To find out what happens to patients admitted to an acute geriatric medical unit, all admissions during 1982 were reviewed. Demographic features were compared with those of the community served, and rehabilitation, inpatient mortality and mortality in the year following discharge were assessed. Inpatients accounted for 4% of the community aged over 65, and most patients were discharged back to the community. Inpatient mortality was 25% and mortality in the year following discharge was 23%, giving a two year mortality of 42%, which was similar in all age groups. The achievement of high rehabilitation rates was tempered by the considerable mortality rates following discharge.

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Microbial contamination of the water system in 12 dental units and nine ultrasonic scalers was investigated. Water samples from ultrasonic scalers, high-speed handpieces and water syringe lines showed microbial concentrations of up to 2.6 million, 3.3 million and 190,000 colony forming units/ml respectively. Flushing the lines for 2 minutes reduced the microbial levels, but complete elimination of all bacteria was not achieved. The infectious potential of contaminated water, to the dentists and patients, particularly the compromised host is discussed.

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