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OBJECTIVE: To evaluate an occupational therapy intervention to improve outdoor mobility after stroke. Design Randomised controlled trial. Setting General practice registers, social services departments, a primary care rehabilitation service, and a geriatric day hospital. Participants 168 community dwelling people with a clinical diagnosis of stroke in previous 36 months: 86 were allocated to the intervention group and 82 to the control group. Interventions Leaflets describing local transport services for disabled people (control group) and leaflets with assessment and up to seven intervention sessions by an occupational therapist (intervention group). MAIN OUTCOME MEASURES: Responses to postal questionnaires at four and 10 months: primary outcome measure was response to whether participant got out of the house as much as he or she would like, and secondary outcome measures were response to how many journeys outdoors had been made in the past month and scores on the Nottingham extended activities of daily living scale, Nottingham leisure questionnaire, and general health questionnaire. RESULTS: Participants in the treatment group were more likely to get out of the house as often as they wanted at both four months (relative risk 1.72, 95% confidence interval 1.25 to 2.37) and 10 months (1.74, 1.24 to 2.44). The treatment group reported more journeys outdoors in the month before assessment at both four months (median 37 in intervention group, 14 in control group: P < 0.01) and 10 months (median 42 in intervention group, 14 in control group: P < 0.01). At four months the mobility scores on the Nottingham extended activities of daily living scale were significantly higher in the intervention group, but there were no significant differences in the other secondary outcomes. No significant differences were observed in these measures at 10 months. CONCLUSION: A targeted occupational therapy intervention at home increases outdoor mobility in people after stroke.

This is the second article describing a qualitative research study, which explores the experience of recovery following hospital discharge. This article presents staff members' experience of health-care delivery in the community following hospital discharge for people aged 75 years and over.

This is the first of two articles describing a multi-faceted qualitative research study exploring the experience of discharge and recovery following an acute stay in hospital. This paper focuses on patient experiences. Suggestions are made to inform the development of an integrated community and primary care-based rehabilitation.

To describe the views of key healthcare professionals on the changes they considered to be important in the reduction of major trauma mortality between 1988 and 1995 in Leeds.

A radioimmunoassay for plasma ethinyl oestradiol, featuring an immunosorbent extraction procedure, is described. Ethinyl oestradiol (EE2) was extracted using a non-specific, anti-oestrogen serum, raised to an oestradiol-17-hemisuccinate conjugate. The antiserum, coupled to microcrystalline cellulose, selectively extracted EE2but not norethisterone (NE), thus conferring specificity on a radioimmunoassay which has previously exhibited unacceptably high cross-reactivity with the synthetic progestagen, norethisterone, often used concomitantly with ethinyl oestradiol. This radioimmunoassay was shown to fulfil accepted assay validation criteria. Levels in subjects not receiving EE2were less than 25 pmol/l. Circulating concentrations of EE2could therefore be accurately determined in patients receiving low-dose combined preparations (EE235 μg; NE 500 μg).

A robust assay for routine measurement of blood-spot 17α-hydroxyprogesterone (17-OHP) concentrations has been developed using a magnetisable, solid-phase antiserum and an 125I-radioligand. The working range of this assay (13.5–500 nmol/L) is well suited for the initial diagnosis of congenital adrenal hyperplasia (CAH) and for monitoring replacement therapy in CAH patients. Data derived from multiple blood-spot samples, collected on two consecutive days, provide 17-OHP profiles. These profiles have been used to construct a chart allowing a rapid visual assessment of the efficacy of replacement therapy in CAH patients. Measurement of 17-OHP in the blood-spots of over-treated patients and accurate determination of normal range values in healthy infants relied on development of a sensitive assay (range 1.7–34 nmol/L). In the blood-spots of normal male (n=50) and female (n=50) infants collected 5–7 days after birth, 17-OHP concentrations were 7.62±2.55 nmol/L and 7.32±2.87 nmol/L respectively. Retrospective measurement of this steroid in samples from known CAH patients (n=4), which had values ranging from 224 to 2145 nmol/L, support a role for measurement of blood-spot 17-OHP in high-risk screening programmes.

A radioimmunoassay suitable for measurement of 17αOH-progesterone concentrations in small aliquots of plasma (20 μL), amniotic fluid (20 μL) and saliva (200 μL) is described. The assay features an antiserum raised against a 17αOH-progesterone-3-(O-carboxymethyl)oxime/BSA conjugate coupled to a magnetisable, solid-phase support; the homologous radioligand is a 125I-iodohistamine conjugate. This combination of a γ-emitting ligand and a magnetic-separation procedure has the advantage of reducing assay time and cost; it also allows processing of plasma and saliva samples in the same assay batch. The method has satisfactory sensitivity, precision and accuracy. Data derived from clinical studies of patients with congenital adrenal hyperplasia indicate the usefulness of this assay in routine practice.

A radioimmunoassay for testosterone in male plasma utilising a gamma-emitting radioligand and a solid-phase antiserum is described. The radioligand is testosterone-3-(O-carboxymethyl)-oxime coupled to 125I-iodohistamine, and the solid-phase antiserum is prepared by coupling antitestosterone-3-bovine serum albumin to cyanogen bromide activated cellulose. The new procedure retains much of the specificity associated with a published, specific radioimmunoassay using an antiserum raised against testosterone-11α-BSA and a tritium radioligand and incorporating a dextran-coated charcoal separation procedure; values obtained by the two procedures are in excellent agreement (r = 0·98, n = 20).The combination of an 125I-radioligand and a solid-phase separation technique greatly increases sample throughput and has the further advantage of reduced running costs and a greater potential for automation. The method gives satisfactory levels of sensitivity, precision, and accuracy.

To account for the apparent high incidence of pain in the feet of elite women kendo players.

Second trimester amniotic fluid was analysed from 54 pregnancies at risk of fetal 21-hydroxylase deficiency; the outcome is currently known in 46. Analysis of samples from a further 96 normal outcome pregnancies provided a reference range for 17P. The assay used an 125I-radioligand and an antiserum raised against a 17P-3-CMO-BSA conjugate coupled to a magnetisable, solid-phase support. Mean ± SD 17P values were: normals, 18.5±5.2 nmol/l (range 9.8 - 30.7); predicted unaffected, 17.4 ± 6.5 (9.4 - 31.3, n = 37); predicted affected, 64.2 ± 46.3 (30 - 170, n = 9; p<0.001). Unaffected pregnancies produced all normal infants at birth, but a male non-salt loser had increased 17P levels at 3 months. Four of 9 predicted pregnancies were terminated, 1 affected male died at 2 weeks after preterm delivery; in the remaining 4 term pregnancies, 21OHD was confirmed postnatally in 3 and excluded in 1 by a normal plasma 17P. Family HLA typing showed he was a heterozygote. Information on 44 index cases showed 61% females and 77% salt-losers; 8 of these had died in infancy. All fetuses in this study predicted to be affected were salt-losers. Thus prenatal steroid analysis is reliable only for this vulnerable group. Preliminary data from the literature indicates that use of current 21OH gene probes may not be any more specific in the diagnosis of the precise phenotype.