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Objective: To assess the long term effects of an obesity prevention programme in schools., Design: Longitudinal results after a cluster randomised controlled trial., Setting: Schools in southwest England., Participants: Of the original sample of 644 children aged 7-11, 511 children were tracked and measurements were obtained from 434 children three years after baseline., Intervention: The intervention was conducted over one school year, with four sessions of focused education promoting a healthy diet and discouraging the consumption of carbonated drinks., Main Outcome Measures: Anthropometric measures of height, weight, and waist circumference. Body mass index (BMI) converted to z scores (SD scores) and to centile values with growth reference curves. Waist circumference was also converted to z scores (SD scores)., Results: At three years after baseline the age and sex specific BMI z scores (SD scores) had increased in the control group by 0.10 (SD 0.53) but decreased in the intervention group by -0.01 (SD 0.58), with a mean difference of 0.10 (95% confidence interval -0.00 to 0.21, P=0.06). The prevalence of overweight increased in both the intervention and control group at three years and the significant difference between the groups seen at 12 months was no longer evident. The BMI increased in the control group by 2.14 (SD 1.64) and the intervention group by 1.88 (SD 1.71), with mean difference of 0.26 (-0.07 to 0.58, P= 0.12). The waist circumference increased in both groups after three years with a mean difference of 0.09 (-0.06 to 0.26, P=0.25)., Conclusions: These longitudinal results show that after a simple year long intervention the difference in prevalence of overweight in children seen at 12 months was not sustained at three years.

Objective: To determine if a school based educational programme aimed at reducing consumption of carbonated drinks can prevent excessive weight gain in children., Design: Cluster randomised controlled trial., Setting: Six primary schools in southwest England., Participants: 644 children aged 7-11 years., Intervention: Focused educational programme on nutrition over one school year., Main Outcome Measures: Drink consumption and number of overweight and obese children., Results: Consumption of carbonated drinks over three days decreased by 0.6 glasses (average glass size 250 ml) in the intervention group but increased by 0.2 glasses in the control group (mean difference 0.7, 95% confidence interval 0.1 to 1.3). At 12 months the percentage of overweight and obese children increased in the control group by 7.5%, compared with a decrease in the intervention group of 0.2% (mean difference 7.7%, 2.2% to 13.1%)., Conclusion: A targeted, school based education programme produced a modest reduction in the number of carbonated drinks consumed, which was associated with a reduction in the number of overweight and obese children.

Patients with cancer in the UK suffer more delays and worse survival than those in many other European states. The national cancer plan has set ambitious targets for improved care. The cancer services collaborative is using improvement methods to reduce delays and improve the service for patients. The nine cancer networks using these methods have cut waiting times and improved patients' experiences of care.

The right of consultants to study leave and expenses is not binding on trusts and has been eroded in directly managed units. Complaints led to a survey of consultants in North West Thames region. This showed that most consultants use their own time and money to maintain their knowledge by buying and consulting journals and textbooks, attending local meetings, and using their annual leave for study, but they feel the need for study leave to attend meetings of specialist societies and courses. Leave is usually granted readily but without cover provided by a locum and with a very limited contribution to expenses. To maintain quality of medical care both the right and obligation to take study leave should be contractual.

Objective: To determine the course of brittle diabetes., Design: 12 year follow up of patients identified in 1977-9 as having brittle diabetes; retrospective review of the case notes., Setting: Nottingham health district., Subjects: 25 brittle diabetic patients were identified in 1979-9; 11 (five men) had three or more admissions with ketoacidosis between June 1977 and 1979 and 14 (eight men) had three or more attendances at the accident and emergency department with hypoglycaemia in 1978. Two controls from our diabetic register were matched to each patient for age, sex, and duration of diabetes., Main Outcome Measures: Frequency of ketoacidosis and severe hypoglycaemia in the 12 years after ascertainment; diabetic control and complications in 1988-90; retrospective attribution of the cause of brittleness., Results: Patients with recurrent ketoacidosis had had a median (range) of 28 (8-67) episodes. One man died of a cerebral tumour but five of the surviving nine patients had not been admitted in the past two years, although diabetic control remained poor (median haemoglobin A1 concentration 14%). Seven patients had pure hypoglycaemic brittleness, and five had also had eight or more admissions with ketoacidosis (mixed brittleness). Two died of uraemia within a year after ascertainment and two others in hypoglycaemic coma seven and 12 years later. Brittle diabetes was in most cases related to a specific situation, usually unhappiness at home or school., Conclusions: Brittle diabetes is often episodic and almost always related to stressful life circumstances. Once the underlying cause is removed it tends to improve. Recurrent hypoglycaemic brittleness of psychological origin has a poor prognosis.

Graft survival after 348 consecutive first cadaver-donor renal transplants was significantly improved by HLA matching when recipients who had received pretransplant blood transfusions were matched with their kidney donor for two HLA-B locus antigens. No other type of HLA matching significantly improved graft survival in transfused recipients nor did any type of HLA matching in non-transfused recipients. Matching for one HLA-DR antigen had no benefit in transfused recipients. Only two patients received kidneys matched for both DR antigens and only two of those in whom DR matching had been performed had not been transfused. These results indicate that pretransplant blood transfusion and selection of graft recipients predominantly on the basis of HLA-B matching has significantly reduced the renal graft rejection rate in Newcastle upon Tyne over two years. Thus, HLA-B antigen matching should be adopted as the main criterion for kidney sharing between transplant centres.

Seven patients with slight but definite proliferative changes in the glomeruli achieved complete remission of the nephrotic syndrome when treated with prednisone. The patterns of response and, in three cases, repeated relapse and response suggested that this was more than a coincidental spontaneous cure. A controlled trial of corticosteroids in patients with slight proliferative glomerulonephritis and severe nephrotic syndrome should be carried out to verify these results.

A shared hospital-GP record for control of hypertension was studied in a sample of 60 patients. Over 80% of patients brought the record to hospital duly completed. Two-thirds of GPs, and the hospital staff, assessed the record as a useful aid in the care of hypertensives. It is still employed enthusiastically, three years after its introduction.

Almost half the sphygmomanometers in a teaching hospital group had defects in the control valve which interfered with accurate blood-pressure reading. Ward staff should be taught to check sphygmomanometers regularly and replace control valves; time consumption and cost are low. The cuffs in general use in these hospitals, and of the standard size sold in Britain, had rubber bags which did not encircle the arm of more than half the patients on whom they were used. This deficiency causes over-reading of blood pressure in obese people. The size of error is uncertain but it should be avoided by adopting a cuff with a longer bag.

Two hundred and twenty nine consecutive patients (129 men, mean age 45) were reviewed 12 to 65 months after starting treatment with continuous ambulatory peritoneal dialysis (CAPD) from January 1979 to December 1983. They received CAPD for a mean of 19.8 (range 0.5-62) months. Actuarial patient survival was 79% at 24 months and 72% at 36 months. Half of the 46 deaths were related to cardiovascular disease, while eight patients died of abdominal complications, including three patients with peritonitis. Peritonitis occurred at a rate of one episode per 35 patient weeks, and 88% of episodes were cleared by one or more courses of antibiotics. This still left peritonitis as the commonest cause of failure of CAPD, leading to a permanent change of treatment in 44 patients and temporary interruption in a further 25. CAPD remains a reasonable medium term treatment in chronic renal failure. Despite the persisting problem of peritonitis the results are comparable with those achieved by haemodialysis, and CAPD has become the treatment of first choice for end stage renal failure in Newcastle. In younger patients judged unsuitable for transplantation and facing long term dialysis, however, haemodialysis is preferred.

Among 39 patients treated by regular haemodialysis for four years or more pathological fractures and histological evidence of osteomalacia were significantly more common in those taking barbiturates. Out of 58 transplant recipients surveyed after one year, seven had osteomalacia; four of these had been taking phenobarbitone and phenytoin and one had taken barbiturates alone. Sedatives and other drugs such as phenobarbitone and phenytoin that induce hepatic microsomal enzymes should probably be avoided when possible in patients with chronic renal failure and after transplantation.

A radiofibrinogen catabolism study performed on 40 patients with glomerulonephritis has shown increased fibrinogen catabolism in active immune-complex disorders.

In an attempt to determine the nature of hypothalamic and pituitary dysfunction in renal failure the secretory patterns of luteinising hormone were measured in men with end stage renal disease and compared with those in healthy controls and renal transplant recipients of similar age distribution. Mean luteinising hormone and oestradiol concentrations were significantly higher and the number of luteinising hormone secretory pulses was significantly lower in uraemic men compared with controls. Plasma testosterone and oestradiol concentrations were significantly lower in renal transplant recipients than normal men, but there were no significant differences in mean gonadotropin concentrations or the number of pulses of luteinising hormone between the two groups. As pulses of luteinising hormone are thought to reflect episodic gonadotropin releasing hormone from the hypothalamus these data suggest that uraemia interferes with central mechanisms controlling synchronised release of gonadotropin releasing hormone. This defect appears to be reversible after successful transplantation.

Renal function was studied in 17 patients with rheumatoid arthritis who had each consumed between 5 and 20 kg of aspirin. After an interval of two years 14 of these patients-seven of whom had consumed a further mean of 2 kg of aspirin-had their renal function retested. No relation was found between total dose, rate, or duration of ingestion and any aspect of renal function that was studied. All patients had plasma creatinine levels within the normal range, though slight depression in creatinine clearance was not uncommon.From this study and other published data we conclude that aspirin rarely if ever causes analgesic nephropathy when prescribed alone in doses appropriate to the treatment of rheumatoid arthritis.

In a dialysis centre with a high tap water aluminium content and a known high incidence of dialysis encephalopathy, 29 patients undertaking regular home dialysis, without clinical evidence of encephalopathy, were studied with a battery of psychological tests that have proved useful in detecting early organic intellectual deterioration in other conditions. Full-scale intelligence quotient, as measured by the Wechsler Adult Intelligence Scale, did not differ significantly from that of the normal population, but the patients showed significant deficiencies in three tests of performance--namely, digit symbol, block design, and picture arrangement. The ability to acquire new information in relation to performance was impaired and the abnormality increased with time on dialysis. Such tests should be useful in early detection of dialysis dementia at a reversible stage.