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Clinical decisions should be based on evidence. This paper explores the skills necessary to read critically and evaluate medical literature, and in particular discusses how to appraise a study from a general practice perspective. It outlines the different types of study used in medical literature and the weight that should be attributed to each. The anatomy of a research paper is described indicating the important features to be found in each section of a study; the Introduction, Methods, Results, Discussion and Conclusion (IMRAD) and the essential components, possible problems, and sources of bias that may be found in each section. The need for close examination of the methodology is emphasised, as this determines the quality of the study, with sufficient detail provided in the methods section that the study could be replicated. Sampling and bias are explored in detail and the important features of a measuring instrument are described. Response rates, confounding factors and the use of statistics are also highlighted. The study upon which the research paper is based is usually the best that was possible within resource limitations and, while the evidence should be appraised objectively, the quality of the study should be seen within the context of these limitations.

The benefits of physical activity are well documented and exercise is included in most health promotion recommendations but, before adopting a population strategy, it is important to establish baseline patterns of physical activity so as to make regional and international comparisons and measure behaviour change. This review examines adult physical activity participation in a national and international context and highlights how difficult it is to draw meaningful conclusions and detect trends from studies that measure physical activity using different measuring instruments. Overall, about 4 in 5 people are active at least occasionally but the more rigorous the definition of habitual physical activity the lower the participation rates so that less than 1 in 5 people perform regular vigorous physical activity. Males are more active than females with a decrease in physical activity with increasing age. There is a social class gradient with those in social classes 1 and 2 being more active.

READER represents a sequence of steps in the assessment of general practice literature. An article may be judged on the first four steps: r for relevance, e for education, a for applicability, d for discrimination. The next step, e, involves the evaluation of the article using a scoring system. Finally the reader decides what to do with the article, as illustrated by r for reaction.

The relationship between physical activity, physical fitness and serum ascorbate was examined in the Northern Ireland Health and Activity Survey. This was a cross sectional population study (n = 1600), using a two stage probability sample, of the population of N. Ireland. Physical activity profile was recorded by computer assisted interview and physical fitness was determined by estimation of VO2 max by extrapolation from submaximal oxygen uptake. Serum ascorbate was measured using a colorimetric reaction of 2,4 dinitrophenylhydrazine with dehydroascorbate. Mean serum ascorbate was greater in females than males (p < 0.001), and was lower in smokers than non-smokers in both males (p = 0.01) and females (p < 0.001). There was no statistically significant relationship between serum ascorbate and age, social class, body mass index, physical activity or physical fitness in males but there was a relationship with age (p < 0.01) and physical fitness (p < 0.05) in females.

Epidemiological studies have demonstrated the considerable benefits of habitual vigorous activity, both at work and during leisure time. There are many benefits at all ages and for all levels of fitness, but particular emphasis is being placed on the cardiovascular benefits. Exercise may induce beneficial changes in lipid profile and thus reduce risk of cardiovascular disease. Lifestyle changes cost little, have few side-effects, and are self-administered. Increasing habitual physical activity is a form of lifestyle modification that can be tailored to all needs--a non-therapeutic intervention of proven efficacy and of value to all patients.

A one-week smoking awareness initiative and subsequent audit in a general practice are described. All patients attending morning surgery during the study period were offered the opportunity to discuss smoking habits at a smoking awareness clinic: 84 smokers attended. They were interviewed by the practice preventive care nurse who took a smoking history, monitored carbon monoxide (CO Hb) levels and offered a follow-up appointment. CO Hb provided immediate feedback on the effect of smoking and patients who smoked 20 or more cigarettes per day had an average CO Hb of 16.1 per cent. Fifteen per cent of smokers made a commitment to stop smoking and agreed to attend follow-up clinics. A random sample (50) of attenders at the initial Smoking Awareness Clinic (84) were followed up by questionnaire six months later. There were 29 replies (58 per cent); 19 patients (65 per cent) found the visit to the clinic helpful, 14 (48 per cent) reduced the number of cigarettes they smoked, and 11 (38 per cent) altered some other aspect of their lifestyle, of whom four modified their diet and four increased exercise. Five patients claimed they had given up smoking.

Exercise may help prevent coronary heart disease ( 1 , 2 , 3 ), maintain a healthy weight, strengthen the bones ( 4 ), and preserve independence in the elderly and disabled ( 5 ). As the Department of Health has recently noted ( 5 ), 'appropriate physical activity or exercise is necessary for healthy living.

The indications for and findings in 431 consecutive patients who had upper gastrointestinal endoscopy in Zaria from June 1978 to August 1982 are reviewed. The major indications were dyspepsia (78.1%), upper gastro-intestinal bleeding (12.1%) and portal hypertension (4.2%). Other indications were persistent vomiting, dysphagia and abdominal masses. The mean age of the patients was 32 years. The male: female ratio (3:1) was not different from that in the hospital population. There were no abnormal findings in 32.7%. 26.6% had duodenal ulcers. Duodenitis was noted in 24.8%, oesophageal varices in 6.3%, gastritis in 6.3% and hiatus hernia in 4.6%. In those who presented with upper-gastrointestinal haemorrhage, oesophageal varices (34.6%) and peptic ulcer (17.3%) were the commonest findings. Complication seen commonly were soreness in the throat and thrombophlebitis at the site of valium injection. One death was recorded from the procedure over the period.

Two children suffering from systemic juvenile chronic arthritis (JCA) complicated by acute disseminated intravascular coagulation (DIC) are described. One had a fatal outcome with acute renal failure and cerebral haemorrhage; the other recovered. Early recognition and treatment of the underlying cause - usually an infection - as well as replacement of clotting factors are important in management.