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BACKGROUND: Usually experts decide on which research is worthwhile, yet it is government policy to involve service users in research. There has been a lack of published research about involving patients from minority ethnic groups and people from deprived areas in setting research agendas. In this study we wanted to hear the voices of patients that are not often heard. AIM: To find out the research priorities of people with diabetes from an inner city community and compare these with current expert-led research priorities in diabetes. DESIGN OF STUDY: A qualitative study using a participatory approach with consumer groups. SETTING: Primary care within inner city Nottingham, UK. METHOD: Thirty-nine adult patients with diabetes with varying ethnic backgrounds recruited from three general practices. Six focus groups carried out in participants' preferred language, analysed using the constant comparative method. RESULTS: Nine main themes equating to research priorities were identified. Within these themes, information and awareness, service delivery and primary prevention of diabetes emerged as the main factors. There were no science-based topics and there was more emphasis on culturally influenced research questions, which differed from recent Department of Health priorities. There were several themes about service delivery, patient self-management and screening and prevention of diabetes that overlapped. CONCLUSIONS: There is some divergence between expert-led and patient-led agendas in research about diabetes. Patient perspectives have a significant influence on research priorities, and there are likely to be several different patient perspectives. [ABSTRACT FROM AUTHOR]

Objective: To investigate the range of knowledge, attitudes and practices of parents regarding baby walkers.Design: A qualitative study using a focus group approach.Setting: Three focus groups were held in community mother and toddler drop-in centres, and one in a hospital antenatal clinic.Methods: Four focus groups were held over a two-month period in 2000. Parents from areas with differing levels of deprivation (including walker users and nonusers) and antenatal parents were recruited. Data were thematically analysed. Revisiting the data for conflicting evidence tested any themes.Results: Some parents believe that walkers could help a child to walk and to build up strength in the legs and that walkers must be safe if British Safety Standards have been met. Other parents want to make life a little easier for themselves and appear to be prepared to take a calculated risk with their child's safety in order to achieve this. Walkers themselves are acknowledged by most parents as being involved in accidents but the blame is attributed to lack of supervision. Most nursery equipment alternatives are seen to have safety problems in their own right, but there is some support for engaging in floor play with children. All the above themes were identified in the discussions of both affluent and deprived walker users and nonusers.Conclusions Any education aimed at reducing walker-related injuries should include an explanation of ways to facilitate motor development, raise awareness of safety standards for walkers, acknowledge the difficulties of life with an active baby and emphasise the need for passive safety measures. [ABSTRACT FROM AUTHOR]

Objective: To explore the perceptions and experiences of health visitors and parents of health education approaches to baby walker use.Design: An exploratory focus group study to inform the development of an educational intervention to reduce baby walker use. Five groups were conducted. One group consisted solely of health visitors, one of antenatal parents and three of parents of children under 5 years of age.Setting: Focus groups took place in the East Midlands area of the UK. Deprived and nondeprived areas were chosen by their 'Jarman' score and parent and toddler groups at local community facilities in these areas were invited to take part. Health visitors working within these areas were asked to participate, as were parents from these areas attending a hospital antenatal group.Method: A purposive sampling strategywas used to recruit 43 professional and parent participants so that there was a mixture of baby walker users and nonusers, living and working in deprived and nondeprived areas. The five focus group interviews lasted for approximately one hour, were facilitated by the authors (AW RH) tape recorded and transcribed and the transcriptions analysed by extracting the themes which emerged using the data management package NUD*ISTResults: A number of common themes emerged including the dilemmas hich arise in the health education consultation; how markets drive parental choices and the literature available; how parents and health visitors perceive each other in the consultation and the difficulties of explaining risks in a way which is understandable.Conclusion There are difficulties in the health education consultation which arise between parents and health visitors that need to be aired and addressed. There is a need for more training and support for health visitors and for them to be provided with evidence-based information which can be used in their daily practice. More research is required which looks at the respective experiences of parents and health visitors in the health education consultation. [ABSTRACT FROM AUTHOR]

The adrenocortical response to stress was studied longitudinally in 10 ill preterm infants using measurements of cortisol and 170H-progesterone concentrations in filter paper blood spots. Mean cortisol and 170H-progesterone concentrations reached a peak of 2200 nmol/l and 65 nmol/l, respectively, between the third and fifth days of life. These concentrations far exceeded those observed in older children and adults subjected to stress as a result of surgery. Further pulses of endogenous cortisol production of 4000 nmol/l or more occurred in association with clinical complications such as intraventricular haemorrhage. These results indicate that infants undergoing intensive care are unduly stressed. Consideration should be given to providing enough sedation and appropriate analgesia for ill preterm infants during painful procedures such as insertion of venous cannulae and arterial puncture. [ABSTRACT FROM AUTHOR]

Adrenocortical function was studied in 52 newborn infants who had been divided into three groups: preterm well, preterm ill, and term ill. Basal plasma 17-hydroxyprogesterone concentrations were significantly increased in both groups of preterm infants. There was no significant difference in basal plasma cortisol concentrations, although they were highest in preterm ill infants. All infants responded to adrenocorticotrophic hormone (ACTH) stimulation (36 micrograms/kg intramuscularly) with a two to three fold increase in the concentration of both steroids. The peak plasma 17-hydroxyprogesterone response was significantly higher in preterm ill infants. A subgroup of five infants, who were highly stressed but had undetectable basal plasma cortisol concentrations, also showed an appropriate response to ACTH. The results provide useful reference data to assess adrenal function in the infant of a mother given glucocorticoids during pregnancy. There is also a change from the pattern of fetal adrenal steroidogenesis soon after birth, which may be affected by exogenous ACTH stimulation. Roughly 10% of stressed newborns failed to synthesise cortisol basally; temporary glucocorticoid replacement for such infants may be appropriate. [ABSTRACT FROM AUTHOR]

The effect of anticonvulsant therapy on early morning concentration of cortisol in saliva and plasma was assessed in a group of epileptic patients receiving regular phenytoin medication and the results compared with those obtained from a group of normal subjects not receiving drug therapy. Values of cortisol in matched samples of plasma (331 +/- 23 nmol l-1, mean +/- s.e. mean, n = 6) and saliva (11.4 +/- 0.9 nmol l-1, mean +/- s.e. mean, n = 9) provided by epileptics did not differ significantly from those in the plasma (334 +/- 41 nmol l-1, mean +/- s.e. mean) and saliva (12.0 +/- 2.0 nmol-1, mean +/- s.e. mean) of healthy volunteers (n = 12). Six anticonvulsant-treated epileptics, together with six age and sex matched normal volunteers, each received intravenous dexamethasone (1 mg h-1) to determine the half-life of cortisol in plasma and saliva. In the anticonvulsant- treated group, the half-life of cortisol in plasma (73 +/- 5 min, mean +/- s.e. mean) and saliva (83 +/- 5 min, mean +/- s.e. mean) was reduced significantly (P less than 0.01 plasma, P less than 0.05 saliva) from that observed in healthy volunteers. In patients, the half life of cortisol and antipyrine showed a significant correlation (r2 = 0.75, P less than 0.05 plasma, r2 = 0.71, P less than 0.05 saliva). The antipyrine half-life in saliva was reduced significantly (P less than 0.02) and the antipyrine clearance rate, increased significantly (P less than 0.005) in the treated epileptic group, reflecting drug- induced microsomal enzyme production.(ABSTRACT TRUNCATED AT 250 WORDS) [ABSTRACT FROM AUTHOR]

Peripheral blood OKT8 cell phenotypes were correlated with measurements of plasma cortisol and serological evidence for exposure to 15 infectious agents, in longitudinal studies involving 13 patients with multiple sclerosis, 13 of their siblings, nine spouses and 13 unrelated controls; 44/48 individuals were HLA typed. Neither circadian rhythms, nor exposure to any one infectious agent accounted for the serial changes in OKT8 cells but there was an association between the presence of HLA-DR2 and periodic reductions in OKT8 cells irrespective of clinical status. Taken with previously reported serial observations in patients and cohabiting relatives, this finding provides indirect evidence for an interplay between environmental and genetic factors in determining OKT8 cell phenotypes in multiple sclerosis. [ABSTRACT FROM AUTHOR]

The concentration of 170H-progesterone was measured in amniotic fluid samples collected from 55 mothers who had previously had a child with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. In eight pregnancies the levels of 170H-progesterone were raised; the parents elected to terminate in four and examinations of the fetus confirmed the diagnosis of congenital adrenal hyperplasia. In each case, the affected sib was a salt loser. The remaining four affected pregnancies proceeded to term and each infant had salt losing 21-hydroxylase deficiency. All 47 infants predicted to be unaffected were normal at birth. However, an increased plasma concentration of 170H-progesterone was documented in a male non-salt loser at three months of age. Prenatal diagnosis of congenital adrenal hyperplasia by amniotic fluid steroid analysis is reliable only for the salt losing variant of 21-hydroxylase deficiency. Of the affected sibs in this study, 20% died during infancy in a salt losing crisis. This simple and rapid prenatal test is sufficiently reliable to predict the group of infants most at risk in early infancy. [ABSTRACT FROM PUBLISHER]

Plasma 17-hydroxyprogesterone concentrations were determined in 47 preterm and term infants who were ill from a variety of causes. The results were compared with those in 53 healthy term infants. Mean plasma 17-hydroxyprogesterone values were appreciably higher in ill term and healthy preterm infants compared with healthy term infants, but the highest values were found in ill preterm infants. None of the infants had adrenal disease but some very ill infants had plasma 17-hydroxyprogesterone values approaching those seen in untreated infants with congenital adrenal hyperplasia. Interpretation of the results of plasma steroid measurements in newborn infants must take account of gestational age and the presence of stress related illness. [ABSTRACT FROM AUTHOR]

BACKGROUND: This paper describes an evaluation of an initiative to increase the research capability of clinical groups in primary and community care settings in a region of the United Kingdom. The 'designated research team' (DRT) approach was evaluated using indicators derived from a framework of six principles for research capacity building (RCB) which include: building skills and confidence, relevance to practice, dissemination, linkages and collaborations, sustainability and infrastructure development. METHODS: Information was collated on the context, activities, experiences, outputs and impacts of six clinical research teams supported by Trent Research Development Support Unit (RDSU) as DRTs. Process and outcome data from each of the teams was used to evaluate the extent to which the DRT approach was effective in building research capacity in each of the six principles (as evidenced by twenty possible indicators of research capacity development). RESULTS: The DRT approach was found to be well aligned to the principles of RCB and generally effective in developing research capabilities. It proved particularly effective in developing linkages, collaborations and skills. Where research capacity was slow to develop, this was reflected in poor alignment between the principles of RCB and the characteristics of the team, their activities or environment. One team was unable to develop a research project and the funding was withdrawn at an early stage. For at least one individual in each of the remaining five teams, research activity was sustained beyond the funding period through research partnerships and funding successes. An enabling infrastructure, including being freed from clinical duties to undertake research, and support from senior management were found to be important determinants of successful DRT development. Research questions of DRTs were derived from practice issues and several projects generated outputs with potential to change daily practice, including the use of research evidence in practice and in planning service changes. CONCLUSION: The DRT approach was effective at RCB in teams situated in a supportive organisation and in particular, where team members could be freed from clinical duties and management backing was strong. The developmental stage of the team and the research experience of constituent members also appeared to influence success. The six principles of RCB were shown to be useful as a framework for both developing and evaluating RCB initiatives. [ABSTRACT FROM AUTHOR]

Presents an abstract of the study "A Ramdomised Controlled Trial of a Travel Promotion Programme," by P. A. Logan, J. Gladman, A. J. Avery, M. F. Walker L. Groom and J. Dyas.