Using a problem detection study (PDS) to identify and compare health care provider and consumer views of antihypertensive therapy.

The objectives of this study were to ascertain consumer knowledge and behaviour about hypertension and treatment and to compare these with health care providers' perceptions (of 'most' consumers). The design for the study was a problem detection study (PDS): focus groups and then survey. Focus groups and survey participants were convenience samples of consumers, doctors, nurses and pharmacists. The main outcome measures were agreement on a 5-point Likert scale with statements about consumers' knowledge and behaviour about high blood pressure and medication. The survey identified areas of consensus and disagreement between consumers and health providers. While general knowledge and concordance with antihypertensive therapy among consumers was good, consequences such as eye and kidney disease, interactions with herbal medicines, and how to deal with missing a dose were less well known. Side effects were a problem for over one-quarter of participants, and cost was a problem in continuing therapy. Half the consumers had not received sufficient written information. Providers overall disagreed that most consumers have an adequate understanding of the condition. They agreed that most consumers adhere to therapy and can manage medicines; and about their own profession's role in information provision and condition management. Consumers confirmed positive provider behaviour, suggesting opportunities for greater communication between providers about actions taken with their consumers. In conclusion, the PDS methodology was useful in identifying consumer opinions. Differences between consumer and provider responses were marked, with consumers generally rating their knowledge and behaviour above providers' ratings of 'most' consumers. There are clear gaps to be targeted to improve the outcomes of hypertension therapy.

Aluminium and fluoride in the water supply and their removal for haemodialysis.

Aluminium and fluoride in the water supply and their removal for haemodialysis have been investigated in the Trent Region, U.K., and wide variations noted. The efficiency of removal of these elements from the mains water supplying home haemodialysis units by different water treatment systems currently installed has been assessed and a follow-up study performed 8 months later. Some improvement in water treatment was noted, with the percentage of home dialysis units receiving waters within the proposed European Economic Community guidelines for aluminium rising from 61.7 to 72.1%. Removal of fluoride by the different treatment mechanisms is analogous to that for aluminium. A comparison of new and older water treatment systems has shown that there is a deterioration in performance with use. However, some cases of poor removal may be due to the installation of unsuitable equipment, or, more probably, due to a change in the waters used to supply the different homes. Thus, adequate maintenance of equipment and frequent sampling of both untreated and treated waters are required in order to maintain the provision of waters suitable for the preparation of dialysate.

A review of, and improvements to, the techniques of trace element analysis of raw water for home dialysis.

The optimum operating conditions for the measurement of aluminium and iron concentrations in water by atomic absorption spectrometry have been determined experimentally. The characteristics of an ion-selective electrode for the measurement of fluoride have also been investigated. Contrary to other work, the addition of acid to samples did not improve their storage stability, although the acid-washing of polyethylene containers is recommended for the storage of water.

Hydrogeochemical studies for Al, F and Fe in waters supplying haemodialysis units in the Trent region, U.K.

Geographical and seasonal variations in the concentrations of Al, F and Fe in tap water supplying home haemodialysis units within the administrative area of the Trent Regional Health Authority, have been examined. Aluminium and fluoride were considered for their implications in bone disorders and iron for its competitive binding with aluminium to transferrin in serum. Four different water treatment systems are currently used and the extractive performance of these have been assessed. In general, the current Department of Health and Social Security's (DHSS) guidelines for aluminium in water used to prepare dialysate are met (30 µg/l), but the proposed European Economic Community's (EEC) levels of 10 µg/l, are not. The removal of fluoride and iron from water by the different treatments was comparable to the removal of aluminium. A comparison between old and new equipment highlights the importance of regular monitoring and maintenance.