Evaluation of a multiprofessional community stroke team: a randomized controlled trial.

OBJECTIVES: There is inconclusive evidence of the effectiveness of stroke rehabilitation by a community stroke team. The aim was to evaluate a specialist multiprofessional team in a community setting. DESIGN: Randomized controlled trial. SETTING: Community. PARTICIPANTS: Stroke patients and their informal carers who were referred to receive rehabilitation from a community stroke team. OUTCOME MEASURES: Barthel Index, Extended Activities of Daily Living Scale (EADL), General Health Questionnaire (GHQ-12) by patient and carer, Carer Strain Index (CSI), Euroquol, knowledge of stroke and satisfaction with services six months after recruitment. RESULTS: There were no significant differences between patients who received rehabilitation from community stroke team (n = 189) and those who received routine care (n = 232) in their independence in activities of daily living, mood, quality of life or knowledge of stroke. The patients in the community stroke team group were significantly more satisfied with the emotional support they had received (p < 0.01). There were no significant differences between the groups in satisfaction with practical help or overall satisfaction. Carers of patients in the community stroke team were under significantly less strain than carers in the routine care group (p < 0.04). Carers of patients in the community stroke team group were significantly more satisfied with their knowledge of stroke (p < 0.01) and were more satisfied overall (p < 0.01). CONCLUSIONS: The patients treated by the community stroke team were more satisfied with the emotional support they received and had equivalent outcomes in terms of independence in activities of daily living and mood. Their carers were under less strain and were more satisfied with their knowledge of stroke recovery, the emotional support they received and overall satisfaction with services. The results support the provision of rehabilitation by a community-based specialist multiprofessional team.

Delta opioid receptors mediate glucose uptake in skeletal muscles of lean and obese-diabetic (ob/ob) mice.

Specific binding sites for [125I]beta-endorphin and the delta1-opioid [3H][D-pen(2), D-pen(5)]enkephalin (DPDPE) were quantified using autoradiography in soleus and extensor digitorum longus (EDL) muscles of lean and obese-diabetic (ob/ob) mice. The density of binding was significantly higher in obese-diabetic than lean mice. The uptake of 2-deoxy-D-[1-3H]deoxyglucose, a nonmetabolized glucose analogue, into isolated soleus and EDL muscles was stimulated by beta-endorphin, beta-endorphin 1-27, and DPDPE, but not by the delta2-opioid deltorphin II. Both beta-endorphin and DPDPE stimulated deoxyglucose uptake in obese-diabetic mice. Thus, glucose transport in skeletal muscle may be partly mediated via delta1-opioid receptors. The increased receptor density in obese-diabetic mice may be an adaptive response.

Analysis of the primary sex ratio, sex chromosome aneuploidy and diploidy in human sperm using dual-colour fluorescence in situ hybridisation.

In situ hybridisation technology provides a new tool for chromosome analysis of human spermatozoa. We have used dual-colour fluorescence in situ with probes specific for the X and Y chromosomes and chromosomes 1 and 12 to (a) identify the primary male gametic sex chromosome ratio; (b) assess the number of numerical sex chromosome abnormalities, and (c) quantify the incidence of diploid sperm. We have examined over 60,000 sperm from three normal males and found the primary sex ratio to be indistinguishable from unity. The frequency of hyperhaploid sperm was 0.8, 1.03 and 2.27 per thousand for XX, YY and XY respectively, whilst 1.67 per thousand sperm were diploid. A comparison of our results with estimates of sex chromosome aneuploidy in human populations suggests that sperm carrying two sex chromosomes may be at a selective disadvantage.

The East Anglian Eye Bank.

The first Corneal Bank in East Anglia is located at the BUPA Hospital in Norwich, a joint venture between NHS, BUPA and the Lions Clubs International (District 101 EA). There was insufficient space to accommodate the Bank at the West Norwich Hospital where the Ophthalmic Department is situated and so, at the suggestion of the BUPA Hospital Manager, Mr Paul Hanke, It came to the BUPA Colney Lane site.

Short-term effects of reclamation of part of Seal Sands, Teesmouth, on wintering waders and Shelduck : I. Shorebird diets, invertebrate densities, and the impact of predation on the invertebrates.

The invertebrate macrofauna of Seal Sands, Teesmouth, is very limited in species composition. Nereis diversicolor has a two-year life cycle; the larger size-class provides the main prey of the birds Pluvialis squatarola, Numenius arquata and Limosa lapponica. Hydrobia ulvae is an important food of P. squatarola and Calidris canutus. Small Carcinus maenas occur in late autumn and are taken by the larger shorebirds. Small Macoma balthica are also taken, but are scarce and not an important bird food. Tadorna tadorna and Calidris alpina subsist chiefly on species of small oligochaetes and polychaetes which occur at very high densities (Gray 1976). Feeding areas of the shorebird species show some segregation, particularly in groups of species taking the same prey. It is calculated that birds removed about 90% of the standing crops of large Hydrobia and Nereis during a single winter. This followed the reclamation of more than half the intertidal land used as feeding grounds by the birds.