Attraction of Triatoma dimidiata and Rhodnius prolixus (Hemiptera: Reduviidae) to combinations of host cues tested at two distances.

The "kissing bugs," Triatoma dimidiata (Latreille) and Rhodnius prolixus (Stål) (Reduviidae: Triatominae) are major vectors of Chagas disease in Central and South America. To further uncover the attraction to certain host cues by these vectors at long and short distances from their host, the behavioral responses of two life stages (fifth-instar nymphs and adult males) of these two species to different known or suspected attractants, alone or in combination, were investigated. Tests were done using short- and long-range environments, namely, a four-port olfactometer and a long-range artificial chamber designed to mimic the insect's natural habitats. In single-attractant trials, heat alone and CO2 alone were found to be more attractive than selected chemicals. In multiple-attractant trials, both species and life stages were attracted at short distances, and a statistically significant synergistic increase in attraction was observed in long-distance multimodal tests. Lures containing CO2 were the most effective attractants at both long and short distances. R. prolixus adult males were significantly less attracted to several lure combinations than the nymphs of either species, perhaps because adults were more motivated to seek mates than feed. Our findings suggest that although the triatomine bugs may be capable of detecting odorants and heat sources at short distances, their ability to locate a host over a long distance is best aided by the presence of a CO2 plume.

A randomised trial comparing endometrial resection and abdominal hysterectomy for the treatment of menorrhagia.

OBJECTIVE: To determine the advantages and disadvantages of endometrial resection and abdominal hysterectomy for the surgical treatment of women with menorrhagia. DESIGN: Randomised study of two treatment groups with a minimum follow up of nine months. SETTING: Royal Berkshire Hospital, Reading. SUBJECTS: 51 of 78 menorrhagic women without pelvic pathology who were on the waiting list for abdominal hysterectomy. TREATMENT: Endometrial resection or abdominal hysterectomy (according to randomisation). Endometrial resections were performed by an experienced hysteroscopic surgeon; hysterectomies were performed by two other gynaecological surgeons. MAIN OUTCOME MEASURES: Length of operating time, hospitalisation, recovery; cost of surgery; short term results of endometrial resection. RESULTS: Operating time was shorter for endometrial resection (median 30 (range 20-47) minutes) than for hysterectomy (50 (39-74) minutes). The hospital stay for endometrial resection (median 1 (range 1-3) days) was less than for hysterectomy (7 (5-12) days). Recovery after endometrial resection (median 16 (range 5-62) days) was shorter than after hysterectomy (58 (11-125) days). The cost was 407 pounds for endometrial resection and 1270 pounds for abdominal hysterectomy. Four women (16%) who did not have an acceptable improvement in symptoms after endometrial resection had repeat resections. No woman has required hysterectomy during a mean follow up of one year. CONCLUSION: For women with menorrhagia who have no pelvic pathology endometrial resection is a useful alternative to abdominal hysterectomy, with many short term benefits. Larger numbers and a longer follow up are needed to estimate the incidence of complications and the long term efficacy of endometrial resection.

Training for team care.

The aim of this paper is to highlight some of the findings of a research study concerned with the perception of general practitioner trainees, health visitor, district nurse and social work students towards the primary health care team. Areas of role understanding; role restriction/role euphoria and high referral of problems to others are illustrated. The results suggest a need for role learning experiences during training which are subsequently extended and reinforced by interdisciplinary participation in simulated patient management experiences. The idea of team care in the United Kingdom was first mooted as early as 1920 when a committee under the chairmanship of Dawson proposed that doctors should work in teams from health centres. This suggestion was destined to lie dormant until the 1960s, when due to a more favourable political, social and economic climate, the idea was rejuvenated. District nurses and health visitors became associated with doctors in general practice and such terms as 'attached', 'aligned', 'linked' and 'in liaison with' were in vogue (C.E.T.H.V. 1977). However, the bringing together of personnel was only the first small step in what should have been a dynamic drive to progress from an individualistic effort to that of a concerted team approach. In recent years however, there has been increasing controversy about the effectiveness of the team as a unit.