Objective: To determine whether a programme of multidisciplinary rehabilitation and group support achieves sustained benefit for people with Parkinson's disease or their carers. Methods: The study was a randomised controlled crossover trial comparing patients and carers who had received rehabilitation four months before assessment with those who had not. Patients were recruited from a neurology clinic, attended a day hospital from home weekly for six weeks using private car or hospital transport, and received group educational activities and individual rehabilitation from a multidisciplinary team. Patients were assessed at entry and at six months using a 25 item self assessment Parkinson's disease disability questionnaire, Euroqol-5d, SF-36, PDQ-39, hospital anxiety and depression scale, and timed stand-walk-sit test. Carers were assessed using the carer strain index and Euroqol-5d. Results: 144 people with Parkinson's disease without severe cognitive losses and able to travel to hospital were registered (seven were duplicate registrations); 94 had assessments at baseline and six months. Repeated measures analysis of variance comparing patients at the 24 week crossover point showed that those receiving rehabilitation had a trend towards better stand-walk-sit score (p = 0.093) and worse general and mental health (p = 0.002, p = 0.019). Carers of treated patients had a trend towards more strain (p = 0.086). Analysis comparing patients before and six months after treatment showed worsening in disability, quality of life, and carer strain. Conclusions: Patients with Parkinson's disease decline significantly over six months, but a short spell of multidisciplinary rehabilitation may improve mobility. Follow up treatments may be needed to maintain any benefit.
Socioeconomic status makes a large difference to the impact of illness on the ability to remain in paid employment, and this impact increases as unemployment rises. Men with chronic illness in manual occupations were not drawn back into the labour force during the economic recovery of the late 1980s.
The behavioural programme produced a modest increase in the number of infants who slept through the night by 12 weeks of age. The results are discussed in relation to other findings, which bear on the programme's adoption for routine health-care policy and practice.
This intensive co-ordinated programme provided immediate benefits to people with Parkinson's disease and their carers.
Objectives: To describe the prevalence of sexually transmitted infection (STIs) in a sample of women who have sex with women (WSW) and to identify risk factors for the acquisition of STI. Method: Cross sectional survey. Questionnaire for demographic, sexual history, and sexual practice data linked with the results of genitourinary examination. 708 new patients attending two sexual health clinics for lesbians and bisexual women in London were surveyed. Results: A majority of WSW reported sexual histories with men (82%). Bacterial vaginosis and candida species were commonly diagnosed (31.4% and 18.4% respectively). Genital warts, genital herpes, and trichomoniasis were infrequently diagnosed (1.6%, 1.1%, and 1.3% respectively). Chlamydia, pelvic inflammatory disease, and gonorrhoea infections were rare (0.6%, 0.3%, and 0.3% respectively) and diagnosed only in women who had histories of sex with men.Conclusions: Although we have demonstrated a low prevalence of STI, WSW may have sexual histories with men as well as women or histories of injecting drug use, and are therefore vulnerable to sexually transmitted or blood borne infections. Diagnosis of trichomoniasis, genital herpes, and genital warts in three women who had no history of sex with men implies that sexual transmission between women is possible.T here are no routinely collected data concerning transmission of sexually transmitted infections (STIs) between women in the United Kingdom. Data from genitourinary medicine (GUM) clinics analysed by the Public Health Laboratory Service Communicable Disease Surveillance Centre do not include female homosexual contact. Health carers may make the assumption that having a lesbian identity precludes sexual activity with men or that transmission of STI between women is unlikely. 2 We present data describing the prevalence and risk factors for STI in a sample of 708 women who have sex with women (WSW). METHODEthical permission was obtained, and all new patients at two lesbian sexual health clinics in London were offered a questionnaire to gather data about potential risk factors for STI: demographic features, sexual history, and sexual practice. Between 1992 and 1995, 803 patients completed questionnaires out of an estimated 1000 attenders. No record of non-responders was kept. A total of 708 out of 803 had a GU examination and results from this were linked with questionnaire responses. This study includes 199 women in an initial prevalence study of STI in WSW 3 ; we present here the results from the complete study population focusing on sexual history and other risk factors for STI.A GU examination comprised cervical and urethral Gram stained smear and culture for Neisseria gonorrhoeae, cervical swab for Chlamydia trachomatis by ELISA, and high vaginal samples for Trichomonas vaginalis by wet preparation. Gram stained vaginal preparations were taken for Candida sp identification and culture. Bacterial vaginosis (BV) was diagnosed using Amsel's criteria. Screening for treponemal disease used the Venereal Disease Research...
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