Objective-To compare the efficacy of self management ofasthma with traditional treatment.Design-12 month prospective randomised trial. Setting-Outpatient clinics in Finland. Subjects-115 patients with mild to moderately severe asthma.Interventions-Patient education and adjustment of anti-inflammatory therapy guided by peak flow measurements.Main outcome measures-Unscheduled admissions to hospital and outpatient visits, days off work, courses of antibiotics and prednisolone, lung function, and quality oflife.Results-The mean number of unscheduled visits to ambulatory care facilities (0 5 higher in the self management group than in the traditionally treated group. In both groups admissions for asthma were rare. Conclusions-Self management reduces incidents caused by asthma and improves quality oflife. IntroductionDeaths from asthma have been associated with underestimation of its severity, delays in starting treatment in exacerbations, and unsatisfactory routine management and treatment of asthma.' 2 Potentially preventable factors are common in deaths from asthma, and 73% of admissions to hospital for acute asthma could be avoided with proper prior medical care.'3 At least 40% of people with asthma do not react appropriately when symptoms of asthma worsen and over half of the patients admitted with acute asthma have had alarming symptoms for a week before admission.45 In its study of deaths due to asthma in the early 1 980s the British Thoracic Association recommended that patients should measure their own peak flow rates and treat deteriorating symptoms

An inappropriate cross-connection between sewage- and drinking-water pipelines contaminated tap water in a Finnish town, resulting in an extensive waterborne gastroenteritis outbreak in this developed country. According to a database and a line-list, altogether 1222 subjects sought medical care as a result of this exposure. Seven pathogens were found in patient samples of those who sought treatment. To establish the true disease burden from this exposure, we undertook a population-based questionnaire investigation with a control population, infrequently used to study waterborne outbreaks. The study covered three areas, contaminated and uncontaminated parts of the town and a control town. An estimated 8453 residents fell ill during the outbreak, the excess number of illnesses being 6501. Attack rates were 53% [95% confidence interval (CI) 49.5-56.4] in the contaminated area, 15.6% (95% CI 13.1-18.5) in the uncontaminated area and 6.5% (95% CI 4.8-8.8) in the control population. Using a control population allowed us to differentiate baseline morbidity from the observed morbidity caused by the water contamination, thus enabling a more accurate estimate of the disease burden of this outbreak.

The effectiveness needs to be evaluated carefully in future clinical trials. This will offer valuable information for policymakers, organizations and health care practitioners about the usability of web-based patient education in the area of mental health care.

Objective: To evaluate the READER model for critical reading by comparing it with a free appraisal, and to explore what factors influence different components of the model. Design: A randomised controlled trial in which two groups of general practitioners assessed three papers from the general practice section of the BMJ. Setting: Northern Ireland. Subjects: 243 general practitioners. Main outcome measures: Scores given using the READER model (Relevance, Education, Applicability, Discrimination, overall Evaluation) and scores given using a free appraisal for scientific quality and an overall total. Results: The hierarchical order for the three papers was different for the two groups, according to the total scores. Participants using the READER method (intervention group) gave a significantly lower total score (P<0.01) and a lower score for the scientific quality (P<0.0001) for all three papers. Overall more than one in five (22%), and more men than women, read more than 5 articles a month (P<0.05). Those who were trainers tended to read more articles (P<0.05), and no trainers admitted to reading none. Overall, 58% (135/234) (68% (76/112) of the intervention group) believed that taking part in the exercise would encourage them to be more critical of published articles in the future (P<0.01). Conclusion: Participants using the READER model gave a consistently lower overall score and applied a more appropriate appraisal to the methodology of the studies. The method was both accurate and repeatable. No intrinsic factors influenced the scores, so the model is appropriate for use by all general practitioners regardless of their seniority, location, teaching or training experience, and the number of articles they read regularly.

No abstract