We have evaluated the cost-effectiveness of using cell culture to test for chlamydial infections in 9979 patients at a clinic for sexually transmitted diseases. From results of cultures, we have established prevalence data and, using decision-theory analysis, have calculated costs and probabilities of various outcomes. According to their histories and presenting signs and symptoms, patients were classified as at high or low risk for chlamydial infections. Empiric treatment of all patients attending the clinic was the most cost-effective strategy, followed by empiric treatment of high-risk women and culture-based treatment of low-risk women. Obtaining cultures for men at high and low risk was not cost-effective. If universal treatment is not provided, the most cost-effective strategy appears to be empiric therapy in patients at high risk for chlamydial infections and therapy based on diagnostic test results in women at low risk.

No abstract

Objective Symptoms of anxiety and depression are prevalent among athletes and often overlap with symptoms of a concussion. Clinical screeners of anxiety and depression are infrequently used by athletic teams despite the relationship between affective symptoms and protracted post-concussion recovery. The study objective was to examine associations between individual symptoms on the post-concussive symptom scale (PCSS) and gold standard measures of anxiety and depression. Methods Pre-season baseline data was collected for 296 varsity athletes from York University, Toronto. Participants were between the ages of 17 and 25 (M = 20.01 yrs, SD = 1.69 yrs; 52% male). The PCSS from the SCAT-5 was used to assess baseline symptoms. Generali. Results Moderate to strong correlations were noted between specific items of the PCSS and the GAD-7 and PHQ-9. Feeling anxious (r = 0.55), concentration problems (r = 0.40), irritability (r = 0.39), trouble falling asleep (r = 0.38), fatigue (r = 0.36), and mental fog (r = 0.35) were the highest correlations with the GAD-7 (ps < 0.001). Trouble falling asleep (r = 0.46), fatigue (r = 0.44), concentration problems (r = 0.41), memory problems (r = 0.37), feeling slowed down (r = 0.36), anxious (r = 0.36), and irritability (r = 0.36) were the highest correlations with the PHQ-9 (ps < 0.001). Conclusions These findings allow for better delineation of symptoms of the PCSS that aid in identification of athletes with symptoms of anxiety or depression, who may be at risk for endorsing persistent symptoms following a concussion.

Since 1952 it has been repeated time and again that prestige depends on membership by examination, and yet during that time prestige has increased remarkably to a point at which a Royal Commission has advised the government to seek the College's advice on a definition of a good general practitioner, and the College has been able to float an appeal for £1 million with hope of success. The number of members has increased, like prestige, at an increasing rate year by year. We are already the second largest college and at the present rate of increase we shall be the largest in less than two years time.Another suggestion reiterated over the years by advocates of examinations is that present methods of selection of members do not attract the best type of candidate. On the other hand the College