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Recurrence of diarrhoea occurs in as many as 25% of patients after the successful resolution of Clostridium difficile infection. One strategy for breaking the cycle is described in Clinical Infectious Diseases (2007;44:846-8, doi: 10.1086/511870). Eight women who had each experienced 4-8 episodes of diarrhoea associated with C difficile were given a two week course of refaximin when asymptomatic after completing their last course of vancomycin (the antibiotic used to treat C difficile). Seven out of the eight had no further recurrence of diarrhoea.
A UK breastfeeding manifesto is to be launched on 16 May 2007 (www.breastfeedingmanifesto.org.uk). Acting on this manifesto would, it is hoped, help reduce inequalities in health, improve the health of the nation, and save the NHS money while ensuring that the UK government fulfils its existing commitments to women. Campaigners say that if all babies were breastfed for at least three months, the reduction in the incidence of gastroenteritis alone would save the NHS in England and Wales more than £35m (€51m; $70m) a year.
Another way to save money is to treat epilepsy with surgery, according to a study in Neurology (2007;68:1290-9 doi: 10.1212/01.wnl.0000259550.87773.3d). For refractory epilepsy, surgery is effective but costly. But this cost should be offset by longer term savings because patients need fewer healthcare services. In this economic analysis, costs remained stable over two years for patients with temporal lobe epilepsy whose seizures persisted after surgery. But patients who became seizure-free used substantially less health care and far fewer drugs than before surgery.
A prospective 10 year comparison of reconstructions of the anterior cruciate ligament by autograft of either hamstring or patella tendon reports that both tendons make excellent materials to autograft (American Journal of Sports Medicine 2007;35:564-74 doi: 10.1177/0363546506296042). Reconstructions with hamstring tendon resulted in fewer symptoms at the site of the harvest, however, and also fewer changes of osteoarthritis on x rays.
Patients with Duchenne muscular dystrophy may eventually benefit from a drug that has recently been tested in mice (Nature 2007 Apr 22 doi: 10.1038/nature05756). This condition and many other inherited diseases result when translation of messenger RNA into a protein stops prematurely. A small molecule called PTC124 has been shown to enable the translation machinery to bypass sites that cause the premature termination but still to stop normally at the end of the messenger RNA. And, in a well known mouse model, muscle function was restored.
An insight into traditional Chinese medicine and how it could be integrated into modern Western medicine is being offered by the Prince's Foundation for Integrated Health by way of an eight day tour to Hong Kong and mainland China in September 2007. The trip is being organised with the school of public health, Chinese University of Hong Kong. Email firstname.lastname@example.org to find out more.
Raised circulating concentrations of homocysteine are associated with greater risk of cardiovascular disease, but the exact mechanism is unclear. To investigate whether the association is mediated through blood pressure, a team in New Zealand gave vitamins to reduce homocysteine to a group of healthy older people (Journal of Nutrition 2007;137:1183-7 http://jn.nutrition.org/cgi/content/abstract/137/5/1183). The team's randomised placebo controlled trial showed that despite significantly lower homocysteine in the vitamin group, blood and pulse pressures were not significantly different than in the placebo group.
Barbershops owned by black people seem to be useful places for monitoring high blood pressure in black men in the United States. Barbers did well in two feasibility studies designed to test whether they could carry out useful and long term programmes to monitor blood pressure (Hypertension 2007;49:1040-53 doi: 10.1161/HYPERTENSIONAHA.106.080432). An additional benefit was that customers seemed to take their drugs more regularly, and control of blood pressure improved more as the number of interventions increased.
There is often a conflict between what people need and the costs involved in meeting these needs. A study of the cost and value of building nursing homes with private or shared bedrooms has found that almost all outcomes are better with private rooms (Gerontologist 2007;47;169-83 http://gerontologist.gerontologyjournals.org/cgi/content/abstract/47/2/169). To build homes with private rooms costs more than a third more, but the difference is recouped within two years if the rooms are fully occupied.