Which workplace health initiatives work, for whom, in what contexts, and how? A rapid realist review

BACKGROUND

The work environment is an important determinant of health and health inequalities. Workplaces have a key role in preventing ill health. The WHO and Office for Health Improvement and Disparities encourage implementing employer-led workplace health award schemes tailored to specific contexts. Therefore, when designing and developing workplace initiatives it becomes imperative to know what works, for whom, and in what circumstances. This research aims to facilitate understanding of the various contexts and mechanisms through which workplace health initiatives are implemented while considering how these might affect employee health outcomes.

METHODS

We did a rapid realist review to explore the different contexts (C) in which workplace initiatives are implemented that may fire a mechanism (M), leading to a change in employee health-related and business outcomes (O). We searched 12 databases for peer-reviewed papers published from June 1, 2019, to March 31, 2022 that referred to a workplace health and or wellbeing programme or intervention. There were no restrictions placed on study design. We recorded the impact of context and mechanisms on any health and business-related outcomes. The review was carried out in accordance with RAMESES publication standards.

FINDINGS

26 articles were included. Most studies were conducted in North America (n=13) and Europe (n=9), with four conducted in Australia and Oceania and one in Asia. We developed eight realist CMO programme theories. For example, when leaders are committed to employee health and wellbeing (C) (identified in 16 studies), demonstrated by role modelling healthy behaviours and actively promoting workers to engage in initiatives, employees feel valued and "permitted" to engage in healthy and wellbeing initiatives (M) which might lead to greater participation in health promotion activities (O). This review is registered with PROSPERO, CRD42022303262.

INTERPRETATION

Findings contribute towards raising employers' awareness of what interventions might work for their employees. For instance, those interventions that encompass engagement of leadership at all levels to promote health and wellbeing are likely to leave employees feeling valued, motivated, and permitted to engage in interventions. Limitations of this study include potential biases arising from using rapid review processes and the inability to produce standardised recommendations. However, knowledge gained, which considers complexity and flexibility, might help inform, tailor, and support the implementation of future workplace health initiatives.

FUNDING

National Institute for Health and Care Research (NIHR).

Age at Diagnosis of Type 2 Diabetes and Depressive Symptoms, Diabetes-Specific Distress, and Self-Compassion

OBJECTIVE

To investigate the association between age at diagnosis of type 2 diabetes and depressive symptoms, diabetes-specific distress, and self-compassion among adults with type 2 diabetes.

RESEARCH DESIGN AND METHODS

This analysis used data from the Chronotype of Patients with Type 2 Diabetes and Effect on Glycemic Control (CODEC) cross-sectional study. Information was collected on depressive symptoms, diabetes-specific distress, and self-compassion, measured using validated self-report questionnaires, in addition to sociodemographic and clinical data. Multivariable regression models, adjusted for diabetes duration, sex, ethnicity, deprivation status, prescription of antidepressants (selective serotonin reuptake inhibitors), and BMI were used to investigate the association between age at diagnosis of type 2 diabetes and each of the three psychological outcomes.

RESULTS

A total of 706 participants were included; 64 (9.1%) were diagnosed with type 2 diabetes at <40 years, 422 (59.8%) between 40 and 59 years, and 220 (31.2%) at ≥60 years of age. After adjustment for key confounders, including diabetes duration, younger age at diagnosis was significantly associated with higher levels of depressive symptoms (βadj: -0.18 [95% CI -0.25 to -0.10]; P < 0.01) and diabetes-specific distress (βadj: -0.03 [95% CI -0.04 to -0.02]; P < 0.01) and lower levels of self-compassion (βadj: 0.01 [95% CI 0.00 to 0.02]; P < 0.01).

CONCLUSIONS

Diagnosis of type 2 diabetes at a younger age is associated with lower psychological well-being, suggesting the need for clinical vigilance and the availability of age-appropriate psychosocial support.

No new fast-food outlets allowed! Evaluating the effect of planning policy on the local food environment in the North East of England

The environment in which we live impacts on our health. The food available to us in our environment is likely to influence what we eat and subsequently our weight. The use of planning policy can be one way for both local and national government to help shape a healthy environment. In England there are three main types of planning policy used to promote a healthy food environment: 1) restricting new fast-food outlets near schools; 2) restricting new fast-food outlets if the density of existing outlets has surpassed a certain threshold of all retail outlets, 3) restricting new fast-food outlets if childhood obesity rates are above a certain threshold. In 2015, Gateshead council, a local authority in the North East of England implemented all three types of guidance. We utilise a longitudinal administrative dataset, the Food Standards Agency Food Hygiene Rating Scheme Data, covering the period 2012-2019 on all premises selling or preparing food in Great Britain. To analyse the impact of employing all three types of planning guidance on the density, proportion, and number of fast-food outlets in Gateshead, we employ a propensity score matching difference-in-difference approach. We match small geographical areas in Gateshead (lower super output areas) to other local authorities in the North East with similar demographic characteristics that did not implement planning guidance. Results show a reduction in density of fast-food outlets by 12.45 per 100,000 of the population and a 13.88% decrease in the proportion of fast-food outlets in Gateshead compared to other similar local authorities in the North East. There was a marginally significant reduction in the number of restaurants which became insignificant after controlling for population density. These results suggest that a multi-pronged planning approach significantly changed the proportion and density of fast-food outlets in the food environment in the short term (4 years).

Where is the greatest potential for resource recovery in wastewater treatment plants?

The restorative and regenerative ability of the circular economy has led to the rapid growth of this concept over the past decade, as it facilitates the broadly adopted principles of sustainable development and beyond, through restorative and regenerative actions. The water sector is poised to benefit from this transition, due to its intrinsic circularity and the resources it handles, predominantly found in wastewater, that are valuable and critical. Currently, the vast range of resource recovery technologies coupled with few industrial examples hinder strategic decision making. Resource recovery on a regional scale improves market share and mitigates investment risk, therefore, a structured approach has been developed for the selection of priority technologies to act as a guide for strategic planning. A representative UK wastewater model acts as the baseline, with multi-criteria analysis used to select resources and create an enhanced resource recovery scenario. It was found that implementing the recovery of 5 'priority resources' (and technology pathways) increased nitrogen and phosphorus recovery by 68% and 71%, respectively. Lastly, the need for a cross-cutting approach for the holistic assessment of circular solutions is discussed.

An analysis of food and beverage advertising on bus shelters in a deprived area of Northern England

OBJECTIVE

To quantify the extent of food and beverage advertising on bus shelters in a deprived area of the UK, to identify the healthfulness of advertised products, and any differences by level of deprivation. The study also sought to assess the creative strategies used and extent of appeal to young people.

DESIGN

Images of bus shelter advertisements were collected via in person photography (in 2019) and Google Street View (photos recorded in 2018). Food and beverage advertisements were grouped into one of seventeen food categories and classified as healthy/less healthy using the UK Nutrient Profile Model. The deprivation level of the advertisement location was identified using the UK Index of Multiple Deprivation.

SETTING

Middlesbrough and Redcar and Cleveland in South Teesside.

PARTICIPANTS

N/A.

RESULTS

Eight hundred and thirty-two advertisements were identified, almost half (48·9 %) of which were for foods or beverages. Of food and non-alcoholic beverage adverts, 35·1 % were less healthy. Most food advertisements (98·9 %) used at least one of the persuasive creative strategies. Food advertisements were found to be of appeal to children under 18 years of age (71·9 %). No differences in healthiness of advertised foods were found by level of deprivation.

CONCLUSIONS

Food advertising is extensive on bus shelters in parts of the UK, and a substantial proportion of this advertising is classified as less healthy and would not be permitted to be advertised around television programming for children. Bus shelter advertising should be considered part of the UK policy deliberations around restricting less healthy food marketing exposure.

Field validity and spatial accuracy of Food Standards Agency Food Hygiene Rating scheme data for England

BACKGROUND

The study aimed to evaluate the validity and spatial accuracy of the Food Standards Agency Food Hygiene Rating online data through a field audit.

METHODS

A field audit was conducted in five Lower Layer Super Output Areas (LSOAs) in the North East of England. LSOAs were purposively selected from the top and bottom quintiles of the Index of Multiple Deprivation and from urban and rural areas. The FHRS data validity against the field data was measured as Positive Predictive Values (PPV) and sensitivity. Spatial accuracy was evaluated via mean difference in straight line distances between the FHRS coordinates and the field coordinates.

RESULTS

In all, 182 premises were present in the field, of which 162 were in the FHRS data giving a sensitivity of 89%. Eight outlets recorded in the FHRS data were absent in the field, giving a PPV of 95%.The mean difference in the geographical coordinates of the field audit compared to the FHRS was 110 m, and <100 m for 77% of outlets.

CONCLUSIONS

After an evaluation of the validity and spatial accuracy of the FHRS data, the results suggest that it is a useful dataset for surveillance of the food environment and for intervention evaluation.

The impact of school exclusion zone planning guidance on the number and type of food outlets in an English local authority: A longitudinal analysis

The use of planning policy to manage and create a healthy food environment has become a popular policy tool for local governments in England. To date there has been no evaluation of their short-term impact on the built environment. We assess if planning guidance restricting new fast food outlets within 400 m of a secondary school, influences the food environment in the local authority of Newcastle Upon Tyne, UK. We have administrative data on all food outlets in Newcastle 3 years pre-intervention 2012-2015, the intervention year 2016, and three years' post-intervention 2016-2019. We employ a difference-in-difference approach comparing postcodes within the school fast food outlet exclusion zone to those outside the fast-food exclusion zones. In the short term (3 years), planning guidance to limit the number of new fast-food outlets in a school exclusion zone did not have a statistically significant impact on the food environment when compared with a control zone.

The effect of hypoglycaemia during hospital admission on health-related outcomes for people with diabetes: a systematic review and meta-analysis

AIM

To assess the health-related outcomes of hypoglycaemia for people with diabetes admitted to hospital; specifically, hospital length of stay and mortality.

METHODS

We conducted a systematic review and meta-analysis of studies relating to hypoglycaemia (< 4 mmol/l) for hospitalized adults (≥ 16 years) with diabetes reporting the primary outcomes of interest, hospital length of stay or mortality. Final papers for inclusion were reviewed in duplicate and the adjusted results of each were pooled, using a random effects model then undergoing further prespecified subgroup analysis.

RESULTS

In total, 15 studies were included in the meta-analysis. The pooled mean difference in length of stay for ward-based inpatients exposed to hypoglycaemia was 4.1 days longer [95% confidence interval (CI) 2.36 to 5.79; I² = 99%] compared with those without hypoglycaemia. This association remained robust across the pre-specified subgroup analyses. The pooled relative risk (RR) of in-hospital mortality was greater for those exposed to hypoglycaemia (RR 2.09, 95% CI 1.64 to 2.67; I² = 94%, n = 7 studies) but not in intensive care unit mortality (RR 0.75, 95% CI 0.49 to 1.16; I² =0%, n = 2 studies).

CONCLUSION

There is an association between inpatient hypoglycaemia and longer length of stay and greater in-hospital mortality. Studies examining this association were heterogenous in terms of both clinical populations and effect size, but the overall direction of the association was consistent. Therefore, glucose concentration should be considered a potential tool to aid the identification of inpatients at risk of poor health-related outcomes.

Children and young people's perceptions of energy drinks: A qualitative study

BACKGROUND

Consumption of soft drinks is declining in many countries, yet energy drink sales continue to increase, particularly amongst young consumers. Little is currently known about the drivers behind these trends. Energy drinks are high in sugar and caffeine, and evidence indicates that regular or heavy use by under 18s is likely to be detrimental to health. This study aimed to explore children and young people's attitudes and perceptions in relation to energy drinks in a UK context.

METHODS

Eight focus groups were conducted with pupils aged 10-11 years (n = 20) and 13-14 years (n = 17) from four schools in northern England. A sub-sample also took part in a mapping exercise to generate further insights. Data were analysed using the constant comparative approach.

RESULTS

Energy drinks were reportedly consumed in a variety of public and private places, generally linked to social activities, sports and computer gaming (particularly amongst boys). Participants demonstrated strong brand awareness and preferences that were linked to taste and perceived value for money. The relatively low price of energy drinks and their widespread availability were identified as key factors, along with gendered branding and marketing. Some participants demonstrated a critical approach to manufacturers' claims and many were keen to become better informed, often through school- or peer-based interventions. Other potential interventions included age restrictions, voluntary schemes involving retailers and improved labelling.

CONCLUSIONS

The lack of a single dominant factor in participants' consumption choices suggests that there is unlikely to be a 'silver bullet' in attempting to address this issue. However, the findings provide support for policy-level interventions that seek to change the behaviours of manufacturers and retailers as well as consumers, and actively involve children and young people where possible.

Obesogenic environments: current evidence of the built and food environments

Aims:

Obesity is one of the most significant global health and social problems, with rates rising dramatically over the past few decades. While the basic drivers of obesity are obvious (more energy consumed than expended), the causes are multifactorial and complex. A decade ago, it was suggested that exploring the ways in which the built environment influenced physical activity and dietary behaviours might provide fertile ground for investigation. This article overviews current evidence and, in particular, emergent themes that are of significance for the United Kingdom.

Methods:

This article is based on literature extracted from keyword searching of electronic databases. A timeframe of 2006–2016 was used.

Results:

In the past decade, the research base has grown significantly; while frustratingly some results are still inconclusive or contradictory, it might be argued enough evidence exists to act upon. Themes such as the importance of the journey to school for young people and the multiple environments in which people spend their time are examples of where real progress has been made in the evidence base.

Conclusion:

Progress towards real change in policy and practice may seem slow; however, the opportunities afforded for health and planning professionals to work together provide a step towards the whole systems approaches to tackle obesity that are desperately needed.

A meta-analysis of Hodgkin lymphoma reveals 19p13.3 TCF3 as a novel susceptibility locus

Recent genome-wide association studies (GWAS) of Hodgkin lymphoma (HL) have identified associations with genetic variation at both HLA and non-HLA loci; however, much of heritable HL susceptibility remains unexplained. Here we perform a meta-analysis of three HL GWAS totaling 1,816 cases and 7,877 controls followed by replication in an independent set of 1,281 cases and 3,218 controls to find novel risk loci. We identify a novel variant at 19p13.3 associated with HL (rs1860661; odds ratio (OR)=0.81, 95% confidence interval (95% CI) = 0.76-0.86, P(combined) = 3.5 × 10(-10)), located in intron 2 of TCF3 (also known as E2A), a regulator of B- and T-cell lineage commitment known to be involved in HL pathogenesis. This meta-analysis also notes associations between previously published loci at 2p16, 5q31, 6p31, 8q24 and 10p14 and HL subtypes. We conclude that our data suggest a link between the 19p13.3 locus, including TCF3, and HL risk.

Obesogenic environments: exploring the built and food environments

Obesity is a significant health and social problem which has reached pandemic levels. The obesogenicity of an environment has been defined as 'the sum of influences that the surroundings, opportunities, or conditions of life have on promoting obesity in individuals or populations'. Prevention and treatment of obesity has focused on pharmacological, educational and behavioural interventions, with limited overall success. A novel and a longer-term approach would be to investigate the environments that promote high energy intake and sedentary behaviour; this has not yet been fully understood. The obesity epidemic has attracted attention at all levels, from general media interest to policy and practice from health and other professions including urban designers and planners. Shaping the environment to better support healthful decisions has the potential to be a key aspect of a successful obesity prevention intervention. Thus in order to develop effective environmental interventions, in relation to obesity, we need to understand how individuals, and different groups of individuals, interact with their environments in terms of physical activity and food intake.

Detection of Epstein-Barr virus (EBV) genomes in the serum of patients with EBV-associated Hodgkin's disease

DNA from malignant cells is present in the serum/plasma of cancer patients and DNA from this source is amenable to analysis by polymerase chain reaction (PCR). In the present study, we evaluated whether Epstein-Barr virus (EBV) DNA is present in the serum of patients with EBV-associated Hodgkin's disease (HD). Using conventional PCR, EBV DNA was detected in serum from 30/33 patients with EBV-associated HD but in only 6/26 patients with non-EBV-associated disease (p < 0.001). Samples from healthy individuals were negative and only 5/12 infectious mononucleosis samples were positive. Real-time quantitative PCR was subsequently employed to determine the concentration of EBV DNA present in serum; among positive samples the level ranged from 1 to 705 copies per 125 microliter of serum. Post-treatment samples from 5/14 cases with EBV-associated HD contained detectable EBV DNA; analysis of this small group of cases suggests that positivity in post-treatment samples correlates with risk factors indicative of a poor prognosis. Overall, our results are consistent with the notion that DNA from Reed-Sternberg cells is present in the serum of HD patients, and further suggest that serum EBV should be evaluated as a prognostic marker. Int. J. Cancer (Pred. Oncol.) 84:442-448, 1999.

Pharmacokinetics of carprofen enantiomers in equine plasma and synovial fluid - a comparison with ketoprofen

Carprofen is a Non Steroidal Anti-Inflammatory Drug (NSAID) which is widely used for the treatment of musculoskeletal disorders in horses. The commercial preparation is a racemic mixture of two enantiomers (R and S carprofen). We used HPLC to measure plasma and synovial fluid R and S carprofen concentrations following a single intravenous (i.v.) dose, and computer modelling to determine the pharmacokinetic parameters of the enantiomers in these two body fluids. A comparison was made with results from an identical experiment using ketoprofen. The plasma elimination half lives of R and S carprofen were 20 and 16 times longer than those of R and S ketoprofen, and clearance was considerably slower for carprofen than ketoprofen. Plasma R carprofen concentrations were higher than S carprofen concentrations throughout the 48-h period. Ketoprofen was no longer detectable in synovial fluid after 5 h (S enantiomer) or 12 h (R enantiomer), whereas synovial fluid carprofen concentrations did not peak until 12 h and were still detectable at 48 h. Synovial fluid concentrations of both carprofen enantiomers were significantly lower than plasma concentrations, probably due to high plasma protein binding which could limit transfer through the synovial membrane. Our results indicate significant differences between carprofen and ketoprofen and between the two carprofen enantiomers.

Nine critical elements of promising violence prevention programs

To identify approaches to school-based violence prevention that are most promising and those that may not be effective, a review of the literature was conducted. In addition, telephone interviews were conducted with 15 experts on topics related to school-based violence prevention. Nine critical ingredients of promising approaches to violence prevention were identified. Specifically, the approaches are comprehensive and multifaceted; begin in the primary grades and are reinforced across grade level; are developmentally tailored: and cover appropriate content area. Appropriate content areas include information; anger management; social perspective taking; decision making and social problem solving; peer negotiation and conflict management; social resistance skills; active listening and effective communication; and material on prejudice, sexism, racism and male-female relationship. In addition, promising programs use interactive teaching techniques, are culturally sensitive, and provide teacher training. They promote a positive school climate and foster norms against violence. Six violence prevention activities that appear not to be effective are also discussed. The authors conclude with a discussion of the need for more rigorous evaluation of violence prevention programs.

A review of the evaluation of 47 drug abuse prevention curricula available nationally

This review determined how many drug prevention curricula available to schools have been shown in rigorous research studies to reduce substance use behavior. Forty-seven curricula which met the following criteria were included: 1) they focused on primary prevention of alcohol and/or drug use, 2) they were classroom-based curricula designed for any grade level P-12, 3) they were nationally and currently available, and 4) program distributors were willing to provide samples of curriculum materials to determine drug abuse prevention content. Of the 47 drug abuse prevention curricula identified, 10 (21%) had been subjected to sufficiently rigorous evaluations. At least eight of the 10 programs have been shown effective at reducing tobacco or drug use, in at least some studies. The remaining two programs did not appear to have sustained effects on drug use, although they had variable success at reducing substance use early on. One of the 10 programs has been shown to have positive effects lasting into young adulthood. Six of the 10 curricula have been shown to have effects lasting for at least two years after the pretest. Two curricula have not been evaluated beyond the post-test, so it is impossible to know whether their effectiveness will last. Recommendations to increase the number of programs rigorously evaluated are offered.

Prevention of complications related to contact lens wear

This paper outlines how contact lenses help correct vision and identifies some ocular problems that are associated with their use. It also examines how nurses can help educate the public on issues concerning contact lenses in order to help combat ocular disease.

Appropriate use of human and non-human milk for the dietary management of children with diarrhoea

The nutritional benefit of milk consumption during diarrhoea must be balanced against its potential to produce increased severity or duration of illness. Continued breastfeeding during diarrhoea results in decreased stool output and is generally recommended. However, continued feeding of non-human milk may cause increased faecal excretion, prolonged diarrhoeal duration, and a greater number of treatment failures among young patients with relatively severe diarrhoea. Although most children can safely continue receiving milk during acute diarrhoea, the possibility of serious complications dictates that they be carefully observed. Acceptable alternatives to exclusive non-human milk feeding during diarrhoea include milk-free formulas, milk-cereal mixtures, and possibly fermented milks. This paper reviews the results of published clinical trials of milk feeding and discusses their implications for the appropriate dietary management of childhood diarrhoea.

Nutritional issues in pediatric inflammatory bowel disease

Malnutrition, characterized by weight loss, growth failure and micronutrient depletion, are prominent features of inflammatory bowel disease (IBD) in the pediatric age group. Accurate evaluation of the patient's nutritional status and appropriate nutritional support, whether enteral or parenteral, constitute integral parts of the management of the growing child with IBD. Over the past two decades, a number of studies have supported the potential use of nutritional therapy to induce remission and to control disease activity in symptomatic Crohn's disease. More recently, preliminary studies on the use of dietary supplements of marine-oil-derived omega-3 fatty acids have also indicated a beneficial effect in IBD patients. In parallel with these clinical trials, scientific research has recently focused on the concept that specific dietary alterations can modulate the immune response. Components of the diet that may have particular relevance to mucosal immunity and the pathogenesis of IBD include polyunsaturated fatty acids, nucleotides, and amino acids such as glutamine and arginine. Future research in the interactions between specific nutrients and the immune system will likely increase our understanding of the causes of IBD, as well as enhance the development of novel nutritional therapies for IBD patients.

Gastrointestinal inflammation after bone marrow transplantation: graft-versus-host disease or opportunistic infection?

Gastrointestinal inflammation after allogeneic bone marrow transplantation may be due to acute graft-versus-host disease (GVHD) and/or superinfection with opportunistic organisms. Twenty-eight patients with barium studies suggesting gastrointestinal inflammation after bone marrow transplantation and either acute GVHD, viral infection, or both were studied to characterize the radiographic appearances of each disease and to determine whether acute GVHD could be distinguished from viral superinfection on the basis of radiographic findings. Thirteen patients had minimal or no acute GVHD, with viral infection proved in eight and strongly suspected in four others; the remaining patient was thought to have nonspecific inflammatory bowel disease. Five patients had pure acute GVHD, and 10 patients had viral enteritis superimposed on acute GVHD. Radiographic abnormalities were found in the gastrointestinal tract in both acute GVHD and viral infection and were more extensive than previously reported. Findings were similar in both entities, although gastric abnormalities were not seen in pure acute GVHD but only in viral infection, either alone or together with acute GVHD. Prolonged small bowel barium coating occurred in both viral infection and acute GVHD. Fold thickening evolved into fold effacement with a shaggy contour in two patients with viral infection. Colonic findings in all groups mimicked ulcerative colitis. Our data indicate that differentiation between acute GVHD and viral enteritis is not possible on the basis of radiographic findings alone. Both entities should be considered when gastrointestinal inflammation occurs after bone marrow transplantation.

The role of the anterior longitudinal ligament in Harrington rod fixation of unstable thoracolumbar spinal fractures

This study was carried out to identify the role of the anterior longitudinal ligament in Harrington distraction rod fixation of the unstable spine, and to suggest clinical means of detecting a ruptured ligament when this is not obvious from a preoperative radiogram. In the unstable thoracolumbar spine, a marked difference in force is required for distraction and stabilization when the ligament is intact compared with when the ligament is disrupted. This can be detected by using a force-indicating distractor during the procedure. Furthermore, when the anterior longitudinal ligament is disrupted, the pattern of vertebral movements during distraction is altered. With the ligament intact, the vertebrae adjacent to the unstable segment will angulate around an axis situated ventral to the vertebral bodies, while the vertebrae will move apart in parallel planes when the ligament is severed. This can easily be detected by studying the movements of Kirschner wires inserted into the spinous processess.

Biofeedback and rational-emotive therapy in the management of migraine headache

Twenty-four migraine patients were randomly assigned to one of four conditions: (a) self-monitoring of headache activity (waiting list), (b) frontalis EMG biofeedback, (c) digit temperature biofeedback, and (d) digit temperature biofeedback plus Rational-Emotive Therapy (RET). Bidirectional control over the target physiological response was assessed through a reversal design in each session. Following at least a four-week baseline, the three biofeedback groups received 8 to 10, 30-minute sessions of bidirectional biofeedback training, scheduled twice a week. Subjects in the combined digit temperature biofeedback plus RET group received three 40-minute sessions of RET as an addition to the third, fifth, and seventh biofeedback sessions. Records of daily home practice were kept throughout treatment and three-month followup. Subjects on the waiting list monitored headaches for at least five months, corresponding to "baseline", "treatment", and three-month followup. Digit temperature biofeedback alone and in conjunction with RET did not prove to be more effective than the control conditions. All the EMG subjects reduced headache activity to two-thirds or less of the baseline level by the third month of followup. Bidirectional digit temperature performance did not improve with training, was demonstrated in only 33% of the biofeedback sessions, was not maintained over time, and was unrelated to improvement in headache activity. EMG subjects reported biofeedback performance to be an easier task and met the performance criterion on 85% of the sessions. The frequency of home practice contributed over 55% of the variance in retrospective estimates of headache improvement but was not related to changes in daily records of headache activity.

An evaluation of the immunoperoxidase technique in renal biopsy diagnosis

An evaluation of the use of horseradish peroxidase labelled antisera against IgG, IgM, IgA and C3 compared with corresponding antisera labelled with fluorescein isothiocyanate has been carried out on renal biopsy material from 200 patients with renal disease. A disparity between the two methods was observed in 10-19% of the readings according to the antigen being demonstrated. The majority of differences recorded would not have influenced the executive diagnosis. Where the immunological results could have influenced the executive diagnosis, 5 probable false results were obtained using innumofluorescence and 4 with immunoperoxidase. Immunoperoxidase has the advantage over immunofluorescence in that it provides a permanent preparation which can be reviewed months or years later. In addition it provides more accurate localization of the immune deposits since the section can be counterstained with Mayer's hemalum and viewed by conventional light microscopy. In view of these advantages we recommend that serious consideration should be given to using immunoperoxidase in place of immunofluorescence for the examination of renal biopsy material.