Screening for congenital hypothyroidism in Maltese newborns using cord blood

Routine screening for congenital hypothyroidism (CHT) has been introduced because clinical features of CHT may not be evident before the baby is a few weeks old and treatment at this stage may already be too late. Since a newborn testing programme employing liquid cord blood for other conditions had already been developed in the University of Malta and the Department of Health, we explored the possibility of implementing newborn thyroid testing using liquid cord blood. A similar programme had been implemented successfully in Finland and Philadelphia. Between September 1989 and August 1995 around 32,000 newborns were tested. This is nearly complete ascertainment. Preliminary testing was by radioimmunoassay for TSH. The sera of those with TSH levels more than 13mU/l were further tested for free T4. If the free T4 level was below 12 pmol/l, the babies were recalled for clinical evaluation and repeat testing. Other babies were recalled for technical reasons, giving a total recall rate of 3.88%. CHT was identified in seven newborns and treatment started within 3 weeks of delivery. One baby was reported normal on screening but was suspected to have CHT on clinical grounds at 3 weeks of age, confirmed biochemically. The incidence of CHT in Malta is therefore 1 in 4500.peer-reviewe

The influence of prior training on GPs’ attitudes to sickness absence certification post-fit note.

AimTo investigate the attitudes to health and work of general practitioners (GPs) with training in occupational medicine (OM) compared with non-OM trained GPs, since the introduction of the fit note.BackgroundChanges to the UK sickness certification system since 2010 and the introduction of the fit note required GPs to change their focus to what patients can do, rather than what they cannot do in relation to work. In an effort to reduce the UK sickness absence burden, GPs completion of the fit note should help to keep people in work, or assist patients to return to work as quickly as possible after a period of absence.MethodsQuestionnaire data were collected via the 7th National General Practitioner Worklife Survey.FindingsResults indicate that responses from GPs who had undertaken training in OM, and GPs having received some form of work and health training in the 12-month period before the study were associated with significantly more positive attitudes to patients’ returning to work and to the fit note. This study reveals evidence of a difference between trained and non-trained GPs in their attitude to the fit note, and to work and health generally. Further work investigating the effect of specific training in OM on the management and recognition of ill-health by GPs is recommended.</jats:sec

The metal content of airborne particles in Edinburgh: application to epidemiological research

Metals are putative causative agents in the association between ill health and exposure to airborne particles. We present preliminary results from an epidemiological study using exposure metrics of metal contained in PM10, PM2.5 and black smoke. A 1 yr monitoring and analysis campaign has been completed for 11 metals at 24 h sampling resolution. Empirical models of environmental determinants of metal concentration have been used to retrospectively extrapolate the pollutant time series. We are currently evaluating whether the use of metal concentration explains more of the variance in the population exposure–response relationship compared with the use of particle mass concentration alone