The clinical efficacy of using specially trained nurses to treat hypertension at the patient's place of work was compared in a controlled trial with management by the patient's family doctor. The 457 study participants were selected from 21 906 volunteers in industry and government whose blood-pressure was screened. The nurses were allowed to prescribe and change drug therapy at the work site without prior physician approval. Patients randomly allocated to receive care at work were significantly more likely to be put on antihypertensive medications (94.7% vs 62.7%, to reach goal blood-pressure in the first six months (48.5% vs 27.5%), and to take the drugs prescribed (67.6% vs 49.1%). Only 6% of patients were dissatisfied with the care provided by the nurses. Thus provision of care at work by specially tranined nurses was well accepted and resulted in significantly improved blood-pressure control and medication compliance among employees with asymptomatic and uncomplicated hypertension.

In a double-blind, cross-over study of twenty male volunteers intravenous injection of 0.4 mg naloxone prevented the impairment of psychomotor performance induced by low levels of blood alcohol. The possibility that alcohol produces intoxication by stimulating the release of endogenous opioid peptides should be investigated.

Motor performance of children born to mothers living in an iodine-deficient region was assessed. The mothers were participants in a controlled trial of intramuscular iodised oil in the prevention of endemic cretinism carried out in the Western Highlands of Papua New Guinea. Mothers received either iodised oil or placebo saline. Children born to mothers given iodine were significantly faster and more accurate in tests of manual function than children from control mothers. The findings indicate that iodine deficiency may lead to a spectrum of subclinical deficits which place the children at a developmental disadvantage.

A prospective study of 116 patients admitted as emergencies with a clinical diagnosis of acute cholecystitis or biliary colic has shown that the best investigation for confirming a diagnosis of acute cholecystitis is 99mTc-pyridoxylidene glutamate (PG) scanning. Its sensitivity is 99% and its specificity 86%, whereas those of oral cholecystography are 75% and 82%, respectively, and those of ultrasonography are 54% and 62%, respectively. However, estimation of plasma liver enzymes is essential to exclude acute hepatitis before proceeding to early cholecystectomy.

375 consecutive patients below 65 years who had an acute myocardial infarction (AMI) took part in a randomised rehabilitation and secondary prevention trial (part of a W.H.O.-coordinated project) designed to study the effects of a multifactorial intervention programme on morbidity, mortality, return to work, &c. After three years' follow-up the cumulative coronary mortality was significantly smaller in the intervention group than in the controls (18.6% versus 29.4%, p = 0.02). This difference was mainly due to a reduction of sudden deaths in the intervention group (5.8% versus 14.4%, p less than 0.01). The reduction was greatest during the first six months after AMI. 18.1% in the intervention group and 11.2% in the controls (p less than 0.10) presented with non-fatal reinfarctions. The number of patients with new Q-QS findings at the end of the three years was, however, almost the same in both groups. The results suggest that organised aftercare during the first six months after AMI with special emphasis on optimum medical control and health education contributes significantly to a reduction in the number of sudden deaths.

DDAVP (1-desamino-8-d-arginine vasopressin), a synthetic analogue of vasopressin with prolonged half-life and high antidiuretic and low pressor activity, was given in a double-blind placebo-controlled trial to four patients with major affective illness. Three of four patients showed highly significant and consistent improvements in tests designed to measure the formation, encoding, and organisation of long-term trace events in memory. Two patients also showed a significant but less consistent amelioration of other depressive symptoms during DDAVP treatment. These findings implicate central vasopressin function in the processing of information and possibly other aspects of affective illness.