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BMJ No 7094 Volume 314 This week in BMJ Saturday 31 May 1997 Autoimmunity in insulin dependent diabetes may be due to early environmental exposure Patients care more than doctors about non-physical manifestations of disease Ethics committees should follow up 10% of approved studies Higher blood cholesterol concentrations linked with improved survival after stroke GPs are enthusiastic about an out of hours cooperative, patients less so Autoimmunity in insulin dependent diabetes may be due to early environmental exposure Twin studies are a means of assessing the contribution of environment and genes to the development of diseases. Petersen et al (p 1575) looked for several islet cell antibodies in serum samples from monozygotic and dizygotic twins in whom one or both twins had insulin dependent diabetes. They found no difference in the prevalence of autoantibodies in monozygotic and dizygotic twins who did not have diabetes, suggesting that islet cell autoimmunity is environmentally determined. Furthermore, antibodies were more prevalent in twins without diabetes than in other first degree relatives. This implies that the natal period is aetiologically important. Patients care more than doctors about non-physical manifestations of disease A doctor's assessment of a patient's clinical state is not necessarily more valid than the patient's own assessment. Using standard measures of physical disability and health related quality of life in patients with multiple sclerosis, Rothwell et al (p 1580) show that self assessment of physical disability by patients correlates well with assessments by clinicians. However, patients are less concerned than clinicians about the physical manifestations of the disease and more concerned about other aspects of quality of life, such as general health, mental health, and vitality, none of which was correlated with physical disability. Ethics committees should follow up 10% of approved studies Few local medical research ethics committees study what happens once they have approved research. Trevor Smith et al (p 1588) of the Tayside research ethics committee report what happens to studies that the committee has approved - for example, whether the investigators follow the agreed protocol or notify any changes to it. Their findings led them to recommend that all committees should randomly select at least 10% of projects for subsequent on site review; that all remaining projects should be reviewed by questionnaire; and that patients should also complete a questionnaire. Higher blood cholesterol concentrations linked with improved survival after stroke The balance of evidence suggests that higher cholesterol is associated with an increased risk of atherothrombotic stroke but a reduced risk of intracerebral haemorrhage. Dyker et al (p 1584) investigated this association in 977 patients hospitalised with acute stroke. They found that higher serum total cholesterol concentrations were associated with a reduction in long term mortality after stroke. This relation was independent of the type or extent of the stroke, vascular territory, age, and hyperglycaemia - all factors known to influence survival independently after stroke. GPs are enthusiastic about an out of hours cooperative, patients less so Many general practitioners now belong to a cooperative that provides primary care outside normal hours. Two papers by Salisbury evaluate a cooperative in London and contrast the views of patients and doctors. Doctors were enthusiastic about their cooperative and were very satisfied with its standard of care (p 1598). Most thought it had a beneficial impact on their personal and professional lives. Patients expressed similar levels of satisfaction with the cooperative and with a deputising service (p 1594). A significant minority of patients expressed dissatisfaction with some aspects of both services. Patients given telephone advice, especially when they had wanted a visit, and those from non-white ethnic groups were particularly likely to be dissatisfied. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline