Endocrine markers and anthropometric measures were degraded, and inflammatory mediators increased after an extended energy deficit. A short-term recovery of 2-6 weeks was sufficient to restore these mediators.

Depression is common in CKD and is associated with a significant risk of adverse outcomes. Given the importance of this issue, there is now an urgent need for well-conducted randomised trials of interventions for depression in CKD in order to provide information on the safety and efficacy of treatments.

Objectives-To determine the reasons for choosing between primary care out of hours centres and accident and emergency (A&E) departments for patients with primary care problems. Methods-Interviews using a semistructured approach of samples of patients attending A&E departments and general practitioner (GP) out of hours centres for primary care problems. Results-102 patient interviews were undertaken. Sixty two per cent of A&E attenders were unemployed compared with 41% of out of hours attenders. White people were more likely to attend A&E departments and Asians the out of hours centre (p<0.01) and unemployed were more likely to attend A&E departments (70% v 30%). Some 46.3% of A&E department attenders had not contacted their GP before attending; 81.3% of first time users of the out of hours centre found out about it on the day of interview. Those attending A&E thought waiting times at the out of hours centre would be 6.3 hours (median) compared with a median perceived time of 2.9 hours by those actually attending the out of hours centre. Actual time was actually much less. Conclusion-Once patients have used the GP out of hours centre they are more likely to use it again. Education should be targeted at young adults, the unemployed and white people. Patients should be encouraged to contact their GP before A&E department attendance for non-life threatening conditions. Waiting time perception may be an important reason for choice of service. (J Accid Emerg Med 2000;17:18-21) Keywords: out of hours care; primary care; patient choice General practice cooperatives are a comparatively new and successful provision of out of hours primary care in the United Kingdom. In these cooperatives groups of general practitioners (GPs) combine resources to provide emergency cover for their practices. Out of hours they usually run an emergency centre. Patients who telephone the GPs may be given advice, advised to attend the centre, or may receive a visit. However, patients continue to attend the accident and emergency (A&E) department with primary care problems out of hours. As primary care attenders to the A&E department can be managed more appropriately and more economically by the GP services, 1 the current state of aVairs represents a poor use of resources.Factors that have been shown to determine why patients choose A&E over general practice are travelling distance, 2 lack of knowledge of the range of GP services, 3 perceived need for immediate attention, 4 and more advanced technology. 5A small proportion of these patients are not registered with a GP, are visitors, or are homeless. 6 These results are from studies that were conducted before the inception of out of hours GP cooperatives, when GP deputising services were the mainstay of out of hours primary care. No study to date has determined the reasons for out of Figure 1 The age distribution of A&E and cooperative patients.

Microbial contamination of sprouts by Salmonella and Escherichia coli O157 : H7 has been a common cause of foodborne diseases and a continuing challenge to the sprout industry. Seed disinfection treatment has been recommended as a major intervention step in a multihurdle approach to reduce the risk of illness associated with contaminated sprouts. U.S. Food and Drug Administration cited 20000 ppm calcium hypochlorite as an example treatment in its recommendation for seed treatment and this treatment has been considered the reference standard for seed disinfection treatment for over a decade. However, promising new disinfection treatments have emerged in recent years. In this study, we summarized published data and compared the efficacies of different disinfection methods in the reduction of microbial contamination on seeds. Our findings suggest that while biological interventions such as competitive exclusion and certain chemical treatments appear to be similar to 20000 ppm calcium hypochlorite for seed disinfection, physical methods especially high pressure may be more effective than the reference standard regardless of the type of bacteria or seed. The combination of 2 or more treatments, sequentially or simultaneously, may further improve disinfection results. Since treatments with high levels of chemical disinfectants, especially 20000 ppm calcium hypochlorite, can pose environmental and worker safety risks, alternative intervention approaches should be considered. Additional studies to confirm the greater efficacy of certain physical and combined seed disinfection treatments and to identify other effective management strategies are needed to further improve sprout safety.