A double blind study compared the efficacy of metronidazole in two doses (20 mg/kg, 10 mg/ kg) with placebo in patients with Crohn's disease. One hundred and five patients participated but only 56 completed the 16 week study -21 were withdrawn for deterioration of symptoms, 17 for adverse experiences, and 11 for protocol violation. Significant improvement in disease activity as measured by the Crohn's disease activity index (metronidazole 20 mg/ kg, 97 units; metronidazole 10 mg/kg, 67 units; placebo -1 unit, p=0002) and serum orosomucoid (metronidazole 20 mg/kg/day, 49; 10 mg/kg/day, 38; placebo, -9, p=0001)) were detected. Changes in C reactive protein concentrations did not achieve significance when all three groups were considered but were significant when all metronidazole treated patients were grouped and compared with the placebo treated patients (0-8 v -0-9, p<005). Although patients receiving metronidazole 20 mg/kg/day had a greater improvement in disease activity than those receiving 10 mg/kg/ day (difference 30 units (95% confidence intervals -27-87), the small sample size may have precluded the detection of statistical significance. Preliminary analysis suggests that metronidazole was more effective in patients with disease confined to the large intestine or affecting both small and large bowel than in those with small bowel disease only. There were no differences in remission rates between metronidazole and placebo treated patients. We conclude that metronidazole warrants further assessment in the treatment of patients with active Crohn's disease.

BackgroundSelf-harm is prevalent in adolescence. It is often a behaviour without verbal expression, seeking relief from a distressed state of mind. As most adolescents who self-harm do not seek help, the nature of adolescent self-harm and reasons for not disclosing it are a public health concern. This study aims to increase understanding about how adolescents in the community speak about self-harm; exploring their attitudes towards and experiences of disclosure and help-seeking.MethodsThis study involved 30 qualitative individual interviews with ethnically diverse adolescents aged 15–16 years (24 females, 6 males), investigating their views on coping with stress, self-harm and help-seeking, within their own social context in multicultural East London. Ten participants had never self-harmed, nine had self-harmed on one occasion and 11 had self-harmed repeatedly. Verbatim accounts were transcribed and subjected to content and thematic analysis using a framework approach.ResultsSelf-harm was described as a complex and varied behaviour. Most participants who had self-harmed expressed reluctance to talk about it and many had difficulty understanding self-harm in others. Some participants normalised self-harm and did not wish to accept offers of help, particularly if their self-harm had been secretive and ‘discovered’, leading to their referral to more formal help from others. Disclosure was viewed more positively with hindsight by some participants who had received help. If help was sought, adolescents desired respect, and for their problems, feelings and opinions to be noticed and considered alongside receiving treatment for injuries. Mixed responses to disclosure from peers, family and initial sources of help may influence subsequent behaviour and deter presentation to services.ConclusionsThis study provides insight into the subjective experience of self-harm, disclosure and help-seeking from a young, ethnically diverse community sample. Accounts highlighted the value of examining self-harm in the context of each adolescent’s day-to-day life. These accounts emphasised the need for support from others and increasing awareness about appropriate responses to adolescent self-harm and accessible sources of help for adolescents.

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The aim of this Guide is to support teacher with the responsibility of designing, delivering and/or assessing diversity education. Although, the focus is on medical education, the guidance is relevant to all healthcare professionals. The Guide begins by providing an overview of the definitions used and the principles that underpin the teaching of diversity as advocated by Diversity and Medicine in Health (DIMAH). Following an outline of these principles we highlight the difference between equality and diversity education. The Guide then covers diversity education throughout the educational process from the philosophical stance of educators and how this influences the approaches used through to curriculum development, delivery and assessment. Appendices contain practical examples from across the UK, covering lesson plans and specific exercises to deliver teaching. Although, diversity education remains variable and fragmented there is now some momentum to ensure that the principles of good educational practice are applied to diversity education. The nature of this topic means that there are a range of different professions and medical disciplines involved which leads to a great necessity for greater collaboration and sharing of effective practice.

The role of theory in qualitative research is often underplayed but it is relevant to the quality of such research in three main ways. Theory influences research design, including decisions about what to research and the development of research questions. Theory underpins methodology and has implications for how data are analyzed and interpreted. Finally, theory about a particular health issue may be developed, contributing to what is already known about the topic that is the focus of the study. This paper will critically consider the role of theory in qualitative primary care research in relation to these three areas. Different approaches to qualitative research will be drawn upon in order to illustrate the ways in which theory might variably inform qualitative research, namely generic qualitative research, grounded theory and discourse analysis. The aim is to describe and discuss key issues and provide practical guidance so that researchers are more aware of the role theory has to play and the importance of being explicit about how theory affects design, analysis and the quality of qualitative research.