Escherichia coli O157 infections cause an estimated 60 deaths and 73000 illnesses annually in the United States. A marked summer peak in incidence is largely unexplained. We investigated an outbreak of E. coli O157 infections at an agricultural fair in Ohio and implicated consumption of beverages made with fairground water and sold by a geographically localized group of vendors who were all on the same branch of the fairground water distribution system. To examine county fair attendance as a risk factor for infection, we conducted two further epidemiological studies. In the first, we enhanced surveillance for E. coli O157 infections in 15 Northeast Ohio counties during the 2000 agricultural fair season and showed increased risk of E. coli O157 infection among fair attendees. In the second study, we examined Ohio Public Health Laboratory Information Service (PHLIS) data for 1999 using a time-varying covariate proportional hazards model and demonstrated an association between agricultural fairs and E. coli O157 infections, by county. Agricultural fair attendance is a risk factor for E. coli O157 infection in the United States and may contribute to the summer peak in incidence. Measures are needed to reduce transmission of enteric pathogens at agricultural fairs.

A questionnaire was sent to 200 psychiatrists asking them about their off-label prescribing in the preceding month. One hundred and sixteen replies (58%) were obtained. Seventy-six (65%) respondents had prescribed medication off-label within the past month. Only 5 (4%) had ever received a complaint from patients related to their off-label prescribing. If this region is typical, off-label prescribing is common amongst psychiatrists. No formal guidelines exist except for the use of high dose neuroleptics. A suggested guideline is given in this article.

We present two cases of supraglottic transection, with concomitant neurotemesis of the superior laryngeal nerve. Both cases were repaired primarily and a temporary tracheostomy was used to protect the airway. In both cases subsequent decannulation was achieved within four weeks, following the initial injury. No long-term swallowing or voice disturbance was noted in either case. We recommend that in such cases it is unnecessary to repair the nerves directly, but that careful repair of the wound itself will achieve a functional result.

Day-case surgery has been urged on the National Health Service by the Audit Commission in the last decade despite concerns about safety. A questionnaire was posted to the parents of 109 children who had recently undergone day-case adenoidectomy, addressing parental concerns and opinions. Eighty per cent of the questionnaires were returned. A high level of satisfaction with day-case adenoidectomy was expressed by the parents. All the children were observed for six hours after surgery prior to discharge. One child was visited at home by his general practitioner in the first 24 hours of discharge but there were no serious post-operative complications and none of the children required re-admission to hospital. Day-case adenoidectomy is safe, very acceptable to parents and does not result in a greatly increased workload for general practitioners.

A prospective study was conducted of all referrals to the emergency psychiatric service of an inner-London hospital over one year. There were 53 individuals who presented with the specific and spontaneous complaint of suicidal ideation without any accompanying act of self-harm. The main diagnoses in this group were personality disorders (40%) and alcohol dependence (15%); only 13% were suffering from depressive illness. Members of the group differed from the other 369 presenters to the service in that they were less likely to be accorded a diagnosis of a defined mental illness, twice as likely to have a criminal record, and more likely to have a previous history of deliberate self-harm. A quarter of the suicidal complainants were admitted to hospital following assessment.