OBJECTIVES:To assess knowledge of Chlamydia trachomatis infections, with a comparison of knowledge of Neisseria gonorrhoeae infections.METHODS:A cross sectional survey, by self completed questionnaire, of 200 subjects attending a genitourinary outpatient clinic.RESULTS:The response rate was 82% (90 male and 73 female). 51% of men (60% of females) had heard of chlamydia. 65 (82%) were unaware of the potential consequences of infection. 66% were unaware that the disease could be asymptomatic. Significantly more men (77%) than women (60%) had heard of gonorrhoea. Most participants (68%-82%) knew little of the possible consequences of this infection, and only 26% were aware that it could be asymptomatic. Knowledge was higher regarding fertility topics. There was no correlation between knowledge and either age or socioeconomic status. However, greater knowledge was displayed by those who read health information leaflets always or often. For both men and women, the preferred source of health information was the doctor. Other popular sources were health information leaflets, women's magazines, and television.CONCLUSIONS:Barely half the participants had heard of chlamydia and gonorrhoea. Further knowledge of either infection was very poor. There are serious implications for public health. The reasons for this are unclear and require exploration before targeted health promotion. Doctors and the popular media are acceptable, and potentially effective, sources of information. Acquisition of knowledge is important, both to reduce sexual risk taking behaviour and its consequences, and to allow for informed consent for chlamydia screening programmes.

AIMS To determine the quantitative relation between the major risk factors for microbial keratitis of previous ocular surface disease and contact lens wear and central and peripheral infiltration, often associated with ulceration, in order to establish a rational chemotherapeutic management algorithm. METHODS Data from 55 patients were collected over a 10 month period. All cases of presumed microbial keratitis where corneal scrapes had been subjected to microbiological examination were included. Risk factor data and laboratory outcome were recorded. Antimicrobial regimens used to treat each patient were documented. RESULTS 57 episodes of presumed microbial keratitis were identified from 55 patients, 24 male and 31 female. There were 30 central infiltrates and 27 peripheral infiltrates of which 28 were culture positive (73% of central infiltrates, 22% of peripheral infiltrates). 26 patients had worn contact lenses of whom 12 had culture positive scrapes (9/14 for central infiltrates, 3/12 for peripheral infiltrates). 31 patients had an ocular surface disease of whom five previous herpes simplex virus keratitis patients developed secondary bacterial infection. Anterior chamber activity and an infiltrate size ⩾ 4 mm2 were more common with culture positive central infiltrates than peripheral infiltrates (χ2 test = 11.98, p<0.001). CONCLUSIONS Predisposing factors for “presumed” microbial keratitis, either central or peripheral, were: ocular surface disease (26/57 = 45.6%), contact lens wear (26/57 = 45.6%), and previous trauma (5/57 = 8.8%). Larger ulceration (⩾4 mm2) with inflammation was more often associated with positive culture results for central infiltration. None of these four variables (contact lens wear, ocular surface disease, ulcer size, anterior chamber activity) were of intrinsic value in predicting if a peripheral infiltrate would yield identifiable micro-organisms. Successful management of presumed microbial keratitis is aided by a logical approach to therapy, with the use of a defined algorithm of first and second line broad spectrum antimicrobials, for application at each stage of the investigative and treatment process considering central and peripheral infiltration separately.

Purpose: Risk factors for microbial keratitis (mk) are previous ocular surface, disease, contact lens (CL) wear and trauma. Their respective roles for central and peripheral infiltration (CI and PI) reflect changing primary car practice influencing predisposing causes. This study quantifies risk factors. Methods: The study was conducted over nine months. All cases of putative mk were investigated using intensive culture of corneal scrapes. Risk factor data were recorded. All patients receiving antimicrobial therapy were included. Results: 26/54 patients (48%) had CI (46% wore CL), 3/54 (6%) had paraxial infiltration and 25/54 (46%) had PI (40% wore CL). For CI, 14/26 (54%) yielded Acanthamoeba sp. (4), S. aureus (3), S. pneumoniae (3), S. viridans (1), Ps. aeruginosa (2) and Acinetobacter sp. (1); 8/14 (57%) wore CL [FDA groups 1(2), 2(1), 4(5)], the former 3 extended wear, the latter 5, 4‐weekly use of ‘disposable’ CL. 5 CI had ocular surface disease (4 HSV); 1 had trauma (mascara brush) with contaminated drops. For PI, 2/25 (8%) were cultured‐positive (1 S. aureus and 1 S. pneumoniae ); neither wore CL and other recognized factors were absent. Conclusions: Predisposing factors in culture‐positive CI were CL wear and previous HSV keratitis. Compliant use of hydrogen peroxide disinfection in CL wearers was not associated with culture‐positive infiltration.

A survey of the hygienic practices of 178 contact lens wearers in west central Scotland was conducted along with assessment of microbial contamination of their lens storage cases. Multivariate analysis indicated that in some subgroups of lens wearers, the method of disinfection used, the use of unmodified tap water and the age of the lens, were significantly associated with microbial contamination of storage cases. In addition, statistical analysis suggested that features other than those commonly considered as important in contact lens hygiene, and therefore included in this study, may be more significant predictors of contamination of cases. Instruction of patients, patient compliance and simplicity of the regimen for the care of contact lenses may be important for achieving their safer use.

Microbial keratitis can occur in association with contact lens wear. The absolute risk of infection is low but may be enhanced as a consequence of increased exposure to potentially pathogenic microbes in a hospital setting. There is variation in risk depending on type of lens worn and its modality of use. Extended-wear lenses carry the greatest risk. Pseudomonas aeruginosa and Acanthamoeba are causes of potentially devastating ocular infections in contact lens wearers. The risk of these infections could be reduced by fastidious hygiene practice. Hydrogen peroxide disinfection is recommended when a storage case is included in the care regimen. This should be cleaned thoroughly and dried prior to disinfection and never exposed to tap water. Daily wear of one-day ‘disposable’ soft contact lenses or use of rigid gas permeable lenses is recommended for hospital staff. Contact lenses should be removed immediately and discarded or disinfected if the eye becomes contaminated and/or use of an eyewash is required.

A cross-sectional study of 178 asymptomatic contact lens wearers attending 10 contact lens practices in the west of Scotland was conducted over a 4 month period. The aims of the study were to identify specific microbial contaminants in lens cases, to determine the rate of contamination of such containers and to assess the value of the steps involved in different lens care regimens in the prevention of case contamination. Microbial contamination affected 53% of lens cases. Cases used with conventional wear and disposable systems were contaminated at similar rates and, therefore, the advantage of regular lens replacement may have been lost if these lenses were stored in contaminated cases. Four percent of lens cases were contaminated with amoebal species and all of these showed concomitant bacterial colonisation. These findings imply that case hygiene is probably as important as lens hygiene if new or disinfected lenses are not to be immediately re-contaminated by storage in dirty cases. Unfortunately simple and effective methods of lens and case disinfection, which would be suitable for use in the average home environment, are not yet available. It follows that frequent and regular disposal of lens cases may prove to be a necessary measure to prevent the build-up of microbial colonisation in such containers.

This study addresses the recent controversy regarding frontal lobe deficits in psychopaths (Gorenstein, 1982; Hare, 1984) and more generally the question of a relationship between psychopathy as variously attributed (by legal criteria, by clinical-behavioural criteria, and by psychometric criteria) and performance on a task used in the assessment of frontal lobe function, Nelson's Modified Wisconsin Card Sorting Test (MWCST). Two samples of Special Hospital patients were tested as well as a small group of normal healthy volunteers. Patients classified legally as suffering from a ‘Psychopathic Disorder’ did not differ on MWCST measures from patients classified legally as ‘Mentally Ill’. There were no differences on performance measures comparing patients assessed as ‘high’ or ‘low’ on Hare's Psychopathy Checklist. Comparison between psychometrically derived patient groups corresponding to Blackburn's (1974) ‘primary’ and ‘secondary’ psychopathic types yielded statistically significant results: ‘secondary’ psychopaths showed significantly more total errors and achieved significantly fewer categories than did ‘primary’ psychopaths and controls. This suggests that the discrepancy between Gorenstein's (1982) and Hare's (1984) results can parsimoniously be explained by their use of different selection criteria to select their ‘psychopaths’. However, it is suggested that performance deficits on the MWCST such as were obtained in ‘secondary’ psychopaths are not a correlate of ‘psychopathy’ (however defined), but rather reflect an inability to maintain set resulting from an over-appraisal of threat on the part of the anxious, socially withdrawn individual.

Hostility and Direction of Hostility Questionnaire (HDHQ) and Personality Deviance Scale (PDS) scores were obtained from a group of normal females in order to compare the major hostility dimensions of extrapunitiveness and intropunitiveness. Statistically significant correlations resulted but only of a moderate order even when the apparently more pathological subscales were omitted from the HDHQ.