Of toddlers to recognise Tv imagesClinical utility of this milestone is just not established Editor–Lloyd and Brodie propose that the ability of an 18 month old child to recognise tv photos may be a helpful milestoneBMJ VOLUME 321 5 AUGUST 2000 bmj.comLetterscalls for enhanced well being care5 have faced big obstacles in their implementation, partly because of the funding implication but we would contend also as a result of the defensiveness all of us feel when faced with issues that we are not competent to tackle. The establishment of a confidential inquiry into PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20018838 deaths of men and women with learning disabilities would enhance transparency and quantification of health inequalities within this marginalised group. The instruction and exposure presented to healthcare undergraduates and postgraduate medical doctors inside the wellness requires, and how you can meet them, of these people today need to also be reviewed. Only by enhancing N6-Phenylethyladenosine biological activity coaching will we increase competence and lower discrimination.Mhairi Duff specialist registrar in psychiatry of finding out issues University of Bristol, Norah Fry Investigation Centre, Bristol BS8 1TX [email protected] Matt Hoghton consultant in physical overall health of people with mastering disability Backwell and Nailsea Study Practice, Brockway Healthcare Centre, Nailsea, Bristol BS48 1BZ Mark Scheepers specialist registrar in psychiatry of finding out disability Severn NHS Trust, Gloucester GL1 3HZ1 Leonard H, Eastham K, Dark J. Heart and heart-lung transplantation in Down’s syndrome. BMJ 2000;320:816-7. (25 March.) two Aspray T, Francis R, Tyrer S, Quilliam S. Sufferers with learning disability in the community. BMJ 1999;318:476-7. 3 Jancar J. Cancer and mental handicap; a further study (1976-1985). Br J Psychiatry 1990;156:531-3. 4 Howells G. Would be the healthcare desires of mentally handicapped adults becoming met J R Coll Gen Pract 1986;36:44953. five Lyndsay M. Signposts for achievement in commissioning and providing overall health services for men and women with mastering disability. Leeds: NHS Executive, 1998.We highlighted the problem of separating a “true” biological impact in the effects of “awareness bias” in communities which might be aware of their exposure, but we didn’t, as Moffatt and Bhopal claim, remove the 25 of individuals who believed that the hazard had an adverse impact on overall health. In fact, we compared the reported wellness differences amongst those who did and did not think that chromium was dangerous after which commented around the variations, pointing out that these participants who believed chromium to be damaging might have had their generic quality of life lowered in the absence of any documented adverse well being effects. We emphatically didn’t rely only on information from people that believed that chromium is not dangerous. The fact that most respondents preferred improvements to local amenities over chromium remediation will not imply acceptance of your hazard on our component. We pointed out that the want for improved amenities more than a clean up highlights the complexities of this circumstance. We then stated that one of the most proper response to environmental pollution difficulties is prompt and frank dialogue with exposed communities and public participation within the evaluation of any wellness dangers to ensure that the resolution of such troubles is democratic and acceptable to these impacted. We share Moffatt and Bhopal’s views on environmental hazards normally, however they have misunderstood our paper in critical respects.Peter McCarron lecturer in epidemiology and public health Tim J Peters reader in m.