Carrier detection in Hunter syndrome.

We have studied the carrier state of the Hunter syndrome using a series of obligate carriers, females at high genetic risk, and normal control women. Specific odds of a female being a carrier of Hunter syndrome were based on serum levels of iduronate 2-sulphate sulphatase activity. These, together with the prior genetic odds, may be used in calculating the overall odds of a woman being a carrier. Iduronate 2-sulphate sulphatase levels were found to increase significantly with age. Obligate carriers from families of severe cases had significantly lower enzyme levels compared with those from families of mild cases. In contrast, enzyme levels in sera of mild and severe cases were not significantly different. With the accumulation of more data the effect of age of the potential carrier and the severity of the disease may have to be taken into consideration in the risk calculation. Hair-root analysis was more reliable in the detection of carriers than estimation of serum enzyme levels, but some individuals could not be classified with confidence by hair-root analysis alone. Carrier detection was most reliable when hair-root analysis and serum enzyme levels were taken together.

Health beliefs and compliance with alcoholism treatment.

This study examined the health beliefs and attitudes of patients seen in an alcoholism treatment clinic and investigated the relationship between these beliefs and attitudes and patient compliance as defined by length of time in treatment contact. Results showed that health beliefs and attitudes measured at the onset of treatment were predictive of patient adherence to treatment. Elements of the Health Belief Model found to be strongly associated with compliance included patients' perceived severity of their drinking problem, their expectations of improvement by remaining in treatment, and their levels of satisfaction with aspects of the doctor-patient relationship during the initial visit. The Health Belief Model offers a fruitful approach to understanding patients' compliance with alcoholism treatment and indicates possible areas for intervention to improve adherence.

Changing patients' health beliefs to improve compliance with alcoholism treatment: a controlled trial.

The purpose of this study was to examine whether changing the health beliefs of alcoholic patients entering treatment would improve their retention in treatment. A control group received the conventional range of treatment options available at an alcoholism clinic whereas an experimental group received, in addition, an opportunity to attend group meetings where attempts were made to modify their health beliefs. Although this intervention resulted in changes in patients' health beliefs, the subsequent difference between groups in average length of stay in treatment was not statistically significant. Explanations for the only modest success of the belief modification strategy are proposed and implications for the Health Belief Model and patient compliance with alcoholism treatment are discussed.

The use of metallic glass scroll as an acoustic transducer element.

A study was made of the piezomagnetic and elastic properties of scrolls of Metglas 2605 SC, used as an acoustic transducer element. This study involved quasi-DC magnetic induction measurements and ultrasonic complex plane analysis of scrolls of various annealing histories. An optimum effective magnetomechanical coupling coefficient. K(eff), of 0.75, was found. The best magnetomechanical response in air obtained for metallic glass scroll during the study was for the unconsolidated case. However, preliminary experiments have shown that structural weakness and corrosion problems are significant when using the unconsolidated scrolls in water.

Occupational stress in health service employees.

Levels of occupational stress were examined in 383 employees of various occupations in one health district, as a preliminary to devising a strategy to reduce the negative effects of stress in the workplace. In comparison with white collar and professional workers in industry, health workers reported significantly greater pressure at work, higher ratings of physical and mental ill health, lower job satisfaction, less internal control over their working environment but used more coping strategies. Approximately one in eight of the subjects has stress symptoms of equal magnitude to patients attending clinical psychology outpatient clinics. It was also found that job satisfaction and psychosomatic ill health were related to sickness absence amongst health employees. The implications of these findings and the consequent challenges facing health service managers are discussed.

Job stress, ill health and job satisfaction among health service employees.

The study examined the effects of occupational stressors, perceived locus of control, Type A behaviour pattern and use of coping strategies on well-being and job satisfaction of 1,176 health service employees. Several stressors were identified as having a negative impact on health and job satisfaction although these differed between the various occupational groups included in the study. The interactionist model of stress used in the study, and the diagnostic tool used (the Occupational Stress Indicator) proved to be useful in suggesting means of intervening to reduce ill health and increase job satisfaction among health service employees.

Prospective patients' reactions to alcoholism clinic referral.

Thirty-seven patients were interviewed at home before their initial appointment at an alcoholism clinic to discover their reactions to referral, attitudes to attending and expectations of what would happen. Referral for the majority was not initiated by the patients themselves but usually by the general practitioner, sometimes at the request of the patient's spouse. Most felt a sense of relief on receiving an appointment to attend. Although embarrassment about the prospects of attending was commonplace, those who informed all their family and friends of the referral were more likely to attend. Few informed their employer of the appointment. Few had any knowledge of what would happen at the clinic but most expected to be told to stop drinking. Most informants were very optimistic about their prospects of recovery. Information collected during the interviews raises questions about the referral process and how patients may be better prepared for attendance at an alcoholism clinic. The referral agent should deal with any misconceptions and misgivings that patients may have about psychiatric referral and treatment. They should attempt to motivate patients to regard referral as a positive step towards eventual recovery from a drinking problem. The evidence to date suggests that patients who are more carefully prepared for referral and consultation have a more positive attitude towards it.

Patient use of treatment options at an ATU and ratings of their relative usefulness.

A sample of new patients attending an ATU was followed up for 6 months. All those who had completed at least 3 months of treatment were asked about the kinds of treatment they had received and their views about the usefulness of the various treatment options available (as were staff). Treatment outcome was assessed in terms of drinking behaviour and patient ratings of the severity of their drinking problem. The survey showed considerable variation in the intensity of treatment received; overall the cohort reduced their alcohol consumption substantially (particularly those who received more intensive treatment) and believed their drinking problem to be much less serious. Patient (and staff) views of the various treatment options are presented and discussed. Although staff and patients differed substantially in their views both groups showed little support for the involvement of relatives in treatment.

Some factors associated with compliance in the treatment of alcoholism.

The investigation set out to examine the extent of problems of low compliance at an alcoholism clinic, to investigate some variables that might differentiate referral failures and initial clinic attenders as well as categories of patients who attend for treatment, and to generate hypotheses concerning these differences as a means of developing a compliance-enhancement strategy. Information, including sociodemographic and personality variables, patient self-reports of drinking behaviour, self-perceptions of their need for help and of drinking problem severity, and therapist ratings of drinking problem severity, was gathered on one hundred referrals to a clinic for new patients. Results showed that 46% of patients were referral failures and that, in comparison with attenders, the former group had both waited longer for the initial appointment and were younger. Few variables differentiated the categories of attenders. A greater proportion of those remaining in treatment contact for longer than a month rated the change in their drinking problem over the previous year as 'worse' and more of them had been arrested for public drunkenness. Those who made five or more clinic visits had waited a shorter time for their initial appointment, and a greater proportion rated the effects of their drinking on their work as 'serious' and the change in their social life as 'worse' than patients who had made fewer visits. The findings suggest that variables related to personal perceptions of drinking problems offer a better account of compliance behaviour than the sociodemographic variables which have been the focus of previous research.

Measurement of alcohol withdrawal in detoxification centre patients.

The pattern and severity of alcohol withdrawal in 49 alcohol dependent subjects admitted to the Manchester Detoxification Centre are described. Assessment over 10 days involved the use of the Selected Severity Assessment Scale (SSA) and allocation of patients to subgroups of the alcohol withdrawal syndrome. There were associations between tremor, clouding of sensorium, hallucinations and convulsions (items of the SSA) and the four pre-delirious clinical sub-groups identified. We concluded that clinical assessment of the pre-delirious stage took into account these four variables and that there was little value in the routine use of the SSA on a unit such as ours.

Sexual jealousy in alcoholics.

A hundred patients referred to an alcoholism service were assessed in terms of sexual jealousy by interview and with a Sexual Jealousy Questionnaire. The overall incidence of sexual jealousy was 35% in men and 31% in women as judged by the interview. Twenty-seven per cent of the men and 15% of the women had morbid jealousy. There was no relationship between sexual jealousy, as measured by the questionnaire, and sexual dysfunction. However, in the men there were inverse relationships between the scores for sexual jealousy and measures of sexual satisfaction and marital stability, and in the women sexual jealousy scores correlated negatively with duration of the marriage and positively with severity of alcohol dependence.

The Manchester detoxification service. Description and evaluation.

The service of Manchester's hospital-based purpose-built alcohol detoxification centre is described, together with demographic data, drinking history, findings on admission, disposal arrangements, and outcome of 235 police referrals. Police referrals under-used the centre, which now accepts from magistrates' courts, the local alcoholism council, accident and emergency departments, and general practice. Police referrals, mostly homeless and without family support, contained many episodic drinkers; this explains the low incidence of severe withdrawal symptoms. Prophylactic treatment was not routine. Very high blood alcohol levels were recorded from some conscious patients. There was little serious medical morbidity. Many discharged themselves within 24 hours. Few accepted the recommended treatment, medical or social; prolonged abstinence was achieved by only 1% but substantially more had short abstinent periods and some social betterment, especially if offered follow-up help. Visits to general practitioners' surgeries fell during the follow-up period, as did admissions to general units for withdrawal symptoms, though not from all causes. Almost half had readmissions to the centre. Referrals from other sources were more likely to stay for assessment and accept help. More referrals from medical sources had severe withdrawal symptoms. Detoxification centres need not be in hospitals but must have close and rapid links with specialist medical services. They must be integrated into the total provision of alcoholism services and assessed in relation to them.