640 Notes and News THE SCALE OF DRUG MISUSE ALTHOUGH there may be signs of a slackening in the rate of increase in the numbers of people misusing heroin throughout the world, a peak has still to be reached, despite a bad year for the traffickers and a bad harvest. There is as yet no sign in Britain of the threatened epidemic of cocaine misuse, which is increasing in countries with historic trading links with America, especially Spain. There has, however, been a disturbing increase in the UK in the misuse of amphetamines. Any increase in amphetamine misuse is worrying, partly because users may acquire a taste for stimulants and so move on to cocaine and partly because an estimated 75 % of people who take amphetamines inject them and so are at risk of AIDS. Drug addiction is the saddening tail-end of a business with huge possible’profits and a never-ending number of people willing to become involved. The British Government, along with many other world governments, has recently been strengthening its powers over traffickers, particularly over their profits. The Drug Trafficking Offences Act 1986, for instance, provides for the tracing, freezing, and confiscation of the proceeds of traffickers’ crimes. This sort of control is being extended internationally to prevent overseas banking of drug profits. Likewise, there has been a substantial strengthening of manpower in Customs and Excise and in the drug squad. In 1986, Customs seized drugs worth 85 million at street prices; and the police have detected, over the past two years, 25 illicit amphetamine laboratories. At a media seminar organised by the Home Office and held in London on March 9, the balance of the presentation was weighted in favour of the control and enforcement side of the current wave of drug abuse. Nevertheless, a national and international picture emerged within which the addict is a small and pitiful figure. Dr John Strang, adviser to the Department of Health and Social Security, suggested that nearly half of the number of addicts are not known to the Home Office. Mrs Edwina Currie, Parliamentary Under Secretary of State at the DHSS, recited the ways in which the Government has spent 29 ’/2 million on the treatment and prevention of drug addiction. Mrs Currie emphasised that those areas with virtually non-existent facilities for drug treatment were being encouraged to develop their services. Dr Strang made it clear that this was simply not good enough. With an estimated 50 000 to 80 000 heroin misusers in the UK, specialist services must be increased. In addition, Dr Strang underlined the responsibility of all doctors and health professionals to work with drug addicts. HEALTH PROMOTION VIA THE OPEN UNIVERSITY IN the 1950s arterial disease was viewed as an incurable, degenerative disease. During the ’60s it was learned that life style affected development of the disease and certain risk factors were identified. During the ’70s and ’80s trials were done to discover whether modification of these risk factors affected people’s risk of arterial disease. It slowly became clear that smoking cessation, weight control and a healthy diet, and exercise were central to a healthy heart, and guidelines on risk reduction were laid down by the World Health Organisation in 1982 and in the Canterbury report in 1984. Medical education, however, still does not teach doctors how to educate their patients to look after their hearts. At a conference held in London on March 4, Prof Geoffrey Rose, professor of epidemiology at the London School of Hygiene and Tropical Medicine, emphasised the central responsibility of the general practitioner to prevent disease. Medical schools, he said, simply did not equip GP trainees for this job. To remedy this situation in a country with one of the highest rates of coronary heart disease in the world, the Health Education Council has funded a study pack on reducing the risk of coronary heart disease. Doctors and other health professionals, particularly nurses and health visitors are invited to purchase the pack, which Professor Rose described as a clear, honest, and accurate representation of the current state of knowledge. The pack is designed for group work or individuals, at a price of £ 95 and jC35, respectively. Further information may be obtained from Learning Materials Service Office, Centre for Continuing Education, Open University, PO Box 188, Milton Keynes MK7 6DH (0908 74066). RECOMMENDED COMPOSITION OF INFLUENZA VACCINE FOR 1987-88 IN 1986-87 type A(H1N1) was the predominant influenza virus and in most countries it was the only type to be isolated. Almost all of the A(H1N1) isolates were similar to the A/Singapore/6/86-like strains found in Asia in April to July, 1986 (prompting WHO to recommend, in August, 1986, that A/Singapore/6/86 be added to the three components chosen in February, 1986). Few type B viruses were isolated in the past year and all were similar to the type used in the previous vaccine, but the A(H3N2) viruses isolated were very heterogeneous and a change in this component seems necessary. The appropriate A(H3N2) antigen has yet to be defmed and further information will be issued at the end of March. In the meantime the recommendation made at the annual WHO meeting on composition of influenza vaccines is that for 1987-88 the vaccine should contain the following three antigens-an A/Singapore/6/ 86(H1N1)-like antigen, a B/Ann Arbor/1/86-like antigen; and an A(H3N2) antigen that has to be decided upon. MALARIA PROPHYLAXIS FOR TRAVELLERS THE latest edition of WHO’s booklet on health advice for international travellers is subtitled "Situation as on 1 January 1987"-a wise proviso, but on March 11 it is not conspicuously out of data. Like its predecessors, the new "Yellow Book"’ will be consulted most for advice on prophylaxis of malaria in non-immune travellers. The options have again narrowed, not only because of the spread of chloroquine resistance in Plasrnodium falciparum but also because of the loss of amodiaquine and sulphonamide-containing agents, which are now thought too hazardous for use in healthy people. Despite the further spread of resistant falciparum strains recorded in the booklet, chloroquine 300 mg weekly remains the mainstay for prophylaxis of all types of malaria. Even where resistance of P falciparum exists but is not widespread and predominantly of low degree the same regimen is advised. Here, in case of breakthrough infection, one or more treatment doses of mefloquine or sulfadoxine-pyrimethamine should be carried, to be taken if fever occurs; and the risk of such breakthrough may be reduced by additional prophylaxis with proguanil (base) 200 mg daily. In areas where Pfalciparum is likely to be highly resistant (eg, South-East Asia and parts of Latin America), the regimen is chloroquine 300 mg weekly plus either proguanil 200 mg daily or dapsone/pyrimethamine 1 tablet weekly. People taking dapsone should have their blood checked once a month in case of agranulocytosis. All travellers should be urged to avoid insect bites by using nets and insect repellants and by wearing protective clothes after sunset. WHAT PATHOLOGY IS ABOUT THE Royal College of Pathologists is 25 years old this year. The College is taking the opportunity to create, with the help of a firm of public relations consultants, a true image of pathology. Its silver jubilee programme thus includes a campaign to educate the public on what pathology is about and what pathologists do. On Feb 19, to mark the jubilee, the College entertained the Queen and the Duke of Edinburgh, who learned, among other things, about screening for cervical and breast cancers, the human immunodeficiency virus and AIDS, and pathology services in a district general hospital. The anniversary celebrations will also include a scientific meeting in London, Sept 8-11. Details are available from Concorde Services Ltd, 10 Wendell Road, London W 12 9RT. 1. World Health Organisation. Vaccination Certificate Requirements and Health Advice for International Travel. Geneva: WHO. 1987. $8.40.
Transcript
640
Notes and News
THE SCALE OF DRUG MISUSE
ALTHOUGH there may be signs of a slackening in the rate ofincrease in the numbers of people misusing heroin throughout theworld, a peak has still to be reached, despite a bad year for thetraffickers and a bad harvest. There is as yet no sign in Britain of thethreatened epidemic of cocaine misuse, which is increasing incountries with historic trading links with America, especially Spain.There has, however, been a disturbing increase in the UK in themisuse of amphetamines. Any increase in amphetamine misuse isworrying, partly because users may acquire a taste for stimulantsand so move on to cocaine and partly because an estimated 75 % ofpeople who take amphetamines inject them and so are at risk ofAIDS. -
Drug addiction is the saddening tail-end of a business with hugepossible’profits and a never-ending number of people willing tobecome involved. The British Government, along with many otherworld governments, has recently been strengthening its powersover traffickers, particularly over their profits. The DrugTrafficking Offences Act 1986, for instance, provides for thetracing, freezing, and confiscation of the proceeds of traffickers’crimes. This sort of control is being extended internationally toprevent overseas banking of drug profits. Likewise, there has been asubstantial strengthening of manpower in Customs and Excise andin the drug squad. In 1986, Customs seized drugs worth 85million at street prices; and the police have detected, over the pasttwo years, 25 illicit amphetamine laboratories.
At a media seminar organised by the Home Office and held inLondon on March 9, the balance of the presentation was weightedin favour of the control and enforcement side of the current wave of
drug abuse. Nevertheless, a national and international pictureemerged within which the addict is a small and pitiful figure. DrJohn Strang, adviser to the Department of Health and SocialSecurity, suggested that nearly half of the number of addicts are notknown to the Home Office.Mrs Edwina Currie, Parliamentary Under Secretary of State at
the DHSS, recited the ways in which the Government has spent29 ’/2 million on the treatment and prevention of drug addiction.Mrs Currie emphasised that those areas with virtually non-existentfacilities for drug treatment were being encouraged to develop theirservices. Dr Strang made it clear that this was simply not goodenough. With an estimated 50 000 to 80 000 heroin misusers in theUK, specialist services must be increased. In addition, Dr Strangunderlined the responsibility of all doctors and health professionalsto work with drug addicts.
HEALTH PROMOTION VIA THE OPEN UNIVERSITY
IN the 1950s arterial disease was viewed as an incurable,degenerative disease. During the ’60s it was learned that life styleaffected development of the disease and certain risk factors wereidentified. During the ’70s and ’80s trials were done to discoverwhether modification of these risk factors affected people’s risk ofarterial disease. It slowly became clear that smoking cessation,weight control and a healthy diet, and exercise were central to ahealthy heart, and guidelines on risk reduction were laid down bythe World Health Organisation in 1982 and in the Canterburyreport in 1984. Medical education, however, still does not teachdoctors how to educate their patients to look after their hearts. At aconference held in London on March 4, Prof Geoffrey Rose,professor of epidemiology at the London School of Hygiene andTropical Medicine, emphasised the central responsibility of thegeneral practitioner to prevent disease. Medical schools, he said,simply did not equip GP trainees for this job. To remedy thissituation in a country with one of the highest rates of coronary heartdisease in the world, the Health Education Council has funded astudy pack on reducing the risk of coronary heart disease. Doctorsand other health professionals, particularly nurses and health
visitors are invited to purchase the pack, which Professor Rosedescribed as a clear, honest, and accurate representation of thecurrent state of knowledge. The pack is designed for group work orindividuals, at a price of £ 95 and jC35, respectively. Furtherinformation may be obtained from Learning Materials ServiceOffice, Centre for Continuing Education, Open University, POBox 188, Milton Keynes MK7 6DH (0908 74066).
RECOMMENDED COMPOSITION OF INFLUENZAVACCINE FOR 1987-88
IN 1986-87 type A(H1N1) was the predominant influenza virusand in most countries it was the only type to be isolated. Almost allof the A(H1N1) isolates were similar to the A/Singapore/6/86-likestrains found in Asia in April to July, 1986 (prompting WHO torecommend, in August, 1986, that A/Singapore/6/86 be added tothe three components chosen in February, 1986). Few type Bviruses were isolated in the past year and all were similar to the typeused in the previous vaccine, but the A(H3N2) viruses isolated werevery heterogeneous and a change in this component seemsnecessary. The appropriate A(H3N2) antigen has yet to be defmedand further information will be issued at the end of March. In themeantime the recommendation made at the annual WHO meetingon composition of influenza vaccines is that for 1987-88 the vaccineshould contain the following three antigens-an A/Singapore/6/86(H1N1)-like antigen, a B/Ann Arbor/1/86-like antigen; and anA(H3N2) antigen that has to be decided upon.
MALARIA PROPHYLAXIS FOR TRAVELLERS
THE latest edition of WHO’s booklet on health advice forinternational travellers is subtitled "Situation as on 1 January1987"-a wise proviso, but on March 11 it is not conspicuously outof data. Like its predecessors, the new "Yellow Book"’ will beconsulted most for advice on prophylaxis of malaria in non-immunetravellers. The options have again narrowed, not only because of thespread of chloroquine resistance in Plasrnodium falciparum but alsobecause of the loss of amodiaquine and sulphonamide-containingagents, which are now thought too hazardous for use in healthypeople. Despite the further spread of resistant falciparum strainsrecorded in the booklet, chloroquine 300 mg weekly remains themainstay for prophylaxis of all types of malaria. Even whereresistance of P falciparum exists but is not widespread andpredominantly of low degree the same regimen is advised. Here, incase of breakthrough infection, one or more treatment doses ofmefloquine or sulfadoxine-pyrimethamine should be carried, to betaken if fever occurs; and the risk of such breakthrough may bereduced by additional prophylaxis with proguanil (base) 200 mgdaily. In areas where Pfalciparum is likely to be highly resistant (eg,South-East Asia and parts of Latin America), the regimen ischloroquine 300 mg weekly plus either proguanil 200 mg daily ordapsone/pyrimethamine 1 tablet weekly. People taking dapsoneshould have their blood checked once a month in case of
agranulocytosis. All travellers should be urged to avoid insect bitesby using nets and insect repellants and by wearing protective clothesafter sunset.
WHAT PATHOLOGY IS ABOUT
THE Royal College of Pathologists is 25 years old this year. TheCollege is taking the opportunity to create, with the help of a firm ofpublic relations consultants, a true image of pathology. Its silverjubilee programme thus includes a campaign to educate the publicon what pathology is about and what pathologists do. On Feb 19, tomark the jubilee, the College entertained the Queen and the Duke ofEdinburgh, who learned, among other things, about screening forcervical and breast cancers, the human immunodeficiency virus andAIDS, and pathology services in a district general hospital. Theanniversary celebrations will also include a scientific meeting inLondon, Sept 8-11. Details are available from Concorde ServicesLtd, 10 Wendell Road, London W 12 9RT.
1. World Health Organisation. Vaccination Certificate Requirements and Health Advicefor International Travel. Geneva: WHO. 1987. $8.40.
641
AGRICULTURE AND DIET
British people are at high risk of coronary heart disease, indicatedby the national average serum cholesterol of 5-7 mmol/l. There ismedical consensus on the need to reduce dietary fat (see p 601), butthe recommendations have taken into account the interests of the
agricultural and food industries. In his book, the Food Revolution,’Verner Wheelock offers some insight into why this should be, andhe is qualified to judge, with his farming background and researchexperience at the food policy research unit at the University ofBradford. For the COMA recommendations on dietary fat to bemet, Wheelock reports, 452 thousand tons of fat would have to beremoved from the human food chain, and the total fat produced bythe livestock industry is about 945 thousand tons each year. Thedifficulty here is that farmers receive no inducement to lower the fatcontent of their animals-the same price is paid for fat and leananimals. So how can farmers be persuaded to produce lean meat?Wheelock suggests that abattoirs could inform farmers of the
quality of each carcass so that they can improve their productionmethods and upgrade their stock. He does not, however, offer anysuggestion of how this cooperation might be achieved. Two moreunpractical suggestions are that venison (lean) might be analternative to beef (fat) and goat’s milk to cow’s milk, but he takes noaccount of cost or taste here. A sign that market forces are at work isthat farmers are producing more skimmed milk and low-fat cheesesthan before. But what is happening to the fat? It cannot all be goingto make lipsticks.
AIDS in the UKThe total number of AIDS cases diagnosed in the UK to the end
of February is:
At the end ot January there were a total ot boo cases ot AIDS and355 deaths.
Public Health Laboratory Service AIDS Centre
The Public Health Laboratory Service has set up a’ centre tocoordinate and expand its work on acquired immunodeficiencysyndrome (AIDS). The centre will develop the PHLS studies ofrisk factors and its monitoring of the spread of infection, particularlyheterosexual spread, and will improve the standards of testing forinfection. Other projects include studies on infectivity and basicresearch on diagnostic services and the bulk growth of humanimmunodeficiency virus for use in diagnostic kits. The centre willalso advise on such matters as hygienic practices in hospitals andmethods of sterilisation and disinfection. The centre is headed byProf Alan Glynn, director of the Central Public Health Laboratory,Colindale.
Education about AIDS
The Department of Education and Science has produced a leafletto help teachers, youth workers, and parents answer children’squestions about AIDS.
Food Irradiation
The British Medical Association’s board of science has produceda report urging the Government to postpone the introduction offood irradiation, on the grounds that it could pose long-termhazards to health while failing to prevent food poisoning.
1 Available from Chalcombe Publications, 13 Highwoods Drive, Marlow Bottom,Marlow, Bucks SL7 3PU £8.95, Pp 119.
Access to Medical Records
According to the Campaign for Freedom of Information, theGovernment is likely to concede that individuals should have theright to access to education, housing, and social work records, butthis right will not extend to medical records. 9 organisations havesigned a letter to the Minister of Health, Mr Tony Newton,emphasising the benefits of a right to access to medical records. Theorganisations include the Royal College of Nursing, the College ofHealth, the Patients’ Association, the Royal College of Midwives,and the Health Visitor’s Association. The British MedicalAssociation has declared itself against any legislation on the subject.The BMA favours the retention of medical control: patientsshould be encouraged to ask for information which may be disclosedas the doctor sees fit.
Lung Cancer as a Prescribed Disease
From April 1, 1987, lung cancer will be a prescribed disease.Benefit will be paid to people with lung cancer who work or haveworked underground in a tin mine, or who are or were exposed tobis(chloromethyl) ether produced during the manufacture of
chloromethyl methyl ether, or who are or were exposed to zincchromate, calcium chromate, or strontium chromate in their pureforms while at work.
Mapping the Human Genome
Sir Sydney Brenner, FRS, director of the Medical ResearchCouncil Molecular Genetics Unit, Cambridge, is to establish anadditional research team in the Daly Laboratories, Babraham, inApril, 1987. Their aim is to map the human genome.Sexual Relationships of People with a DisabilityA series of one-day courses on sexuality and disability have been
arranged to take place over the year. Details are available from theAssociation to Aid the Sexual and Personal Relationships of Peoplewith a Disability, 286 Camden Road, London N7 OBJ (01-6078851).Chiropody and Diabetes
A working party, chaired by Prof A. J. Willcocks, has beenestablished by the British Diabetic Association in association withthe Society of Chiropodists to examine the provision of chiropodyservices to diabetic people under the NHS. Evidence is invited andshould be addressed to Susan Knibbs, Head of Services Division,BDA, 10 Queen Anne Street, London W1M 08D.
Oncology Information Service
The service, based at the University of Leeds, produces abibliographic current-awareness service on AIDS and HIV.References are derived from about 1300 biomedical journals andpublished in booklet form monthly. Abstracts or short annotationsare included for virtually every item. Since the first issue in
February, 1985, OIS has reported nearly 2000 papers, includingcase reports, and epidemiological and immunological studies.
Subscriptions and inquiries should be directed to OncologyInformation Service, Medical and Dental Library, University ofLeeds, Leeds LS2 9JT (0532 450059).
The 1987 edition of the Guide to Postgraduate Degrees, Diplomasand Courses in Medicine is available ([6.35 including postage) from theCouncil for Postgraduate Medical Education in England and Wales, 7Marylebone Road, London NW1 5HH.A Microsurgical workshop is to take place at Northwick Park Hospital,
Harrow, on March 23-27: Dr C. J. Green, Surgical Research Group, MRCClinical Research Centre, Northwick Park Hospital, Harrow, MiddlesexHA1 3UJ (01-864 5311 ext 2511).A joint spring meeting on The Mammalian Y Chromosome
Molecular Search for the Sex Determining Gene and the secondAbercrombie conference on Cell Behaviour will take place in Oxford onMarch 24-26: Linda Sole, Wisepress Limited, Ashford House, 39 HighStreet, Wimbledon Village, London SW19 5BZ (01-947 0927).A one-day meeting entitled Hypertension in Pregnancy will take place
at the Royal College of Obstetricians and Gynaecologists, London NW1, onWednesday, March 25: Beryl Stevens, Postgraduate Education Secretary,Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, Regent’sPark, London NWl 4RG (01-262 5425).
642
A one-day conference entitled AIDS and the Workplace is to be held atthe Institution of Civil Engineers, Westminster, London, on Thursday,March 26: Bureau of National Affairs International Inc, 17 DartmouthStreet, London SW1H 9BL (01-222 8831).
A one-day symposium on 5HT as a Target for Drug Research will beheld at the School of Pharmacy, London University, on Thursday, March 26:Barbara Cavilla, Secretariat, Institute of Biology, Society for Drug Research,20 Queensberry Place, London SW7 2DZ (01-5818333).
A postgraduate school on Solution Processes and Dissolution Testingis to be held at the School of Pharmacy, London WC1, on March 30-April 3:Mr R. E. Marshall, School Secretary, Department of PharmaceuticalSciences, Pharmaceutical Society of Great Britain, 1 Lambeth High Street,London SE1 7JN (01-735 9141 ext 287).
A one-day conference entitled Rehabilitation after Facial
Disfigurement will be held at the King’s Fund Centre, London NW1, onTuesday, March 31: Mrs Susan Hodge, King’s Fund Centre, 126 AlbertStreet, London NW 7NF (01-267 6111 ext 210).
A one-day meeting entitled Monitoring, Surveillance, Causes andEffects-Respiratory Epidemiology and the Clinician is to take placeat the National Motorcycle Museum, near Birmingham, on Friday, May 1:Miss Megan Wood, Postgraduate Centre, East Birmingham Hospital,Bordesley Green East, Birmingham B9 5ST (021-772 4311).
Diary of the Week
MARCH 15 TO 21
Monday, 16thROYAL COLLEGE OF SURGEONS OF ENGLAND, Lincoln’s Inn Fields, London
WC2A 3PN5 pm Mr P. K. Donnelly: Natural Methods of Regulating Immune Responses in
Clinical Surgery.ST GEORGE’S HOSPITAL MEDICAL SCHOOL, Hunter Wing, Cranner Terrace,
’ London SW17 ORE12.30 pm Mr Keith Holmes: Ambiguous Genitalia.
Tuesday, 17thROYAL COLLEGE OF PHYSICIANS OF LONDON, 11 St Andrew’s Place,
Regent’s Park, London NWl 4LE5 pm Dr C. E. Stroud: Paediatncs-Progressing, Polansed or Perplexed?
ROYAL MASONIC HOSPITAL, Ravenscourt Park, London W6 OTN7 pm Dr C. G. Blakeney: Radiology for MRCP and Quiz.
LONDON MEDICAL GROUP5.45 pm (University College Hospital, Gower Street, London WCI) Symposium-
The Doctor’s Role in Torture.ICRF CANCER EPIDEMIOLOGY AND CLINICAL TRIALS UNIT, Ida Green
Seminar Room, Observer’s House, Green College, Oxford5 pm Prof M. Bracken: Some New Risk Factors and Classification Problems for
Intrauterine Growth Retardation.
Wednesday, 18thROYAL COLLEGE OF SURGEONS OF ENGLAND
3 pm Dr D. B. Scott: The Need to Know.5 pm Prof W.E.G. Thomas: Testicular Torsion-A New Twist (Diagnosis,
Management and Outcome).WELLCOME INSTITUTE FOR THE HISTORY OF MEDICINE, 183 Euston
Road, London NWI 2BP5.30 pm Prof Morns Vogel (Philadelphia): How Long Fallen? A History of Homes for
Unwed Mothers m America.CHACE POSTGRADUATE MEDICAL CENTRE, Chase Farm Hospital, The
DURHAM POSTGRADUATE MEDICAL CENTRE, Drybum Hospital, Durham1.15 pm Prof J. Anderson: Continuing Medical Education—Why, How and Where?
Thursday, 19thLONDON MEDICAL GROUP
5.45 pm (Westminster Hospital, Horseferry Road, London SW1) Symposium-The Ethics of Research with Children.
EXETER POSTGRADUATE MEDICAL CENTRE, Royal Devon and ExeterHospital, Barrack Road, Exeter EX2 5DW
12.50 pm Dr T Smyth and Dr A. Nicholls: Diagnostic Difficulties or Incompetence?NINEWELLS HOSPITAL AND MEDICAL SCHOOL, Dundee DDI 9SY
2 pm Dr O. L. Lloyd and Mrs F. Williams: The Methodology of the Atlas of Mortalityin Scotland.
PERTH ROYAL INFIRMARY, Perth12.30 pm Mr J K. Brennaud: Hay Fever-The Limitations of Current Treatment.
Friday, 20thCARDIOTHORACIC INSTITUTE, Fulham Road, London SW3 6HP
8 am Prof J. Hogg (Vancouver): The Pathogenesis of Emphysema.
Corrections
Overwhelming Pneumococcal Sepsis Post-splenectomy.-In the letter by DrA. S. Duncombe and colleagues (March 7, p 570), the last sentence of the lastparagraph should have read "... compliance [with penicillin prophylaxis]was probably not good and that the availability of penicillin in the home,rather than the prophylaxis itself, may have contributed to the reduction inthe frequency of pneumococcal sepsis and the zero case-fatality in thetreatment group". We apologise to Dr Duncombe and colleagues for
introducing this error.
Crisis at Christmas 1986.-We apologise to Mr Ben Weller and luscolleagues for two errors in their article (March 7, p 553). (1) In the Resultsunder the heading Social Isolation the figures should read "64% for thosewith a psychiatric history, 36% for those without (X2 = 10-4 ; p < 0 005)". (2)The 2nd sentence of paragraph 3 of the Discussion should read "Theproportion of mental illness in those respondents remaining in London hasrisen from 27 out of 68 (39-7%) in 1985 to 48 out of 88 (545%) in 1986".
Progressive Systemic Sclerosis: Autoimmune Arteriopathy.-In the articleby Dr D. J. Evans and colleagues (Feb 28, p 480) the caption to the figureshould have read subintimal IgM, not subintemal IgM.
International Diary4th international meeting on Low Frequency Noise and Vibration:
Umea, Sweden, June 9-11 (Multi-Science Publishing Co Ltd, 107 HighStreet, Brentwood, Essex CM14 4RX, UK).
Congres de Pneumologie: Grenoble, France, June 11-13 (Secretariat,Ch. Brambilla, Pavillon D2, BP 217 X, 38043 Grenoble Cedex).
5th forum of International Andrology: Paris, France, June 15-17 (ProfG. Arvis, Department of Andrology-Urology, Hopital Saint-Antoine, 184Rue du Faubourg Saint-Antoine, Paris 75012).
4th international summer school on Mathematical Modelling inPhysiology and Clinical Medicine: Padova, Italy, June 15-19 (Prof E. R.Carson, Centre for Measurement and Information in Medicine, CityUniversity, Northampton Square, London EC1V OHB, UK).
Advanced course on Epidemiological Methods: Heidelberg, WestGermany, June 15-26 (Unit of Education and Training, International
Agency for Research on Cancer, 150 cours Albert Thomas, 69372 LyonCedex 08, France).
International symposium on Artificial Blood Substitutes: Bari, Italy,June 19-20 (Segreteria Organizzativa, Ad Convention Program, via Carulli54, 70100 Bari).
4th congress of the International Society for Peritoneal Dialysis:Venice, Italy, June 29-July 2 (Dr Carmelo Giordano, Padiglione 17,Policlinico Cappella Cangiani, Universita di Napoli, via Pansini 5, 80131Naples, Italy).
7th annual summer programme of Epidemiology: Medford, MA, July26-Aug 14 (New England Epidemiology Institute, Department SC-17, POBox 57, Chestnut Hill, MA 02167, USA).
2nd international course and seminar on Disorders of Ear and Hearingin Children in Developed and Developing Countries: Malino, Sweden,Sept 20-30 (Dr I. Bastos, ENT Department, General Hospital, S-21401Mairn6).
5th international congress on Ultrasonic Examination of the Breast:New Orleans, Louisiana, Oct 3-5 (Prof E. Kelly-Fry, Department ofRadiology Wishard Memorial Hospital, 1001 West 10th Street, Indianapolis,In 46202, USA).
12th European symposium on Hormones and Cell Regulation:Strasbourg, France, Oct 5-8 (Prof E. Carafoli, Laboratorium fur Biochenue,ETH-Zentrum, CH-8092 Ziifich, Switzerland).
2nd international symposium on Sepsis--an InterdisciplinaryChallenge: Berlin, West Germany, Oct 22-24 (Dr K. Reinhart, KhraumSteglitz, Freie Universitat Berlin, Hindenburgdamm 30, 1000 Berlin, 45.FRG).
