The Measurement of Opiate Dependence

The application of a dimensional concept of dependence which has received much attention over recent years in relation to alcohol, is explored here in relation to opiate dependence. A Severity of Opiate Dependence Questionnaire (SODQ) was completed by 98 subjects attending a New York drug treatment clinic. The factor structure of this questionnaire was explored and a strong first factor (39% of variance) identified which loaded on items conceptually related to a dimensional opiate dependence syndrome. Some preliminary investigation was made of issues relating to validity: SODQ correlated significantly with ‘number affixes a day’ and with a subjective measure of dependence (OSDQ), but not with quantity of heroin used or milestones in drug career. Research leads are discussed.     

Severity of Opiate Dependence in an Australian Sample: further validation of the SODQ

The Severity of Opiate Dependence Questionnaire (SODQ) was administered to 114 subjects attending an Australian drug dependency treatment canter. The psychometric properties of the SODQ were examined and compared with previous findings reported on American and British samples of opiate addicts. Severity of opiate dependence was assessed independently using a structured clinical interview based on DSM-III-R criteria (i.e. SCID-R). Together those analyses suggested (i) measurement difficulties with some aspects of the opiate dependence syndrome and (ii) only a modest relationship between subjects' self-report and clinicians’judgments of severity of opiate dependence.     

Measurement of the severity of amphetamine dependence

A Severity of Amphetamine Dependence Questionnaire (SAmDQ) was administered to 101 subjects attending an Australian drug dependency treatment centre. The SAmDQ was adapted from the Severity of Opiate and Alcohol Dependence Questionnaires (SODQ & SADQ). The structural characteristics of the SAmDQ were examined and compared with previous findings reported on samples of opiate addicts with the SODQ. A high degree of consistency was found between the results obtained with the SAmDQ and previous findings with the SODQ. The relationship between the SAmDQ and the Severity of Dependence Scale (SDS) was also examined. The findings suggest that further development of amphetamine dependence measurement is required.     

Validation of the amphetamine dependence syndrome and the SAmDQ

The Severity of Amphetamine Dependence Questionnaire (SAmDQ) was administered to 132 subjects who were amphetamine dependent by DSM-III-R criteria. The structural characteristics of the questionnaire were examined and findings compared with those reported previously for both the SAmDQ and its forebear, the SODQ. There was a high degree of consistency in the present psychometric analyses and those reported earlier; and comparisons between samples of differing dependence severities indicated that the SAmDQ is capable of discriminating between these groups. The findings support the existence of an amphetamine dependence syndrome, and help to explicate the dimensions underlying such a syndrome and the characteristics of the population in which it may be manifest.     

An Assessment of an Amidolytic Assay for Factor VII in the Laboratory Control of Oral Anticoagulants

S ummary . A comparison has been made between the prothrombin time test using British Comparative Thromboplastin (BCT) and a chromogenic substrate assay for factor VII in the assessment of laboratory control of oral anticoagulants in short-term and long-term patients. Opportunity was also taken to compare the findings with parallel results obtained with the venous Thrombotest technique and a specific clotting assay for factor VII. There was good agreement between the amidolytic factor VII assay, using a method modified from Seligsohn et al (1978) with the Quick test using BCT and Thrombotest in 60 long-term patients. Tests in 53 patients within the first 3 weeks of starting oral anticoagulant administration gave less satisfactory agreement between the above amidolytic method and the conventional tests. In contrast, there was a good correlation between the two conventional tests in both groups and also between the clotting and amidolytic factor VII method. Although the results are an improvement on previous, less satisfactory correlations between the BCT prothrombin time method and amidolytic assays for factor II and X, the present study indicates the limitations of a specific clotting assay versus a broad spectrum extrinsic clotting test in oral anticoagulant control. While not warranting the routine use of the chromogenic assay for factor VII in place of the prothrombin time using BCT, the factor VII amidolytic assay offers a limited but dependable guide to dosage in long-term patients. The complexity of the technique in its present form militates against its adoption for routine anticoagulant control in hospital laboratories.     

High antiretroviral drug adherence key in effort to avoid drug resistance. New study highlights its importance

A new study confirms the findings of previous research that antiretroviral drug adherence is a strong predictor of whether or not drug resistance occurs in HIV patients. Investigators at the British Columbia Centre for Excellence Research Labs in Vancouver looked for signs of HIV drug resistance among 1,200 HIV patients.     

High risk of non-A non-B hepatitis after a first exposure to volunteer or commercial clotting factor concentrates: effects of prophylactic immune serum globulin

After a first exposure to factor VIII concentrates, 9/9 British patients treated with U.S.A.-derived commercial products, and 10/12 treated with British volunteer (NHS) products, developed acute non-A, non-B (NANB) hepatitis. Hepatitis following commercial products was more severe, and of shorter incubation. High previous exposure to NHS blood products seemed to prevent NHS but not commercial factor VIII-induced hepatitis; the latter was also not attenuated by administration of U.S.A.-derived commercial immune serum globulin (ISG). After a first exposure to NHS factor IX concentrates without ISG, 4/4 patients developed short incubation NANB hepatitis; one also contracted prolonged incubation hepatitis B. One patient treated with ISG and factor IX of proven infectivity did not develop hepatitis, suggesting protection by ISG. Observed differences between concentrates might be attributable to their content of different NANB agents, but dose-related effects could provide alternative explanations. This data provides a basis for comparative assessment of new products of possible reduced infectivity in only small numbers of patients.     

Policies for managing hypertensive patients: a survey of the opinions of British specialists

In September 1988 medically-qualified members of the British Hypertension Society were asked to complete anonymously a questionnaire relating to their views on the management of hypertensive patients. Of 149 questionnaires posted, 90 were returned (60%). There was general agreement that non-pharmacological measures, particularly weight loss and alcohol restriction, are effective treatments. However, there was wide variation in the minimum level of blood pressure considered to warrant drug treatment and little consensus regarding measurement policies or target blood pressures. The drugs of first choice were beta-blockers (54% in men, 35% in women) and thiazide diuretics (28% in men and 47% in women), and they were also the most frequent second choices with 54% of respondents advocating 'stepped-care' based on these drugs. The maximum age at which respondents would be prepared to introduce antihypertensive drugs varied widely although 63% considered that thiazide diuretics are first choice in the elderly. These findings demonstrate a broad range of opinion on the management of hypertension among British specialists, and suggest a continuing need for large clinical trials.     

The Homogeneity of the Alcohol Dependence Syndrome: a factorial analysis of the SADD questionnaire

The Severity of Alcohol Dependence Data (SADD) questionnaire was administered under different conditions to three groups of patients in Leeds, Deny and Omagh. The results were then factor analysed using both exploratory and confirmatory procedures. There was a consistent and strong first factor which suggests that with some small modifications the SADD is a unidimensional scale. The results are interpreted as providing further evidence for the homogeneity of the alcohol dependence syndrome.     

BSR guidelines for TNF blockers in ankylosing spondylitis--how useful are they?

SIR, We are writing in response to the British Society of Rheumatology(BSR) guidelines for prescribing tumour necrosis factor (TNF)blockers in adults with ankylosing spondylitis (AS) [1]. Thereare several points that we would like to make. The first issue relates to the ongoing reliance on the modifiedNew York criteria [2] for the diagnosis of AS     

HTLV-III antibody and T-cell subset ratios in haemophiliacs and their spouses

44% of 63 British patients with either haemophilia A or B were HTLV-III antibody positive (HTLV-VIII+). HTLV-III+ was more frequent in high factor VIII concentrate users and 75% of severely affected haemophilia A patients were HTLV-III+. All eight patients who were exposed to factor IX concentrate were HTLV-III-. 17 haemophilia A patients who received only British made factor VIII concentrate (average 12,000 units/year) were HTLV-III-. Two of 63 patients had evidence of a pre-AIDS type symptom complex and both were HTLV-III+. Information from a cohort of 21 Liverpool haemophiliacs suggests that HTLV-III was first introduced into this country in 1981. OKT4/T8 ratios were abnormal in 52% of 21 patients studied but this finding was not confined to either HTLV-III+ or HTLV-III- individuals. The spouses of 14 HTLV-III+ haemophiliacs were all HTLV-III-.     

Severe bleeding in two patients due to increased sensitivity of factor IX activity to phenprocoumon therapy

 Two male patients with severe and recurrent bleeding episodes under phenprocoumon therapy are reported. Both patients exhibited a strong decrease of their factor IX activities below 1% of normal, whereas the activities of the vitamin K-dependent factors prothrombin, VII, and X were found to be within or above the expected therapeutic ranges of 20–40%. Upon removal of phenprocoumon and substitution with vitamin K, the factor IX activities increased to 85% and 55%, respectively. Reexposition to phenprocoumon in one patient confirmed the rapid and selective decrease of the factor IX activity. These findings provide the first report of an abnormally high sensitivity of factor IX activity to oral anticoagulant therapy. Received: 24 October 1996 / Accepted: 13 March 1997     

British research into the increased vulnerability of young gay men to eating disturbance and body dissatisfaction

Forty-one young gay British males (aged between 15 and 25 years) and 47 heterosexual men were compared on measures of eating disturbance and body dissatisfaction. All participants completed a questionnaire containing a number of previously validated scales including EAT-26, the BSS and a series of line-drawings. Gay participants scored higher on all measures of eating disturbance and were more dissatisfied with their bodies. The gay sample chose ideal images that were significantly slimmer than the heterosexuals and were much more likely to show symptoms of a clinical disorder. Results from gay participants revealed strong correlations between levels of eating disturbance, self-esteem and body dissatisfaction whilst these relationships did not achieve significance for heterosexuals. The findings strongly confirm American research that suggests that gay men are particularly vulnerable to serious eating disturbance. Potential explanations and implications of these findings for gay men and those who work with them are briefly discussed. © 1998 John Wiley & Sons, Ltd and Eating Disorders Association.     

Prevalence and characteristics of nosocomial infections in a Turkish university hospital

BACKGROUND: The purpose of this study is to estimate the prevalence of nosocomial infections in a university hospital, as well as determining the groups at high risk of such infections. MATERIALS AND METHODS: Two surveys based on a modification of the British National Survey protocol for nosocomial infection were conducted in July and December 1998. RESULTS: In the first survey, hospital infections were found in 41 (13.4%) of the patients, and in the second survey in 34 (10.9%). The study showed that the risk of nosocomial infection was associated with being in the intensive care unit, undergoing surgery, and invasive procedures. CONCLUSION: Prevalence data are consistent with results reported in many other regions of the world. These findings provide the principal information for future surveillance in association with prevention programs in Turkish hospitals.     

HLA antigens in Behçet's disease: a reappraisal by a comparative study of Turkish and British patients.

We have compared the distribution of histocompatibility antigens of 22 Turkish and 14 British patients with Behçet's disease with those of their respective controls. There was a strong association of B5, specifically its Bw51 split, with the disease. A modest increase in the incidence of HLA B27 was noted in British patients, but numbers were too small for analysis. The incidence of DRw2 and DRw4 antigens among Turkish and British patients did not differ from that of their respective controls.     

Scientific publications in gastroenterology and hepatology in Western Europe, USA and Japan in the years 1992-1996: a global survey

AIM: To evaluate number and quality of publications in gastroenterology, hepatology and digestive endoscopy from Western Europe (Belgium, Denmark, France, Germany, Great Britain, Italy, the Netherlands, Spain, Sweden, Switzerland), Japan and USA over a recent 5-year period. METHODS: We screened by computer for full liver/gastrointestinal-related articles and reviews the top 40% of journals (according to the annual rating of the SCI Journal Citation Reports; Institute for Scientific Information database) in most clinical and basic science disciplines in the years 1992-1996. To be credited with an article, a given country had to be the site of the first institution where the work was conducted. Papers were rated according to the impact factor of the Institute for Scientific Information and to the ratio impact factor/mean European impact factor. Data were also normalized for nondefense research and development expenditure. RESULTS AND CONCLUSIONS: As randomly tested, the computer search had an error of +/- 5-10%. In Europe, Great Britain achieved the highest total impact factor and the highest number of papers. Most of the British impact factor came from publications in British journals. The total USA impact factor exceeded that of Europe by 20%. The average impact factor for a single paper was highest for the USA and, in Europe, for Germany. The temporal trend of total impact factor showed Spain improving by 9% per year, with Germany and Italy also displaying a substantial growth. Expressed per funds allocated in nondefense research and development, Great Britain and the USA had the highest cumulative impact factor.     

Psoriatic arthritis in British and Italian patients: a comparative clinical, radiologic, and scintigraphic study

OBJECTIVE: To investigate the similarities and differences in pattern and severity of clinical expression of psoriatic arthritis (PsA) in British and Italian patients. METHODS: Detailed clinical data were obtained on 48 British patients with PsA and compared with the data of 48 Italian patients. A systematic evaluation of joints, spine, and skin was performed. Forty-one British and 42 Italian patients also underwent a whole body bone scintigram. Radiographic details of hands and wrists were also taken. RESULTS: The Italian patients did not differ from their British counterparts with respect to duration of arthritis, sex, clinical subgroups, axial involvement, number of tender and swollen joints, or radiographic score. However, significant differences were found with respect to age, duration of psoriasis, number of joints with deformity and/or loss of function, number of affected joints, and number of "active" joints on scintigraphy, which were all higher in the British group. After correction for age, duration of arthritis, and duration of psoriasis the only significant difference was the number of affected joints. CONCLUSION: Our findings suggest that British patients with PsA are more severely affected than a matched cohort of Italian patients.     

A Study of Alcoholism Treatment Units: Some Findings on Links with Community Agencies

Alcoholism Treatment Units (ATUs) are as the major institutional treatment system for alcoholics within the British National Health Service. This paper is part of a series of papers to report the results of a national survey on ATUs. It examines the links which ATUs have with community agencies: special service links, general service links and training links. It also describes these links in relation to the ‘community variable’ and presents a discussion on the implications of these findings for future treatment provisions.     

An update on aspirin in the primary prevention of cardiovascular disease

BACKGROUND: In 1988, the aspirin component of the Physicians' Health Study, a randomized, double-blind, placebo-controlled trial of 22 071 apparently healthy men was terminated early, due principally to a statistically extreme (P<.00001) 44% reduction in the risk of a first myocardial infarction (MI). The Cardio-Renal Drugs Advisory Committee recommended that the US Food and Drug Administration approve professional labeling of aspirin to prevent first MI. The agency did not act on this recommendation because the only other trial, the British Doctors' Trial of 5139 men, showed no significant benefits. Since that time, 3 additional randomized trials (which included men and women) of aspirin in the primary prevention of MI have been published. METHODS: A computerized search of the English literature from 1988 to the present revealed 5 published trials: the Physicians' Health Study (22 071 participants), the British Doctors' Trial (5139), the Thrombosis Prevention Trial (5085), the Hypertension Optimal Treatment Study (18 790), and the Primary Prevention Project (4495). RESULTS: Among the 55 580 randomized participants (11 466 women), aspirin was associated with a statistically significant 32% reduction in the risk of a first MI and a significant 15% reduction in the risk of all important vascular events, but had no significant effects on nonfatal stroke or vascular death. CONCLUSIONS: The current totality of evidence provides strong support for the initial finding from the Physicians' Health Study that aspirin reduces the risk of a first MI. For apparently healthy individuals whose 10-year risk of a first coronary event is 10% or greater, according to the US Preventive Services Task Force and the American Heart Association, the benefits of long-term aspirin therapy are likely to outweigh any risks.     

Individualism, Collectivism and Ethnic Identity: Cultural Assumptions in Accounting for Caregiving Behaviour in Britain

Britain is experiencing the ageing of a large number of minority ethnic groups for the first time in its history, due to the post-war migration of people from the Caribbean and the Indian subcontinent. Stereotypes about a high level of provision of informal caregiving among minority ethnic groups are common in Britain, as in the US, despite quantitative studies refuting this assumption. This paper reports on a qualitative analysis of in-depth interviews with older people from five different ethnic groups about their conceptualisation of their ethnic identity, and their attributions of motivations of caregiving within their own ethnic group and in other groups. It is argued that ethnic identity becomes salient after migration and becoming a part of an ethnic minority group in the new country. Therefore, White British people who have never migrated do not have a great sense of ethnic identity. Further, a strong sense of ethnic identity is linked with identifying with the collective rather than the individual, which explains why the White British participants gave an individualist account of their motivations for informal care, whereas the minority ethnic participants gave a collectivist account of their motivations of care. Crucially, members of all ethnic groups were providing or receiving informal care, so it was the attribution and not the behaviour which differed.