FRAILTY OF WOMEN

FRAILTY OF WOMEN

877 PERFORMANCE OF CLINICAL TOXICOLOGY LABORATORIES knowledge the performance of clinical toxicology not been assessed in Europe. In April, 1982, a s...

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877 PERFORMANCE OF CLINICAL TOXICOLOGY LABORATORIES

knowledge the performance of clinical toxicology not been assessed in Europe. In April, 1982, a survey was organised in Austria. Thirteen laboratories took part. They all did clinical toxicological analyses round the clock. Two urine samples of 50 ml were sent to the laboratories by express post to be tested for unknown drugs. No hint was given as to the nature or number of the substances. The samples contained 20 mg/1 of the following drugs, which were added to drug-free patients’ urine: phenobarbitone, secobarbitone, methaqualone, and nicotine in urine A, and chlorpromazine, morphine, diazepam, and salicylate SIR,-To

our

laboratories has

having been received or because the result was asked for. Thus 190 samples were not tested-yet nobody chased up these requests and no subsequent samples were sent to the laboratory from these patients. Thus the result of an HLA-B27 test seems to have been of no importance for about half the samples sent in. An HLA-B27 test takes 3 h to complete and good monospecific HLA-B27 sera are difficult

to

obtain. Clinicians should be

Northern Ireland Tissue Belfast City Hospital, Belfast BT9 7AD

in urine B. Of the 104

(13x2x4) possible positive results the laboratories identified only 51 (49%). Eleven laboratories detected the phenobarbitone, eight the secobarbitone, eight the chlorpromazine, seven the morphine, seven the diazepam, four the methaqualone, three the nicotine, and three salicylate. Besides the substances missed there were (not shown in the table) 7 wrong positive results, 6 of which were reported by two CORRECT POSITIVE RESULTS IN FIRST AUSTRIAN CLINICAL TOXICOLOGY SURVEY

more

selective in

determining which samples they submit for HLA-B27 testing. Typing Laboratory,

DEREK MIDDLETON

FRAILTY OF WOMEN

SiR,—Your editorial, Frailty, Thy Name is Woman (July 24, p. 194), misses the point. In my monograph, it is not suggested that men with psychiatric symptoms are more likely to consult their general practitioners than women. My findings relate primarily to the -notion that psychological disturbance manifests itself differently in the two sexes. Men with manifest difficulties were found to be comparatively rare. Moreover, they differed from their female counterparts in showing a drop in positive feelings of wellbeing (as compared with the general population) rather than an increased level of unpleasant feelings. It appears that there are underlying factors which predispose the sexes to show different degrees of affective response, with women being more likely to express their feelings (both pleasant and unpleasant) than men. Specific social pressures (in relation to employment, marriage, and so on) appear to be superimposed on this basic tendency. Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF

MONICA BRISCOE

THE SCOTTISH ADVANTAGE

*GC/MS = gas chromatography/mass spectroscopy; TLC = thin-layer chromatography. were: ’Toxi-Lab’ (Analytical Systems Inc., Laguna Hills, California); ’EMIT AED’, ’EMIT DAU’, and ’EMIT Tox’ (Syva Corporation, Palo Alto, California); and ’ACA’ (automatic clinical analyser: Du Pont Co., Wilmingham, Delaware). The photometry method was that of A. Bruckner and M. Bernheim (Antzl Lab 1978; 24: 198). The commercial systems

laboratories using the ’Toxi-Lab’ system. This suggests that considerable analytical experience is necessary even with simple, rapid test systems. This experience was obviously lacking in laboratory no. 5, which reported 5 of the 7 wrong positive results. Bearing in mind the high demands made in this first survey and the different analytical methods used the overall result may be just satisfactory, though some laboratories will have to improve their methods, equipment, and experience. One subject of such surveys is to improve performance, and for the next survey we plan to reduce the concentration of the substances to 5 mg/l. Central

Laboratory, County Hospital, Salzburg, Austria

A-5020

H.J.GIBITZ I. SCHMID

DO CLINICIANS REALLY WANT TO KNOW ABOUT HLA-B27?

SIR,-Economies are very important in times offmancial restraint in the Health Service. With this in mind I did a survey on samples sent to this laboratory for HLA-B27 testing during the period May, 1981, to March, 1982. Lymphocytes were isolated and stored in liquid nitrogen from 316 suitable samples. A further 75 samples could not be examined for various reasons. Of the 316 lymphocyte suspensions frozen in liquid nitrogen 201 were selected for HLAB27 testing on the basis of adequate clinical details of the patient

SiR,-Dr Pilkington (Oct. 9, p. 826) asks about the results in Scotland and Northern Ireland of the larger allocations of N.H.S. funds made to those countries than to England and Wales. The advantage is not an "extra 10%", as he postulates, but 24% as reported by Buxton and Klein in their research paper for the Royal Commission on the N.H.S. Unfortunately there are no certain indices of the health of populations, still less of the sensitivity of caring services. The only figures I can offer on health are provided by the Office of Population Censuses and Surveys in Population Trends (no. 29, p. 28) and relate to the years from 1961. By then Scotland, which had had considerably worse health indices than England, had already recovered some ground. In 1961 perinatal mortality in Scotland was 36-0per 1000 live and still births and by 1980 this had fallen to 13-1. The figures for England and Wales in the same years were 32 - 0 and 13-3.1I do not have recent figures for maternal mortality,’ though they must be available, but in the years 1950-52 the maternal deaths per 100 000 live births were 82 in England and Wales and 109 in Scotland, compared with rates of 39 and 35 respectively, in 1960. I do not know whether the greater rate of improvement in Scotland can be attributed to the already substantial advantage that country enjoyed in N. H.S. funding, but I do know that the proportion of confinements taking place in hospitals rose much more rapidly in Scotland. As to sensitivity, there can be no objective measures, nor does that characteristic depend on funding, but it is certainly possible to provide a larger number of places in hospitals for the elderly and the mentally ill or handicapped in Scotland. An extra 10% is not "the answer to our ills" but the troubles of the Oxford region show how much even 2% would help. 21 Almoners Avenue, Cambridge CB 14NZ

1. Briscoe M. Sex differences

suppl. 1, 1982.

G. E. GODBER in

psychological well-being. Psychol Med, Monograph