- Email: [email protected]
Maternal deaths in the UK
786
Noticeboard Code for
infertility treatments
The Human Fertilisation &
Embryology Authority (HFEA), set following the Royal Assent of the Human Fertilisation and Embryology, has published proposals for a code of practice for centres offering infertility treatments and those carying up last November
research on human embryos.’ The authority’s principal task is to regulate, through a licensing system, any research or treatment that involves the creation, storage, and use of human embryos outside the body or the storage or donation of human eggs or sperm. Because these activities raise moral, ethical, and social questions, as well as scientific ones, the HFEA is consulting not only the treatment and research centres but also a wide range of professional organisations, religious groups, ethicists, and social interests. The consultation period ends on May 20. In drafting the code the HFEA has been guided by the right due to human life; the right of infertile people to be considered for treatment; the welfare of children, which may conflict with the interests of the adults involved; and the benefits that can flow from the responsible pursuit of medical and scientific knowledge. There has been widespread concern about the variable (and sometimes very low) success rates achieved with infertility treatments, which in private clinics can be very costly. The Authority, which will carry out annual checks of licensed premises, aims to "support the best clinical and scientific practice, while guarding against the undoubted risk of exploitation of people at a time when they may be particularly vulnerable". However, the HFEA says it has no hard evidence that patients are being deliberately misled about the chances of success. To reduce the chances of multiple births, the code proposes that no more than three eggs or embryos should be transferred in any out
one
cycle.
The HFEA code comes at a time when so-called "virgin births" have been hotly debated in the media, following publication of a letter in The Lancet (March 2, p 559) from a psychotherapist whose patient, though never having had sexual intercourse, was seeking assisted conception. The code does not exclude such women from consideration for treatment but says that "people seeking treatment are entitled to a fair and unprejudiced assessment of their situation and needs". One of the factors to be considered is the commitment of patients and "that of their husband or partner, if any, to having and bringing up a child or children". A patient who is refused treatment should be told the reason for refusal, the code says, and should be given the chance to reply. The 1990 Act imposes new obligations on centres offering in-vitro fertilisation and donor insemination to provide counselling for patients and to take account of the welfare of children bom as a result of infertility treatments. The scope of the HFEA code is thus more complex than the guidelines produced by a Voluntary (later
Interim) Licensing Authority. 1. Code of
practice: consultation document. Human Fertilisation & Embryology Authority, Clements House, 14-18 Gresham Street, London EC2V 7JE.
Passive smoking In a concerted effort to stimulate action against passive smoking, booklet! that outlines its health hazards and the measures that can be taken to reduce environmental tobacco smoke is being sent to groups such as members of parliament (British and European), employers’ organisations, and trade unions. The booklet, commissioned by the Health Education Authority, British Medical Association, Action on Smoking and Health, and the Coronary Prevention Group, and funded by the HEA, the two cancer charities that published it, the British Heart Foundation, the National Asthma Campaign, and the Department of Health, carries the endorsement of some thirty organisations, including the Royal Colleges of Physicians and Surgeons in England and Scotland. a
Existing methods of extracting the smoke as it is released into the air is unlikely to provide adequate protection. The booklet points out that although Britain, unlike several other countries, does not yet have comprehensive legislation to restrict smoking in enclosed places used by the public, existing health and safety legislation can sometimes be invoked. Employers, who are expected not only to provide employees with a safe environment but also to warn them of health hazards, will find it difficult to plead ignorance of the dangers of passive smoking as a mitigating factor because the courts have established that they must keep reasonably abreast of developing knowledge. The booklet also points out that in places such as hospitals, where a non-smoking policy is adopted, efforts should be made to ensure that the policies are implemented. 1. Passive Smoking: A Health Hazard. London: Imperial Cancer Research Fund and Cancer Research Campaign. 1991. Pp 17. £3.95 (including postage and packaging, from Passive Smoking, PO Box 4RP, London W1A 4RP). ISBN 0-901682063
Paternal radiation exposure and childhood leukaemia In 1990 Prof M. J. Gardner and his colleagues provided a much-needed stimulus to the faltering debate about whether (and, if so, how) there was a causative association between radiation, nuclear facilities, and leukaemia in childhood. It seemed that paternal radiation exposure had to be taken into account, even though there is no more radiobiological sense to that explanation than there is to some more direct environmental exposure. Last week the British Medical Journal published two more studies.!,2 We are no further forward, largely because the publications and commentaries have had to be ankle-deep in caveats. The study on the Dounreay area’ looks negative-ie, non-supportive of paternal radiation exposure as a factor-but the Committee on Medical Aspects of Radiation in the Environment comments that "... the findings in this small study fail to support but do not negate ...". The other study is cautiously positive on certain paternal occupations (including radiation work), but Prof P. G. Smith’s EMJ editorial notes that with exclusion of three cases already in Gardner’s study "the evidence suggesting an effect of preconception irradiation is much weaker". Urquhart JD, Black RJ, Muirhead MJ, et al. Case-control study of leukaemia and non-Hodgkin’s lymphoma in children in Caithness near the Dounreay nuclear installation. Br Med J 1991; 302: 687-92. 2. McKinney PA, Alexander FE, Cartwright RA, Parker L. Parental occupations of 1.
children with leukaemia in west Cumbria, north Humberside, and Gateshead. Br Med J 1991; 302: 681-87.
Maternal deaths in the UK The four countries of the United Kingdom have, for the first on confidential inquiries into maternal deaths into one publication, which covers deaths occurring in 1985-87. The report covers 265 deaths (212 England, 18 Wales, 25 Scotland, 10 Northern Ireland), of which 249 occurred in the first 42 days after delivery, and 139 (56%) of these were judged to be direct obstetric deaths. The mortality rate in the triennium covered (7-6 per 100 000 total births) was 18% lower than that in the previous triennium. The commonest causes of death were thromboembolism and hypertensive disorders of pregnancy. Although the death rate from hypertensive disorders was similar to that previously reported for England and Wales, there was a shift in the pattern of immediate cause of death, from cerebral complications to the acute respiratory distress syndrome. The explanation offered is that patients are now surviving the early period, when they are at greatest risk of cerebral haemorrhage from uncontrolled hypertension. Cardiac disease was the third commonest cause of death. Patients successfully operated on for congenital heart disease (who sometimes become pregnant against advice) form a newly identifiable group of patients: the additional circulatory load of pregnancy and labour probably proves too much for the heart.
time, pooled their reports
787
Substandard care-the term that replaces "avoidable factors" used in previous reports for England and Wales-was the factor associated with most of the deaths. The report points out that a major contribution to such care was the level of seniority and experience of those looking after the patient; "too little, too late" was
recurring theme in many of the deaths. Among the many recommendations that the report makes are the setting up within every health region of an expert team (consisting of obstetricians, physicians, anaesthetists, and midwives) to advise on or accept for care any woman with severe pre-eclampsia or eclampsia; that any woman admitted with recurrent or moderately severe vaginal bleeding be seen as soon as possible by the most senior obstetrician in the duty team; that all available methods be used to establish the diagnosis of thromboembolism, radioactive isotopes for this purpose not being contraindicated in the latter half of pregnancy; and that an anaesthetist be involved early in the management of severe pre-eclampsia, even if preoperative delivery is not planned, to assist with analgesia, sedation, antihypertensive therapy, and monitoring. a
1. Department of Health, Welsh Office, Scottish Home and Health Department, Department of Health and Social Services, Northern Ireland. Report on Confidential Enquiries into Maternal Deaths m the United Kingdom 1985-87. London. HM Stationery Office. 1991. Pp 164. £9.85. ISBN 0-113253336.
Milk, butter, and heart disease The curious affair of the lilac-covered progress report VII from the MRC Epidemiology Unit (Cardiff) Caerphilly and Speedwell Studies (March 9, p 607) reached some sort of conclusion on March 21 when a Medical Research Council panel of referees concluded that the results "provide no basis for altering public health recommendations about diet". The panel (Prof D. J. P. Barker, Prof N. Day, Prof G. Rose, and Dr R. Whitehead) states of the findings of less heart disease in men who drank more milk and used butter rather than polyunsaturated margarine that "a statistical association of this kind does not necessarily mean that observed differences in diet cause differences in heart disease". "This is a single study", the panel adds, "which is briefly reported... and a full evaluation will only be available on completion." The report is 138 pages long. "The interim data must be set against the considerable body of evidence supporting the role of dietary fat in heart disease. More work is needed to understand the reasons for the results obtained
Psoriasis Association award The Psoriasis Association is offering a Josie Bradbury award to support travel outside the United Kingdom by suitable applicants interested in the study of any aspect of psoriasis and its treatment. The total sum available in any one year will not exceed ;[800. Application forms, which should be returned by June 1, 1991, can be obtained from The Secretary, Josie Bradbury Travel Award, Psoriasis Association, 7 Milton Street, Northampton NN2 7JG.
Calling
Dr Davies
Recently, an American television journalist was beaten up by unidentified people in Iasi, Romania. The journalist, called Davies, responded not by anger and revenge but by donating$200 to establish a prize to be offered to a Romanian medical student who demonstrates an interest and ability in clinical research. The prize will be offered through the Society of Physicians and Naturalists of Iasi (secretary, Dr Traian Mihaescu, 16 Independentei Blvd, PO Box 25, Iasi 6600, Romania). Anyone called Davies who welcomes the idea behind this response to violence is invited to contribute.
International Diary 10th joint meeting of British Endocrine Societies is to take place in Sussex on April 15-18: Janet Crompton, Administrative Officer, Society for Endocrinology, 23 Richmond Hill, Bristol BS8 1EN, UK (0272 734662).
International conference on Melanoma will take place in Brighton on May 8-11: Dr J. E. White, Wykeham House, 88 The Hundred, Romsey S05 8BX, UK (0794 512350). National conference on Alcohol and Health is to be held in Edinburgh on Wednesday, May 22: Hamish Macandrew, Training Executive, University of Edinburgh Technologies, FREEPOST, 16 Buccleuch Place, Edinburgh EH8 OLL, UK (031-650 3476). 2nd national conference on Immunisation will take place in Canberra, on May 27-29: Immunisation Secretariat, PO Box 746, Turramurra, NSW 2074, Australia (02-449 1525).
Australia,
A course entitled Magnetic Resonance Imaging and Spectroscopy will be held in Trondheim on May 27-31: Mona Kirkeby Eidem, MR Center, N 7034 Trondheim, Norway (47 7 99 7700).
»
Gloomy prospect for
UK medical research
"A plan for contraction" is how Dr Dai Rees, secretary of the Medical Research Council, described the council’s corporate plan for the next four years,l published this week. Despite a modest rise in grants-in-aid between 1991-92 CC200 4 million) and 1994-95 (209million), the MRC is proposing to reduce the number of annual research awards by 30% from the 1989-90 level and allocated funds also by 30%. Commitment to the council’s existing units (excluding the National Institute for Medical Research, the Centre for Clinical Research, and the Laboratory of Molecular Biology) is expected to fall by 15% by the end of the planning
period. Many research workers will be wondering who is to be next for the axe. "The MRC cannot be at the forefront of every field", says the plan, "but must maintain diversity in its areas of research" in order and opportunities. New MRC initiatives human genetics, neuroscience, nutrition, the environment, diabetes, and imaging. Dr Rees said "we have judged it still feasible-just-to continue to aim to cover all important health issues". But further reduction in resources, he warned, "will force us to abandon these aims and seek to define a more modest role". The prospects for governmentfunded medical research in the UK have never looked bleaker.
A conference on Developmental and Genetic Disorders of the Central Nervous System is to be held in British Columbia, Canada, on July 7-10: Carol Blagowidow, Project Coordinator, Professional Services Department, March of Dimes, Birth Defects Foundation, National Office, 1275 Mamaroneck Avenue, White Plains, New York 10605, USA (914-428
7100). A meeting of the International Association of Cancer Registries will take place in Quito on October 7-9: National Tumor Registry, Shyris 3307 y Tomas de Berlanga, PO Box 4965 CCI, Solca, Quito, Ecuador (442-122).
European workshop on Progress in Magnetic Resonance Imaging is take place in Cologne, Germany, on Oct 24-25: European Magnetic Resonance Forum, PO Box 161, CH 1807 Blonay, Switzerland (4121943 to
3834). A symposium on Perinatal Bereavement will take place in London on Tuesday, Oct 29: Symposium Secretariat, Royal Postgraduate Medical School, Institute of Obstetrics and Gynaecology, Queen Charlotte’s and Chelsea Hospital, Goldhawk Road, London W6 OXG, UK (081-740 3904).
to adapt to changing needs
will
concentrate on
1. Corporate plan W1N 4AL.
1991. Medical Research
Council,
20 Park
Crescent, London
6th world conference on Lung Cancer will be held in Melbourne on Nov 10-14: MCS Convention Services, PO Box 335, Heidelberg 3084, Victoria, Australia (03-499 6722). 1st Dead Sea conference entitled The Interaction Between Western and Eastern Medicines will take place at the Dead Sea, Israel, on Nov 4-8: The Secretariat, PO Box 50006, Tel Aviv 61500, Israel (03-654571). An international symposium on Cervical Cancer is to be held in Saint Lucia on Nov 26-30: Dr Jean Paul Tyst, Ministry of Health, Chaussee Road, Castries, Saint Lucia, West Indies (80945 32668).
Noticeboard Code for
infertility treatments
The Human Fertilisation &
Embryology Authority (HFEA), set following the Royal Assent of the Human Fertilisation and Embryology, has published proposals for a code of practice for centres offering infertility treatments and those carying up last November
research on human embryos.’ The authority’s principal task is to regulate, through a licensing system, any research or treatment that involves the creation, storage, and use of human embryos outside the body or the storage or donation of human eggs or sperm. Because these activities raise moral, ethical, and social questions, as well as scientific ones, the HFEA is consulting not only the treatment and research centres but also a wide range of professional organisations, religious groups, ethicists, and social interests. The consultation period ends on May 20. In drafting the code the HFEA has been guided by the right due to human life; the right of infertile people to be considered for treatment; the welfare of children, which may conflict with the interests of the adults involved; and the benefits that can flow from the responsible pursuit of medical and scientific knowledge. There has been widespread concern about the variable (and sometimes very low) success rates achieved with infertility treatments, which in private clinics can be very costly. The Authority, which will carry out annual checks of licensed premises, aims to "support the best clinical and scientific practice, while guarding against the undoubted risk of exploitation of people at a time when they may be particularly vulnerable". However, the HFEA says it has no hard evidence that patients are being deliberately misled about the chances of success. To reduce the chances of multiple births, the code proposes that no more than three eggs or embryos should be transferred in any out
one
cycle.
The HFEA code comes at a time when so-called "virgin births" have been hotly debated in the media, following publication of a letter in The Lancet (March 2, p 559) from a psychotherapist whose patient, though never having had sexual intercourse, was seeking assisted conception. The code does not exclude such women from consideration for treatment but says that "people seeking treatment are entitled to a fair and unprejudiced assessment of their situation and needs". One of the factors to be considered is the commitment of patients and "that of their husband or partner, if any, to having and bringing up a child or children". A patient who is refused treatment should be told the reason for refusal, the code says, and should be given the chance to reply. The 1990 Act imposes new obligations on centres offering in-vitro fertilisation and donor insemination to provide counselling for patients and to take account of the welfare of children bom as a result of infertility treatments. The scope of the HFEA code is thus more complex than the guidelines produced by a Voluntary (later
Interim) Licensing Authority. 1. Code of
practice: consultation document. Human Fertilisation & Embryology Authority, Clements House, 14-18 Gresham Street, London EC2V 7JE.
Passive smoking In a concerted effort to stimulate action against passive smoking, booklet! that outlines its health hazards and the measures that can be taken to reduce environmental tobacco smoke is being sent to groups such as members of parliament (British and European), employers’ organisations, and trade unions. The booklet, commissioned by the Health Education Authority, British Medical Association, Action on Smoking and Health, and the Coronary Prevention Group, and funded by the HEA, the two cancer charities that published it, the British Heart Foundation, the National Asthma Campaign, and the Department of Health, carries the endorsement of some thirty organisations, including the Royal Colleges of Physicians and Surgeons in England and Scotland. a
Existing methods of extracting the smoke as it is released into the air is unlikely to provide adequate protection. The booklet points out that although Britain, unlike several other countries, does not yet have comprehensive legislation to restrict smoking in enclosed places used by the public, existing health and safety legislation can sometimes be invoked. Employers, who are expected not only to provide employees with a safe environment but also to warn them of health hazards, will find it difficult to plead ignorance of the dangers of passive smoking as a mitigating factor because the courts have established that they must keep reasonably abreast of developing knowledge. The booklet also points out that in places such as hospitals, where a non-smoking policy is adopted, efforts should be made to ensure that the policies are implemented. 1. Passive Smoking: A Health Hazard. London: Imperial Cancer Research Fund and Cancer Research Campaign. 1991. Pp 17. £3.95 (including postage and packaging, from Passive Smoking, PO Box 4RP, London W1A 4RP). ISBN 0-901682063
Paternal radiation exposure and childhood leukaemia In 1990 Prof M. J. Gardner and his colleagues provided a much-needed stimulus to the faltering debate about whether (and, if so, how) there was a causative association between radiation, nuclear facilities, and leukaemia in childhood. It seemed that paternal radiation exposure had to be taken into account, even though there is no more radiobiological sense to that explanation than there is to some more direct environmental exposure. Last week the British Medical Journal published two more studies.!,2 We are no further forward, largely because the publications and commentaries have had to be ankle-deep in caveats. The study on the Dounreay area’ looks negative-ie, non-supportive of paternal radiation exposure as a factor-but the Committee on Medical Aspects of Radiation in the Environment comments that "... the findings in this small study fail to support but do not negate ...". The other study is cautiously positive on certain paternal occupations (including radiation work), but Prof P. G. Smith’s EMJ editorial notes that with exclusion of three cases already in Gardner’s study "the evidence suggesting an effect of preconception irradiation is much weaker". Urquhart JD, Black RJ, Muirhead MJ, et al. Case-control study of leukaemia and non-Hodgkin’s lymphoma in children in Caithness near the Dounreay nuclear installation. Br Med J 1991; 302: 687-92. 2. McKinney PA, Alexander FE, Cartwright RA, Parker L. Parental occupations of 1.
children with leukaemia in west Cumbria, north Humberside, and Gateshead. Br Med J 1991; 302: 681-87.
Maternal deaths in the UK The four countries of the United Kingdom have, for the first on confidential inquiries into maternal deaths into one publication, which covers deaths occurring in 1985-87. The report covers 265 deaths (212 England, 18 Wales, 25 Scotland, 10 Northern Ireland), of which 249 occurred in the first 42 days after delivery, and 139 (56%) of these were judged to be direct obstetric deaths. The mortality rate in the triennium covered (7-6 per 100 000 total births) was 18% lower than that in the previous triennium. The commonest causes of death were thromboembolism and hypertensive disorders of pregnancy. Although the death rate from hypertensive disorders was similar to that previously reported for England and Wales, there was a shift in the pattern of immediate cause of death, from cerebral complications to the acute respiratory distress syndrome. The explanation offered is that patients are now surviving the early period, when they are at greatest risk of cerebral haemorrhage from uncontrolled hypertension. Cardiac disease was the third commonest cause of death. Patients successfully operated on for congenital heart disease (who sometimes become pregnant against advice) form a newly identifiable group of patients: the additional circulatory load of pregnancy and labour probably proves too much for the heart.
time, pooled their reports
787
Substandard care-the term that replaces "avoidable factors" used in previous reports for England and Wales-was the factor associated with most of the deaths. The report points out that a major contribution to such care was the level of seniority and experience of those looking after the patient; "too little, too late" was
recurring theme in many of the deaths. Among the many recommendations that the report makes are the setting up within every health region of an expert team (consisting of obstetricians, physicians, anaesthetists, and midwives) to advise on or accept for care any woman with severe pre-eclampsia or eclampsia; that any woman admitted with recurrent or moderately severe vaginal bleeding be seen as soon as possible by the most senior obstetrician in the duty team; that all available methods be used to establish the diagnosis of thromboembolism, radioactive isotopes for this purpose not being contraindicated in the latter half of pregnancy; and that an anaesthetist be involved early in the management of severe pre-eclampsia, even if preoperative delivery is not planned, to assist with analgesia, sedation, antihypertensive therapy, and monitoring. a
1. Department of Health, Welsh Office, Scottish Home and Health Department, Department of Health and Social Services, Northern Ireland. Report on Confidential Enquiries into Maternal Deaths m the United Kingdom 1985-87. London. HM Stationery Office. 1991. Pp 164. £9.85. ISBN 0-113253336.
Milk, butter, and heart disease The curious affair of the lilac-covered progress report VII from the MRC Epidemiology Unit (Cardiff) Caerphilly and Speedwell Studies (March 9, p 607) reached some sort of conclusion on March 21 when a Medical Research Council panel of referees concluded that the results "provide no basis for altering public health recommendations about diet". The panel (Prof D. J. P. Barker, Prof N. Day, Prof G. Rose, and Dr R. Whitehead) states of the findings of less heart disease in men who drank more milk and used butter rather than polyunsaturated margarine that "a statistical association of this kind does not necessarily mean that observed differences in diet cause differences in heart disease". "This is a single study", the panel adds, "which is briefly reported... and a full evaluation will only be available on completion." The report is 138 pages long. "The interim data must be set against the considerable body of evidence supporting the role of dietary fat in heart disease. More work is needed to understand the reasons for the results obtained
Psoriasis Association award The Psoriasis Association is offering a Josie Bradbury award to support travel outside the United Kingdom by suitable applicants interested in the study of any aspect of psoriasis and its treatment. The total sum available in any one year will not exceed ;[800. Application forms, which should be returned by June 1, 1991, can be obtained from The Secretary, Josie Bradbury Travel Award, Psoriasis Association, 7 Milton Street, Northampton NN2 7JG.
Calling
Dr Davies
Recently, an American television journalist was beaten up by unidentified people in Iasi, Romania. The journalist, called Davies, responded not by anger and revenge but by donating$200 to establish a prize to be offered to a Romanian medical student who demonstrates an interest and ability in clinical research. The prize will be offered through the Society of Physicians and Naturalists of Iasi (secretary, Dr Traian Mihaescu, 16 Independentei Blvd, PO Box 25, Iasi 6600, Romania). Anyone called Davies who welcomes the idea behind this response to violence is invited to contribute.
International Diary 10th joint meeting of British Endocrine Societies is to take place in Sussex on April 15-18: Janet Crompton, Administrative Officer, Society for Endocrinology, 23 Richmond Hill, Bristol BS8 1EN, UK (0272 734662).
International conference on Melanoma will take place in Brighton on May 8-11: Dr J. E. White, Wykeham House, 88 The Hundred, Romsey S05 8BX, UK (0794 512350). National conference on Alcohol and Health is to be held in Edinburgh on Wednesday, May 22: Hamish Macandrew, Training Executive, University of Edinburgh Technologies, FREEPOST, 16 Buccleuch Place, Edinburgh EH8 OLL, UK (031-650 3476). 2nd national conference on Immunisation will take place in Canberra, on May 27-29: Immunisation Secretariat, PO Box 746, Turramurra, NSW 2074, Australia (02-449 1525).
Australia,
A course entitled Magnetic Resonance Imaging and Spectroscopy will be held in Trondheim on May 27-31: Mona Kirkeby Eidem, MR Center, N 7034 Trondheim, Norway (47 7 99 7700).
»
Gloomy prospect for
UK medical research
"A plan for contraction" is how Dr Dai Rees, secretary of the Medical Research Council, described the council’s corporate plan for the next four years,l published this week. Despite a modest rise in grants-in-aid between 1991-92 CC200 4 million) and 1994-95 (209million), the MRC is proposing to reduce the number of annual research awards by 30% from the 1989-90 level and allocated funds also by 30%. Commitment to the council’s existing units (excluding the National Institute for Medical Research, the Centre for Clinical Research, and the Laboratory of Molecular Biology) is expected to fall by 15% by the end of the planning
period. Many research workers will be wondering who is to be next for the axe. "The MRC cannot be at the forefront of every field", says the plan, "but must maintain diversity in its areas of research" in order and opportunities. New MRC initiatives human genetics, neuroscience, nutrition, the environment, diabetes, and imaging. Dr Rees said "we have judged it still feasible-just-to continue to aim to cover all important health issues". But further reduction in resources, he warned, "will force us to abandon these aims and seek to define a more modest role". The prospects for governmentfunded medical research in the UK have never looked bleaker.
A conference on Developmental and Genetic Disorders of the Central Nervous System is to be held in British Columbia, Canada, on July 7-10: Carol Blagowidow, Project Coordinator, Professional Services Department, March of Dimes, Birth Defects Foundation, National Office, 1275 Mamaroneck Avenue, White Plains, New York 10605, USA (914-428
7100). A meeting of the International Association of Cancer Registries will take place in Quito on October 7-9: National Tumor Registry, Shyris 3307 y Tomas de Berlanga, PO Box 4965 CCI, Solca, Quito, Ecuador (442-122).
European workshop on Progress in Magnetic Resonance Imaging is take place in Cologne, Germany, on Oct 24-25: European Magnetic Resonance Forum, PO Box 161, CH 1807 Blonay, Switzerland (4121943 to
3834). A symposium on Perinatal Bereavement will take place in London on Tuesday, Oct 29: Symposium Secretariat, Royal Postgraduate Medical School, Institute of Obstetrics and Gynaecology, Queen Charlotte’s and Chelsea Hospital, Goldhawk Road, London W6 OXG, UK (081-740 3904).
to adapt to changing needs
will
concentrate on
1. Corporate plan W1N 4AL.
1991. Medical Research
Council,
20 Park
Crescent, London
6th world conference on Lung Cancer will be held in Melbourne on Nov 10-14: MCS Convention Services, PO Box 335, Heidelberg 3084, Victoria, Australia (03-499 6722). 1st Dead Sea conference entitled The Interaction Between Western and Eastern Medicines will take place at the Dead Sea, Israel, on Nov 4-8: The Secretariat, PO Box 50006, Tel Aviv 61500, Israel (03-654571). An international symposium on Cervical Cancer is to be held in Saint Lucia on Nov 26-30: Dr Jean Paul Tyst, Ministry of Health, Chaussee Road, Castries, Saint Lucia, West Indies (80945 32668).