1
975 ment. With his experience of helping to prepare part of last year’s report on prevention for the Royal College of General Practitioners, and while currently working on a follow-up to the cardiac aspects of that report, Dr Tudor Hart says: "The Royal College is coming more and more round to the view that if you are going to improve primary care and preventive medicine, then you can only do it by having more people being paid to do more things. It means the end of the five minute consultation. In future at least ten minutes is going to be needed, looking for needs and not wants." But, he fears, the growing acceptance of the need for more facilities will not reach the Welsh Office. "Ifthe D.H.S.S. has not got a national policy, then it is not surprising that the Welsh Office has only a fraction of that non-policy." The Welsh Office’s approach amounts to what Dr Tudor Hart calls the average GP’s policy of "What shall we do on Monday?" The Government, he says, just wants to keep the N.H.S. ticking over, "and hopes that any bits which drop off won’t be noticed". This situation is compounded by the widespread lack of interest in prevention, of which Dr Tudor Hart accuses many cardiology consultants. Many could not care less about prevention and primary care, except for teaching hospital consultants, he says. But the basic problem, he insists, is that resources are insufficient to provide the level of care for heart disease sufferers in Wales which is provided elsewhere, and they will remain insufficient until the Government changes its priorities. "It is far worse for us to stop being a first-class medical power than to stop being a first-class military power," Dr Tudor Hart claims. RODNEY DEITCH International Diary Annual meeting of American Lung Association: Los Angeles, California, May 15-18 (American Lung Association, 1740 Broadway, New York, NY 10019, U.S.A.). International postgraduate course on Public Information and Cancer Prevention: Aosta, Italy, May 26-28 (Istituto Scientifico Tumori, Viale Benedetto XV 10, 16132 Genova, Italy). 25th annual session of Health Executives Development Program: Cornell University, New York, June 14-24 (Health Executives Development Program, Cornel University, Malott Hall, Ithaca, NY 14853, U.S.A.). Continuing medical education course in Topics in Emergency Medicine: San Francisco, California, June 28-July 2 (University of California, Extended Programs in Medical Education, Room 569-U, San Francisco, California 94143, U.S.A.). 1982 World Assembly on Aging: Vienna, Austria, July 26-Aug. 6 (Information Officer, World Assembly on Aging, Room 1061, DESI/DPI, United Nations, New York, NY 10017, U.S.A.). 19th congress of International Society of Haematology and 17th congres of International Society of Blood Transfusion: Budapest, Hungary, Aug. 1-7 (Publishing House of Hungarian Academy of Sciences, H-1363 Budapest, P.O. Box 24). Continuing medical education symposium on Fine Needle Aspiration: Aspen, Colorado, Aug. 21-28 (University of California, Extended Programs in Medical Education, Room 569-U, San Francisco, California 94143, U.S.A.). 18th annual meeting of European Association for the Study of Diabetes: Budapest, Hungary, Sept. 1-4 (Dr Gy. Tamas, 1st Department of Medicine, Semmelweis University of Medicine, Koranyi S. u. 2/a, Budapest, H-1083). 4th annual pharmacy symposium on Cancer Chemotherapy: Houston, Texas, Sept. 12-14 (Sharon Bronson, Department of Pharmacy, M.D. Anderson Hospital and Tumor Institute, 6723 Bertner Avenue, Houston, Texas 77030, U.S.A.). Notes and News WORLD HEALTH DAY ACCORDING to figures from the United Nations, there were about 214 million people over the age of 60 in the 1950 world population. It has been predicted that, by the year 2025, there will be more than 1 billion elderly people-that is, 1 person in every 7 will be over the age of 60. A presentation to mark World Health Day 1982, with its theme of improving conditions for elderly people, Add Life to Years, was organised by Age Concern and took place in London on April 7. The Secretary of State, Mr Norman Fowler, opened the proceedings with an account of the part played by the Government in "supporting and maintaining the independence of elderly people in the community." He described two new Departmental enterprises: a grant of L90 000 to help Age Concern establish a national training centre in Birmingham to meet the demands of an ageing society; and a seminar on community care to take place in Norwich in September. He also announced an award of 2500, to mark the World Health Assembly on Ageing, to be held in July, for the best innovative voluntary action supporting elderly people in the community. An exhortation to "accept our individual responsibilities" and thereby enable "older members to live lives of dignity, purpose, and fulfilment" concluded Mr Fowler’s speech. There followed a review of 110 projects launched or coming to fruition on or around World Health Day. Totalling a value of over jC21 million, they illustrated the variety of work undertaken to enhance the quality of life for old people throughout the world. NUCLEAR FALL-OUT 1980 ALTHOUGH indices of radioactive fall-out in the U.K. in 19801 were at levels well below those recorded in 1964, the worst year from fall-out, they remain sensitive to atmospheric weapons tests. In October, 1980, caesium-137 in air concentrations at Shrivenham, Wiltshire, stood at 2 J.lBq/m3. On the 16th of that month there was an intermediate yield nuclear test explosion in Central Asia. Caesium-137 concentrations rose sharply, and the preliminary result for April, 1981, was nearly 100 J.lBq/m3. THE MENTALLY HANDICAPPED AND PSYCHIATRIC DISORDER MENTALLY handicapped people are particularly vulnerable to psychiatric disorder, as a result, speculates Dr A. H. Reid, author of a new book2 on the subject, of their brain pathology and the adverse effects of social rejection, family stress, and educational failure. Little has been written about this aspect of mental handicap, yet the presence of psychiatric disorder may well decide whether a person lives in the community or within an institution. Reid has written this book on the psychiatry of mental handicap for medical students, nurses, social workers, and teachers. He identifies the major disorders (early childhood autism, hyperkinesia syndromes, the affective disorders, and schizophrenia) but warns of the difficulties of diagnosis. Schizophrenic symptoms, such as echolalia for example, may simply be the incomplete development of language ; ritual may be significant, but not necessarily of psychiatric origin. Psychiatric definition is always difficult, but when the patient is mentally handicapped it is compounded by limited self-expression and excitability. The mentally handicapped person’s ability to communicate goes hand in hand with awareness of the people around him or her. This book has been written to improve understanding among those who work with the mentally handicapped whether in institutions or elsewhere. Compared with an estimated 6 - 6% prevalence of psychiatric disorder among 1. Environmental Radioactivity Surveillance Programme Results for the U.K. for 1980. By F. A. Fry, N. J. Dodd, N. Green, R. O. Major, and B. T. Wilkins. London: H.M. Stationery Office. 1981. Pp. 34. £3. 2. The Psychiatry of Mental Handicap. By Andrew H. Reid. Oxford: Blackwell Scientific Publications. 1982. Pp 145 £6.

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975

ment. With his experience of helping to prepare part of lastyear’s report on prevention for the Royal College of GeneralPractitioners, and while currently working on a follow-up tothe cardiac aspects of that report, Dr Tudor Hart says: "The

Royal College is coming more and more round to the viewthat if you are going to improve primary care and preventivemedicine, then you can only do it by having more peoplebeing paid to do more things. It means the end of the fiveminute consultation. In future at least ten minutes is going tobe needed, looking for needs and not wants."But, he fears, the growing acceptance of the need for more

facilities will not reach the Welsh Office. "Ifthe D.H.S.S. hasnot got a national policy, then it is not surprising that theWelsh Office has only a fraction of that non-policy." TheWelsh Office’s approach amounts to what Dr Tudor Hartcalls the average GP’s policy of "What shall we do onMonday?" The Government, he says, just wants to keep theN.H.S. ticking over, "and hopes that any bits which drop offwon’t be noticed".This situation is compounded by the widespread lack of

interest in prevention, of which Dr Tudor Hart accuses manycardiology consultants. Many could not care less about

prevention and primary care, except for teaching hospitalconsultants, he says. But the basic problem, he insists, is thatresources are insufficient to provide the level of care for heartdisease sufferers in Wales which is provided elsewhere, andthey will remain insufficient until the Government changesits priorities. "It is far worse for us to stop being a first-classmedical power than to stop being a first-class militarypower," Dr Tudor Hart claims.

RODNEY DEITCH

International DiaryAnnual meeting of American Lung Association: Los Angeles, California,

May 15-18 (American Lung Association, 1740 Broadway, New York, NY10019, U.S.A.).

International postgraduate course on Public Information and CancerPrevention: Aosta, Italy, May 26-28 (Istituto Scientifico Tumori, VialeBenedetto XV 10, 16132 Genova, Italy).

25th annual session of Health Executives Development Program:Cornell University, New York, June 14-24 (Health Executives DevelopmentProgram, Cornel University, Malott Hall, Ithaca, NY 14853, U.S.A.).

Continuing medical education course in Topics in Emergency Medicine:San Francisco, California, June 28-July 2 (University of California, ExtendedPrograms in Medical Education, Room 569-U, San Francisco, California94143, U.S.A.).1982 World Assembly on Aging: Vienna, Austria, July 26-Aug. 6

(Information Officer, World Assembly on Aging, Room 1061, DESI/DPI,United Nations, New York, NY 10017, U.S.A.).19th congress of International Society of Haematology and 17th

congres of International Society of Blood Transfusion: Budapest,Hungary, Aug. 1-7 (Publishing House of Hungarian Academy of Sciences,H-1363 Budapest, P.O. Box 24).

Continuing medical education symposium on Fine Needle Aspiration:Aspen, Colorado, Aug. 21-28 (University of California, Extended Programsin Medical Education, Room 569-U, San Francisco, California 94143,U.S.A.).

18th annual meeting of European Association for the Study ofDiabetes: Budapest, Hungary, Sept. 1-4 (Dr Gy. Tamas, 1st Department ofMedicine, Semmelweis University of Medicine, Koranyi S. u. 2/a, Budapest,H-1083).

4th annual pharmacy symposium on Cancer Chemotherapy: Houston,Texas, Sept. 12-14 (Sharon Bronson, Department of Pharmacy, M.D.Anderson Hospital and Tumor Institute, 6723 Bertner Avenue, Houston,Texas 77030, U.S.A.).

Notes and News

WORLD HEALTH DAY

ACCORDING to figures from the United Nations, there were about214 million people over the age of 60 in the 1950 world population.It has been predicted that, by the year 2025, there will be more than1 billion elderly people-that is, 1 person in every 7 will be over theage of 60. A presentation to mark World Health Day 1982, with itstheme of improving conditions for elderly people, Add Life toYears, was organised by Age Concern and took place in London onApril 7. The Secretary of State, Mr Norman Fowler, opened theproceedings with an account of the part played by the Governmentin "supporting and maintaining the independence of elderly peoplein the community." He described two new Departmentalenterprises: a grant of L90 000 to help Age Concern establish anational training centre in Birmingham to meet the demands of anageing society; and a seminar on community care to take place inNorwich in September. He also announced an award of 2500, tomark the World Health Assembly on Ageing, to be held in July, forthe best innovative voluntary action supporting elderly people inthe community. An exhortation to "accept our individual

responsibilities" and thereby enable "older members to live lives ofdignity, purpose, and fulfilment" concluded Mr Fowler’s speech.There followed a review of 110 projects launched or coming tofruition on or around World Health Day. Totalling a value of overjC21 million, they illustrated the variety of work undertaken toenhance the quality of life for old people throughout the world.

NUCLEAR FALL-OUT 1980

ALTHOUGH indices of radioactive fall-out in the U.K. in 19801were at levels well below those recorded in 1964, the worst year fromfall-out, they remain sensitive to atmospheric weapons tests. InOctober, 1980, caesium-137 in air concentrations at Shrivenham,Wiltshire, stood at 2 J.lBq/m3. On the 16th of that month there wasan intermediate yield nuclear test explosion in Central Asia.Caesium-137 concentrations rose sharply, and the preliminaryresult for April, 1981, was nearly 100 J.lBq/m3.

THE MENTALLY HANDICAPPED AND PSYCHIATRICDISORDER

MENTALLY handicapped people are particularly vulnerable topsychiatric disorder, as a result, speculates Dr A. H. Reid, author ofa new book2 on the subject, of their brain pathology and the adverseeffects of social rejection, family stress, and educational failure.Little has been written about this aspect of mental handicap, yet thepresence of psychiatric disorder may well decide whether a personlives in the community or within an institution. Reid has writtenthis book on the psychiatry of mental handicap for medical students,nurses, social workers, and teachers. He identifies the majordisorders (early childhood autism, hyperkinesia syndromes, theaffective disorders, and schizophrenia) but warns of the difficultiesof diagnosis. Schizophrenic symptoms, such as echolalia for

example, may simply be the incomplete development of language ;ritual may be significant, but not necessarily of psychiatric origin.Psychiatric definition is always difficult, but when the patient ismentally handicapped it is compounded by limited self-expressionand excitability. The mentally handicapped person’s ability tocommunicate goes hand in hand with awareness of the peoplearound him or her. This book has been written to improveunderstanding among those who work with the mentallyhandicapped whether in institutions or elsewhere. Compared withan estimated 6 - 6% prevalence of psychiatric disorder among

1. Environmental Radioactivity Surveillance Programme Results for the U.K. for 1980.By F. A. Fry, N. J. Dodd, N. Green, R. O. Major, and B. T. Wilkins. London: H.M.Stationery Office. 1981. Pp. 34. £3.

2. The Psychiatry of Mental Handicap. By Andrew H. Reid. Oxford: Blackwell ScientificPublications. 1982. Pp 145 £6.