1331
emphasis is now being placed on selective immunisation of adults who have first been screened for antibody. Rather disquieting have been the findings that up to 24% of children given the HPV77.DE5 vaccine had no detectable haemagglutination-inhibiting (H.I.) antibodies at a mean of 4-7 years later,15 and that H.I. antibodies seem particularly apt to slump in children whose H.I. response is poor 8 weeks after vaccination.16 We urgently need to know whether loss of H.I. antibody renders such children susceptible to wild or vaccine rubella strains and whether the more immunogenic rubella vaccine RA27/3 provides a more durable immune response among children. In the U.K. substantial obstacles to the vaccination campaign are the high rates of school absenteeism in inner city areas, and the mistaken belief among children, their parents, and even their doctors, that a history of rubella is a reliable index more
of immunity.
UROLOGISTS AND THE ELDERLY THE great bulk of the urologist’s adult work is concerned with urinary incontinence, precipitancy, and retention. Therefore the urologist is and should be concerned with the elderly. Yet in Britain, it seems, most of the old people admitted to hospital with incontinence never see a urologist. Urinary incontinence is one of the prime troubles of patients referred for geriatric admission, yet only 20% of respondents to a national questionnaire, involving over a hundred geriatric departments, indicated a helpful partnership between urologists and geriatric physicians. Isaacs’ surveyl is an assessment of how much help geriatric physicians get, in dealing with persistently incontinent patients, from urologists and gynxcologists, and from physiotherapy, charting, urodynamic studies, and radiology. It might be supposed that the old people concerned have problems irrelevant to the urologist’s skills-that locally remediable causes ’are a rarity, the majority being cortical or neurogenic in origin. But there is some evidence that urodynamic studies may be helpful even in this latter group. Those geriatricians reporting good liaison with urology departments were enthusiastic about the value of the
partnership. Urinary incontinence
was
recognised
as an
important
line of research from the inception of geriatric medicine as a specialty, and Wilson2 was the first to demonstrate the potential diagnostic and therapeutic benefits of cystometry. Bladder irritability was identified in relation to diuretics, constipation, senile vaginitis, and stroke.3 Since 1975, when Brocklehurst4 presented some striking results from urodynamic studies in the alleviation of elderly incontinence, the technique has been taken up in various centres.5 Yet only a minority of the geriatric departments responding to Professor Isaacs’ questionnaire used these techniques. It was largely these same departments who had the best liaison with the urologist. 15. Balfour, H. H., Amren, D. P. Am. J. Dis. Child. 1978, 132, 573. 16. Horstmann, D. M. Ann. intern. Med. 1975, 83, 412. 1. Isaacs, B. Hlth Trends, 1979, 11, 42. 2. Wilson, T. S. Lancet, 1948, ii, 374. 3. British Medical Journal, 1978, 1, 61. 4. Keston, M., Brocklehurst, J. C. A Paper presented at meeting of the International Continence Society, Glasgow, Sept. 4-6, 1975. 5. Lancet, 1977, 1, 521.
These techniques, which might well be a source of relief for a substantial number of elderly incontinents, have hardly been exploited anywhere. There are, of course, problems of space, staff, and equipment, but these are best solved by interdepartmental collaboration. Urologists and geriatric physicians should be discussing how it can be done.
PSYCHOLOGICAL TROUBLES AT THE MENOPAUSE A breeze from Australia has lightly fanned the H.R.T. controversy. One of the chief benefits of "hormone replacement therapy" is said to be relief of psychological troubles. Symptoms such as depression, irritability, insomnia, and fatigue are indeed very frequent in women attending menopause clinics, but Prof. Carl Wood, of Monash University, doubts whether they are primary. He had access to the results of a health and social survey which included 948 women of all ages and social groups from the suburbs of Melbourne. The prevalence of twenty symptoms, including ten listed in gynxcology textbooks as menopausal, was assessed in 5-year cohorts, each of about 100 women. Sleeplessness, joint pains, numbness, palpitations, dizziness, and weakness all tended to increase with age; headache, skin problems, and irritability to decrease. Tiredness, fainting, loss of appetite, nervousness, backache, frequency, depression, restlessness, tension, and weight gain bore no obvious relation to age. But no symptom had a prevalence, in the menopausal years, or in any single cohort, that fell outside the mean and two standard deviations of the regression line. Wood judges that the "mental tonic" effect of postmenopausal oestrogen therapy is likely to stem from relief of primary menopausal troubles such as hot flushes and vaginal atrophy.
V DAY JULY 7 or was the Declaration of Vancouver? The of offspring a cabal of medical chauvinists, some say. A conspiracy of Canadian lumber merchants? Certainly
WHAT is
the announcements in the journals must have accounted for many hectares of forest; and that is to say nothing of the future demands of the Declaration. No; the motives of the Vancouverists, described in our issue of Feb. 24, were pure. The Declaration is, of course, all about the uniform style in which various medical editors have agreed to receive contributions. V day, for The Lancet, is July 7; and that issue will be embellished with the lengthier references demanded by the Vancouver style. Despite the modest hectarage of forest so far expended by Adam Street, by no means everything is yet arriving in the reformed style. Those eager Vancouverists who look for revolution may have to settle, in Lancet columns, for evolution. But we hope that, from now on, contributors will be trying the new medium for their messages. An early-for-dates article on p. 1322 sets the
style. 1.
Wood, C. Med. J. Aust. 1979, i, 496.
emphasis is now being placed on selective immunisation of adults who have first been screened for antibody. Rather disquieting have been the findings that up to 24% of children given the HPV77.DE5 vaccine had no detectable haemagglutination-inhibiting (H.I.) antibodies at a mean of 4-7 years later,15 and that H.I. antibodies seem particularly apt to slump in children whose H.I. response is poor 8 weeks after vaccination.16 We urgently need to know whether loss of H.I. antibody renders such children susceptible to wild or vaccine rubella strains and whether the more immunogenic rubella vaccine RA27/3 provides a more durable immune response among children. In the U.K. substantial obstacles to the vaccination campaign are the high rates of school absenteeism in inner city areas, and the mistaken belief among children, their parents, and even their doctors, that a history of rubella is a reliable index more
of immunity.
UROLOGISTS AND THE ELDERLY THE great bulk of the urologist’s adult work is concerned with urinary incontinence, precipitancy, and retention. Therefore the urologist is and should be concerned with the elderly. Yet in Britain, it seems, most of the old people admitted to hospital with incontinence never see a urologist. Urinary incontinence is one of the prime troubles of patients referred for geriatric admission, yet only 20% of respondents to a national questionnaire, involving over a hundred geriatric departments, indicated a helpful partnership between urologists and geriatric physicians. Isaacs’ surveyl is an assessment of how much help geriatric physicians get, in dealing with persistently incontinent patients, from urologists and gynxcologists, and from physiotherapy, charting, urodynamic studies, and radiology. It might be supposed that the old people concerned have problems irrelevant to the urologist’s skills-that locally remediable causes ’are a rarity, the majority being cortical or neurogenic in origin. But there is some evidence that urodynamic studies may be helpful even in this latter group. Those geriatricians reporting good liaison with urology departments were enthusiastic about the value of the
partnership. Urinary incontinence
was
recognised
as an
important
line of research from the inception of geriatric medicine as a specialty, and Wilson2 was the first to demonstrate the potential diagnostic and therapeutic benefits of cystometry. Bladder irritability was identified in relation to diuretics, constipation, senile vaginitis, and stroke.3 Since 1975, when Brocklehurst4 presented some striking results from urodynamic studies in the alleviation of elderly incontinence, the technique has been taken up in various centres.5 Yet only a minority of the geriatric departments responding to Professor Isaacs’ questionnaire used these techniques. It was largely these same departments who had the best liaison with the urologist. 15. Balfour, H. H., Amren, D. P. Am. J. Dis. Child. 1978, 132, 573. 16. Horstmann, D. M. Ann. intern. Med. 1975, 83, 412. 1. Isaacs, B. Hlth Trends, 1979, 11, 42. 2. Wilson, T. S. Lancet, 1948, ii, 374. 3. British Medical Journal, 1978, 1, 61. 4. Keston, M., Brocklehurst, J. C. A Paper presented at meeting of the International Continence Society, Glasgow, Sept. 4-6, 1975. 5. Lancet, 1977, 1, 521.
These techniques, which might well be a source of relief for a substantial number of elderly incontinents, have hardly been exploited anywhere. There are, of course, problems of space, staff, and equipment, but these are best solved by interdepartmental collaboration. Urologists and geriatric physicians should be discussing how it can be done.
PSYCHOLOGICAL TROUBLES AT THE MENOPAUSE A breeze from Australia has lightly fanned the H.R.T. controversy. One of the chief benefits of "hormone replacement therapy" is said to be relief of psychological troubles. Symptoms such as depression, irritability, insomnia, and fatigue are indeed very frequent in women attending menopause clinics, but Prof. Carl Wood, of Monash University, doubts whether they are primary. He had access to the results of a health and social survey which included 948 women of all ages and social groups from the suburbs of Melbourne. The prevalence of twenty symptoms, including ten listed in gynxcology textbooks as menopausal, was assessed in 5-year cohorts, each of about 100 women. Sleeplessness, joint pains, numbness, palpitations, dizziness, and weakness all tended to increase with age; headache, skin problems, and irritability to decrease. Tiredness, fainting, loss of appetite, nervousness, backache, frequency, depression, restlessness, tension, and weight gain bore no obvious relation to age. But no symptom had a prevalence, in the menopausal years, or in any single cohort, that fell outside the mean and two standard deviations of the regression line. Wood judges that the "mental tonic" effect of postmenopausal oestrogen therapy is likely to stem from relief of primary menopausal troubles such as hot flushes and vaginal atrophy.
V DAY JULY 7 or was the Declaration of Vancouver? The of offspring a cabal of medical chauvinists, some say. A conspiracy of Canadian lumber merchants? Certainly
WHAT is
the announcements in the journals must have accounted for many hectares of forest; and that is to say nothing of the future demands of the Declaration. No; the motives of the Vancouverists, described in our issue of Feb. 24, were pure. The Declaration is, of course, all about the uniform style in which various medical editors have agreed to receive contributions. V day, for The Lancet, is July 7; and that issue will be embellished with the lengthier references demanded by the Vancouver style. Despite the modest hectarage of forest so far expended by Adam Street, by no means everything is yet arriving in the reformed style. Those eager Vancouverists who look for revolution may have to settle, in Lancet columns, for evolution. But we hope that, from now on, contributors will be trying the new medium for their messages. An early-for-dates article on p. 1322 sets the
style. 1.
Wood, C. Med. J. Aust. 1979, i, 496.
