Unsolved problems for the '80s.
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Biomedical subjects
Publications and source records attributed to M A Chamberlain.
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A postal survey was mounted to investigate the use of the British Rheumatism and Arthritis Association's (B.R.A.A.) postal aids service. Of the 288 persons who ordered aids between B.R.A.A. and 446 from other sources. Many simple aids were valuable and well used; several had faults, which in many cases could easily have been rectified if the manufacturers been aware of them. Respondents appreciated the speedy provision of aids but many had problems which would have been better solved by attendance at an Aids Centre or Occupational Therapy Department. A quarter of the subjects were unaware that departments of social services provided aids.
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.
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A brief survey of the difficulties facing a mother of pre-school children has been made. The time from 1 to 2 1/2 years is probably most demanding of the mother's patience and energy. Much can be done to support the family by adequate control of the disease, splinting and sparing of involved joints and provision of an easily maintained home, children's clothes and attention to environmental design. Domestic help, education of the husband, playgroup for the child and correct family spacing are all helpful.
Ninety-five patients with rheumatoid arthritis or osteoarthrosis were interviewed and questioned in their homes, being randomly selected from 354 outpatients with these diseases. The findings were compared with answers from 30 matched able-bodied controls. The handicapped were mainly female and elderly; over half were severely or appreciably handicapped; nearly one-third lived alone. The average weekly income of these households was pound25, at least pound6 a week less than their age-matched counterparts. Very few subjects lived in adapted or specially designed housing, and half the housing had at least 2 steps to street level. A third of the sample could not walk more than 10 yards (9 m), and only half could walk 100 yards (90 m); yet only one-third had a bus stop, one-quarter a local park, and one-third a local shop within this distance. One-third of the patients could not shop for themselves. Powered wheelchairs were not used. Buses were rarely or never used by nearly half these arthritics because of severe disability. Cars were owned by less than a quarter of the sample, and only by those financially better off. Over a third were unable to get a lift when wanted. Cars ameliorated much of the frustration and lack of social contact caused by physical disability. Adequate financing would enable those with severe disability to engage in normal activities. Better designed buses stopping nearer the homes of handicapped would improve independence for those less severely disabled. Correct siting of mobility housing, shops, community facilities, and parks would be greatly appreciated, as would removal of all unnecessary steps and kerbs.
Diflunisal (750 mg per day) has been compared with acetylsalicylic acid (ASA) (3000 mg per day) in the treatment of osteoarthrosis of the hip and knee in a double-blind, randomised, multicentre, outpatient study. Thirty-one patients entered the diflunisal group and 29 the ASA group. The response of the 2 groups was comparable, but the incidence of side effects was higher in the ASA group. At the end of the 12-week period more patients in the diflunisal group chose to remain in a further, open study.
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The first-degree family members of patients with Behcet's syndrome were investigated to determine (1) whether there was a familial aggregation of Behcet's syndrome or of its component features, (2) whether there was an increased incidence of sacro-iliitis in these families, and (3) whether a link exists between Behcet's syndrome and spondarthritides in first-degree relatives. Of the 226 relatives and patients seen, 21 patients with definite Behcet's syndrome and their 71 relatives were analysed in some detail. Orogenital ulceration was found in 2 mothers of probands; 1 patient had psoriasis and Behcet's but neither disease featured in the pedigree. Another family showed numerous manifestations of psoriasis and psoriatic arthritis, 1 member having severe sacro-iliitis but the proband had Behcet's syndrome only. Family trees including HLA pedigrees, where known, are presented. Spouses suffered few of the complaints found in patients, and to a less extent in relatives, but showed a high incidence of backache, perhaps of psychogenic origen.
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