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Background: Doctors are poor at help-seeking, particularly for mental ill health; attitudes of colleagues reflecting stigmatisation may be important factors influencing decisions to seek support. Aims: This article focuses on doctors’ attitudes to depression rather than mental illness in general. It seeks to determine the extent to which doctors perceive depression is stigmatised within the medical profession and whether the level of perceived stigma affects patterns of help-seeking behaviour. Method: A postal survey was sent to 1488 General Practitioners and 152 psychiatrists in Devon and Cornwall. Questions assessed stigmatising attitudes to depression; help-seeking behaviour and barriers to help-seeking. Prevalence of self-reported depression and time off work was measured. Results: The response rate was 76.6%. Doctors perceived that many of their profession hold stigmatising views of depression. Some 46.2% of respondents reported that they had suffered an episode of depression. Help-seeking was significantly reduced in those with a history of depression. Barriers to help-seeking were reported as letting colleagues down (73.1%), confidentiality (53.4%), letting patients down (51.9%) and career progression (15.7%). Gender and a history of depression significantly affected help-seeking behaviour and perceived stigmatisation. Higher levels of perceived stigma increased concerns about help-seeking and reduced help-seeking from own GP or colleagues. Conclusion: Stigma associated with depression in doctors is endemic in the medical profession and the level of perceived stigma is related to reduced help-seeking behaviour. Efforts need to be made by the profession to reduce the stigma anticipated by those who become depressed, to enable appropriate help-seeking and support.

Background/Aims: Alzheimer’s disease patients commonly suffer from behavioural and psychological symptoms of dementia (BPSD); a genetic component to the development of BPSD has been demonstrated. Genetic risk factors for other psychiatric disorders have been implicated in BPSD; however, this is the first known investigation of the dopamine transporter (DAT1) gene in BPSD. Methods: Our large cohort of 395 patients with probable Alzheimer’s disease was dichotomised into whether they had ever suffered from a given symptom over the study period or not, based on longitudinal data using the BPSD (Neuropsychiatric Inventory). These measures were related to the DAT1 3′-untranslated region (UTR) variable number tandem repeat (VNTR) polymorphism. Results: Potential associations were revealed between the 9-repeat allele and presence of irritability and between the 10-repeat allele and aberrant motor behaviour (AMB); however, these do not remain significant after correction for multiple testing. No associations were observed with delusions, hallucinations, depression, agitation/aggression or elation. Conclusion: Our data suggest that the DAT1 3′-UTR VNTR could play a role in susceptibility to irritability and AMB. The findings presented here require replication in large well-characterised cohorts.

Background: Patients with Alzheimer’s disease and dementia commonly suffer from behavioural and psychological symptoms of dementia (BPSD). A genetic component to BPSD development in Alzheimer’s disease has been demonstrated. Several studies have investigated whether the exon 4 e2/e3/e4 haplotype of the apolipoprotein E ( APOE ) gene is associated with BPSD, with variable results. Objective: We investigated the exon 4 polymorphisms and extended this study to include promoter polymorphisms and the resultant haplotypes across the gene. Methods: Our large independent cohort of 388 patients with longitudinal measures of BPSD assessed by the Neuropsychiatric Inventory was used to analyse whether any of these variants were associated with the presence of BPSD. Results: We revealed several significant relationships before correction for multiple testing. The exon 4 haplotype was associated with hallucinations and anxiety, A-491T with irritability, T-427C with agitation/aggression and appetite disturbances, and T-219C with depression. Haplotype analyses of all variants did not reveal any statistically significant findings. Conclusions: Our data and a review of previous studies showed a diversity of relationships, suggesting that these findings might be due to chance and so collectively do not support a role for the APOE gene in BPSD.

Background/Aims: Alzheimer disease (AD) patients commonly suffer from behavioural and psychological symptoms of dementia (BPSD). A genetic component to BPSD development in AD has been demonstrated. This is an investigation of whether the linked polymorphic region and variable number tandem repeat variants of the serotonin transporter (SERT) are associated with BPSD. Methods: The longitudinal measures of BPSD of our large cohort of 367 AD patients were assessed by the Neuropsychiatric Inventory. Measures with good evidence of serotonergic involvement (delusions, hallucinations, depression, anxiety, agitation/aggression and irritability) were related to genotype and allele frequencies of the linked polymorphic region and variable number tandem repeat variants. Results: Analysis revealed significant relationships between the linked polymorphic region variant long allele with irritability and the variable number tandem repeat 10-repeat allele with psychosis, but no associations were found with depression, anxiety or agitation/aggression. Conclusion: Our data and review of previous studies suggest SERT could play a minor role in development of psychosis and aggressive/irritable tendencies; however, further investigations are required in large, well-characterized cohorts.

Genome scans in sporadic Alzheimer's disease (AD) have revealed a possible susceptibility locus on chromosome 12. The low density lipoprotein receptor related protein (LRP1) gene lies within this area of linkage. Eighteen previous AD case-control studies have investigated the C766T polymorphism in LRP1 with conflicting results, including a protective effect on AD of the T allele, an increased susceptibility towards AD with both the C and T alleles, or no association at all. We have now performed a case-control study based on a large UK cohort of 477 AD patients and 466 matched controls, and have included these data, with those drawn from the 18 previous studies, into in a meta-analysis of 4668 AD patients and 4473 controls. We find no evidence for influence on the risk for AD in either our own present cohort or in the combined data set. Furthermore, we investigated whether the C766T polymorphism might modify the clinical and pathological phenotype in our cohort. We found no association with AD when the cohort was stratified into those with early ( 65 years) onset, or when split into Apolipoprotein E (APOE) epsilon 4 bearers and 64 non-bearers. In addition, the C766T polymorphism was shown not to influence the age onset of AD. In a separate autopsy-confirmed cohort of 130 AD cases, no association with genotype or allele was observed for tissue levels of beta-amyloid 40, P-amyloid 42, total beta-amyloid, pathological tau proteins, microglial cells or extent of astrocytic activity. Therefore, in this present study, we find no evidence for the involvement of this polymorphism either in increasing the susceptibility to AD, or by acting as a phenotypic modifier. (c) 2005 Published by Elsevier Ireland Ltd.

There have, of course, been modifications to the Registrar-General’s SCS since 1921. The purpose of this chapter is to explore whether these modifications have affected the conceptual basis of the scheme.

Until fairly recently, the standard practice in official uses of the SCS has been to assign women a social class according to the occupation of the ‘head of the household’ in which the women live. For practical purposes, this has meant that the social class of married women has been assigned on the basis of their husband’s occupation. More recently, some attempt has been made to include tabulations based on the woman’s own occupation coded according to the SCS.

This set of three chapters assesses the value of the claim that HORG works empirically as an index to discriminate a whole range of socially valued outcomes. For an indicator of social classness can ‘work’ without helping us to understand what is happening. This may arise because — as with the SCS — the indicator is not derived coherently and systematically or because it fails to fulfil simple technical criteria. The purpose of this, the first chapter in the sequence, is to discuss the extent to which SCS meets the technical criteria for index construction and then to consider the possible options which were available to us for analysis.

Our demonstration that, in purely empirical terms, the woman’s own height is a consistent — although relatively weak — discriminator could be taken as a recommendation that the erstwhile investigator should sally forth with her tape measure. The implications of that possible advice are considered in more detail in the concluding chapter. Here, standing back from ourselves, we are concerned with the rather bizarre interest evidenced in the previous two chapters with characteristics of the women themselves.

The previous chapter showed how maternal height performed rather well in comparison to HORG at discriminating fertility and perinatal outcomes. Whilst that demonstration is interesting, the empirical argument for using and retaining the SCS as a classifier which discriminates is, of course, far more broad. Thus, the SCS has been used to discriminate not only fertility and infant mortality, but also a wide range of death and ill-health variables (see the excellent summary provided in the Black Report (publicly available earlier, Townsend and Davidson 1982); and the update by Whitehead (1987) for the Health Education Council), educational outcomes (Plowden, 1967) and habitual behaviours such as alcohol and tobacco consumption (Cox, Blaxter and Buckle et al., 1984). An illustration of the eclecticism of the measure is the compendium of social class differences edited by Reid and Wormald (1982).

The rationale for the analyses using height presented earlier was a methodological one. Height has most of the characteristics which are desirable in classificatory schema, and the intention was to show that the failure of the SCS to measure up to those requirements detracted from its empirical value. Of course, we were aware that height does discriminate a range of socio-biological variables and that, at least in perinatal epidemiology, it accounts for a large proportion of the variation generally attributed to social class (see Butler and Alberman, 1969). However, we were also aware that it had no pretensions to be a measure of social status; there was certainly no respectable prior theory of social structure that would suggest the use of anthropometric data (pace Galton, Pearson and the whole eugenicist gang).

The purpose of this chapter is to examine empirically the final justification of the HORG classification: that it works. This is, essentially, a methodological exercise assessing the usefulness of HORG in discriminating between valued outcomes for women. Because this is an empirical issue, we have to make this assessment in comparison to some other possible index and we have suggested using the woman’s own height as one which fulfils several of the technical criteria for a reliable and useful index (and certainly more so than HORG).

The main ‘theoretical’ justification1 for using husband’s social class as an index for their unfortunate spouses therefore rests on the empirical claim that marriages are on the whole homogamous by social class. The difficulty with testing that claim — suspending, for the purposes of this chapter, our doubts about what the SCS is actually an index of — is that some independent indicator of a woman’s social class is obviously essential to that argument: that is, even assuming that we know that the husband’s social class reflects his social position, we have to find a similar index for the woman in order to test the claim that marriages are class homogamous. Of course, if we had such an index, the question of class homogamy would not arise in this context!

The Registrar-General’s SCS provides by far the most common social classification used in Britain by sociologists, epidemiologists and official statisticians. The reporting of social class information is almost routine, while the use of the highly derivative Market Research Classification dominates commercial surveys.

Summary. The standardization of birthweight for gestational age, taking into accounhd sex of infant and maternal height and weight, is clinically useful and essential for some research purposes. In Britain, the most commonly used standards for singletons are those derived from Thomson et al. (1968) from a series of births to women in Aberdeen between 1948 and 1964. The present study starts with the observation that the present population of births in Aberdeen is different. This prompted work to ‘update’ the standards at least for research purposes, and in so doing a number of problems have been encountered which complicate the task of developing universally applicable standards.

A retrospective sample of 164 pregnancies in the years 1956 to 1975 of 78 insulin-dependent diabetic women was examined to assess the extent of the risk of clinically recognizable spontaneous abortion relative to the expected risk in a comparable population. This study was done before the implementation of the policy to establish good control of maternal diabetes before conception was attempted. After control of data for pregnancy number, maternal age, and epoch, the risk of spontaneous abortion among the diabetic women was almost double the estimate of the expected risk (p less than 0.001).

The basic form of experiencing process as such, then, lies in the apprehension of an object changing through an ordered sequence of states towards an end state. The sequence is grasped in the light of the final state of things which stands in close relation to the central noema of "changing object" in terms of which the phases of the sequence are recognized and related. The central noema is itself an emergent property of the identification of the sequence of states as "pertaining to the same something." This complex, not to say convoluted, constitution is iteratively established through polythetic acts in which change itself is grasped and sequence evidenced through the positing of possible sequences in the light of the intuition of succession. Eventually the whole sequence may be grasped monothetically and the process experienced as such as a whole. This prototype of process itself provides a basic form by which the events of intentional life may be ordered. The core experience, that objects do change in an ordered manner towards a defined and defining end may provide a way of meaningfully structuring experience. Thus for example, the succession Sii to Siii may be experienced as such. That succession may lead to a question like "towards what end does this succession tend?" More germane to the present argument, a particular state of things may lead to the question "by what process has this state of things come about?" In both these cases, the prototype of process leads to the attempt to interpret the succession or the state of things in terms of orderly change through time and in this way the intuition of process, in its own right, may provide a structure in which the phenomena of consciousness may be experienced and meaningfully related.

(1984). Type and Eidos—Schutz and Husserl. Journal of the British Society for Phenomenology: Vol. 15, No. 3, pp. 307-311.