Between 1976 and 1986, 258 incidents of suspected scombrotoxic fish poisoning were reported in Britain. Histamine analysis was carried out on 240 fish samples from these incidents, and 101 were found to contain > 5 mg histamine/100 g fish. The symptoms most consistently reported were rash, diarrhoea, flushing and headache. In recent years there has been a decrease in the number of confirmed scombrotoxic outbreaks and a trend towards more sporadic incidents. Of fish samples with > 20 mg histamine/100 g, 94% were from incidents in which scombrotoxic symptoms were characteristic, but where fish had 5–20 mg/100g only 38% of incidents were clinically distinctive. Guidelines are presented based on the interpretation of quantitative histamine analysis of fish samples from scombrotoxic poisoning incidents.

Background: Dementia and visual impairment are among the most common medical conditions in later life. Almost nothing is known about the experiences and needs of older adults with both conditions.

Method: In this qualitative study using in-depth individual interviews, multiple perspectives were sought through a case-study approach. Fifty-two interviews were conducted: 17 with older adults with visual impairment and dementia, 17 with family caregivers, and 18 with care professionals.

Results: Impaired memory and a lack of visual cues created profound disorientation and distress, which could be manifested in disruptive behavior. Visual hallucinations compounded older adults' disorientation, and caregivers were uncertain about how to manage them. Visual impairments reduced the ability of older adults to perform certain activities safely, while dementia impaired their ability to assess the risks accurately. Concerns about safety prompted family members to limit their relatives' activities even in early stages of dementia. Low-vision services perceived themselves to be ill equipped to manage dementia-related needs, while visual needs were accorded a low priority by dementia services. A lack of joint working by the two services led to an overcautious approach.

Conclusions: The research identified considerable unmet needs and opportunities to improve care. The provision of clear verbal communication and optimized visual inputs is likely to reduce disorientation, distress and agitated behavior, while one-to-one contact is needed to overcome feelings of isolation. Family caregivers require additional respite services and advice on managing hallucinations. Increased sharing of information and skills between mental health and low-vision professionals would help maximize older adults' independence.

The authors regret that they omitted to include an acknowledgment of financial support in the original publication. The acknowledgment should have read:

This work was funded by a grant from the Thomas Pocklington Trust.

Background. Research suggests high levels of depression and low levels of service use among older adults from UK minority ethnic groups. This study aimed to explore older adults' attitudes and beliefs regarding what would help someone with depression, and to consider how these may facilitate or deter older people from accessing treatment.

Method. In-depth individual qualitative interviews were conducted with older adults with depression (treated and untreated) and the non-depressed older population. A multi-cultural approach was used that incorporated the perspectives of 32 black Caribbean, 33 South Asian and 45 white British older adults.

Results. Participants felt that the responsibility for combating depression was an internal and individual task with support considered secondary. However, the majority expressed a willingness and desire to discuss psychosocial problems. Within the black Caribbean group, conversing with God through prayer was seen as an effective means of overcoming depression, while a large proportion of South Asian and white British participants identified families as an important source of help. There was wide variation in how older adults construed the role of the general practitioner (GP) and many expressed acute awareness of the demands on GPs' time.

Conclusions. Efforts to socialize and remain active may provide a useful and acceptable adjunct to clinical interventions. However, there is a need to communicate that depression often necessitates formal help, and that it is acceptable to voice concerns regarding emotional states in a GP consultation. The findings suggest that older adults would welcome the opportunity to discuss their feelings with health-care professionals.

The services used by people with dementia and their carers were measured at three time points over 17 months. This analysis is unusual in that both informal care and formal inputs were costed. The costs estimates for informal inputs developed here may be applied to other data sets. Two hypotheses to explain the inter-relationship between informal and formal care inputs, substitution and supplementation, were compared in analysing the data. This paper explores the variations in costs according to the living arrangements of the people with dementia, by level of dependency and over time, and finds systematic differences. The costs of the inputs from co-resident carers consistently exceeded the costs of formal services, with informal care constituting up to 40 per cent of the total costs burden for dementia care. When informal inputs were included, non-domestic residential care emerged as less, not more, costly than care in the community. There was a shift in costs burden from health services to social services over time as more people moved into non-domestic settings. Multivariate analyses identified several predictors of informal and formal care costs: physical disability, level of cognitive impairment, living in non-domestic settings, and formal care provided. Non-domestic care predicted lower inputs of both formal and informal services. Dementia level was positively associated with informal inputs. Physical frailty was associated with more formal care, but less informal care. More formal service inputs predicted higher informal care inputs. There is evidence of supplementation of informal care by formal services in the early stages of care, followed by substitution as the person with dementia enters residential care.

An understanding of ways in which older carers' perceptions of their marital relationship and duty to their spouse underlie adjustment to care-giving is required for the development of acceptable and efficacious services for spouse carers. With this aim we conducted qualitative interviews with 20 spouses of older people with a mental illness identified in a representative community study. While carers acknowledged distressing changes in their spouse, a history of reciprocity and intimacy emerged, comprising positive themes and perceived continuity which favourably influenced adjustment to care-giving. Those who still experience closeness in the relationship see themselves as coping and are reluctant to accept formal help. Others describe long-term unhappiness in marriage and experience feelings of entrapment in the role of carer. They require early and comprehensive services. Hypotheses regarding these themes are proposed.

The individual's response to the occurrence of symptoms is conditioned by a variety of non-medical factors, of both an enduring (e.g. personality attributes) and a changing nature (e.g. social support). The health diary provides a particularly appropriate method of studying the daily variations in health and illness behaviour which make up so much of the clinical content of general practice.

After the journalists of a national newspaper had been issued with redundancy notices, a prospective study was carried Out to examine the effect of the threat of their redundancy on minor psychiatric morbidity. Following the subsequent withdrawal of redundancy notices, there was considerable reduction in minor symptomatology, and the implications of this are discussed.

The clinician has no objective criteria of good health; he is likely to identify its presence only in the absence of disease and dysfunction. Yet the layman is able to give a global assessment of his own health as good, average or poor. The present paper explores the correlates of self-assessment of health in a large community sample and, by the use of two linear models, describes the effects of age, sex, reported symptoms, and long-standing illness on self-rated health status. It is suggested that global ratings are influenced by age and sex and by the experience of both physical and psychological symptoms, and that there are no interactive effects between symptoms and the demographic variables.

Perceived efficacy and reliance on psychotropic drugs is explored in a sample of mainly long-term consumers. A comparison of past and present users elucidates some of the factors involved in prolonged usage and the experiences of those who withdraw from the medication.