Current status of programmes to measure and reduce radon exposure in Irish workplaces.

National legislation, which implements European Council Directive 96/29/EURATOM in Ireland, sets a reference level of 400 Bq m(-3) averaged over any 3 month period for radon exposure in the workplace and also empowers the Radiological Protection Institute of Ireland to direct employers to have radon measurements carried out. This legislation came into effect in May 2000. Radon measurements have already been completed in show caves and other underground workplaces. Between 1998 and 2001, over 33 800 individual radon measurements were carried out in all ground floor offices and classrooms in 3444 schools nationwide as part of a programme undertaken jointly with the Department of Education and Science. Where the average indoor radon concentration in one or more rooms exceeded 200 Bq m(-3), remedial measures were implemented. For concentrations up to 400 Bq m(-3) this involved increased ventilation while for higher concentrations an active sump was normally installed. The results of the survey, as well as the effectiveness of the different remedial strategies, are discussed. In the case of other above ground workplaces, different approaches have been adopted. As a first step, workplaces in two known high radon areas were directed to have radon measurements carried out. This programme had limited success because of problems in obtaining accurate workplace databases and a general lack of awareness on the part of employers of the issues involved. From a sample of 2610 employers directed to measure radon, only 408 actually completed measurements and 37 workplaces were identified as having average 3 month average radon concentrations above 400 Bq m(-3). A total of 1356 employers ignored all correspondence, some of which was sent by registered post and signed for on receipt. Current initiatives are focused on the provision of information and include newspaper advertising as well as publications aimed specifically at both employer and employee representative groups. The ability to provide accurate information that encourages both measurement and remediation is seen as central to an effective radon workplace programme.

The definition of alcoholism.

Formulations of alcohol dependence are continuously refreshed, in line with changing concepts and altered needs. Two new descriptions have been prepared: the revised WHO criteria for substance use disorders and an educative definition of alcoholism. The major sets of diagnostic criteria provided by WHO and by the American Psychiatric Association are moving closer together but have not solved all the semantic problems. More refined assessments are also available to quicken fulfillment of the long-awaited hope that treatments can be matched to patients.

Alcohol and depression.

Chronic alcohol misuse lowers mood and often leads to suicide or suicide attempts. yet drinking problems are often overlooked in patients presenting with depression, or the severity of mood change is unrecognized in a known alcohol misuser. Anxiety frequently accompanies problem drinking and accentuates depression. This article considers the implications for therapy.

Tissue thiamin levels of hospitalised alcoholics before and after oral or parenteral vitamins.

A new high performance liquid chromatographic method has been used to measure erythrocyte levels of the physiologically active form of thiamin, thiamin diphosphate (ETDP), in 25 alcoholics admitted to hospital for detoxification and rehabilitation. Measurements were made before, during and after multivitamin supplementation, either orally or parenterally, on a controlled basis. Before treatment, only one case of thiamin deficiency was detected. Within 24 hr of receiving 250 mg of thiamin both treated groups showed an increase in their mean ETDP levels, though only that of the parenterally treated group was significantly higher (P less than 0.05) than the pre-treatment mean. However, after 250 mg thiamin daily for 5 days, both treated groups showed a significant (P less than 0.05) and almost identical increase in their mean ETDP levels (90 nmol/l. and 91 nmol/l. for the oral and parenteral routes respectively). The results suggest that except for alcoholics requiring thiamin urgently, for whom the parenteral route is demonstrably quicker at raising tissue levels, oral supplementation achieves the same result as parenteral.

Long-term brain impairment in chronic alcoholics: N2-P3 cognitive potentials in a template-matching memory task.

Neuropsychological measurements and N2-P3 visual cognitive potentials evoked by a template-matching visual-memory task were collected from seemingly intact chronic alcoholics and normal controls. Psychometric results were not significantly different between alcoholics and controls, but the N2-P3 cognitive potentials of the alcoholic population showed a decreased amplitude and an atypical interhemispheric pattern of latencies that point to alcohol-related deficits. The different functional nature and possibly separate intracranial origin of N2 and P3 suggest respective cortical and hippocampal localisation of these deficits. Cognitive brain potentials were a more sensitive indicator of cerebral impairment than psychometric data.

Psychiatric advances in the understanding and treatment of alcohol dependence.

Several psychiatric topics have been under recent investigation. Cerebral impairment is now known to occur in over half of alcoholic patients. Its improvement with abstinence and its interference with the considerable intellectual and volitional requirements needed by controlled drinking programmes point to abstinence as the necessary drinking goal when brain damage is suspected. A hereditary element to alcohol dependence has been suggested by several adoption and twin studies, but the many contradictions between research results emphasise that any genetic contribution is overshadowed by socio-cultural factors. Depression and anxiety are frequent accompaniments of alcoholism but are shown by investigations usually as results rather than causes of excessive drinking. The onset of depression with suicidal ideas secondary to alcoholism has been sensitively described, and attention drawn to its identification, potential risk, and prevention. Long-term drug treatments are little used at present, but several developments are feasible. They include an effective long-acting chemical deterrent; drugs to protect against organic damage; sobering agents; immunotherapy; chemical reversal of the neuroadaptive changes responsible for physical dependence; drugs to counteract dysphoria and craving produced by alcohol; pharmacological modification of reflex behaviour; and drugs for the abstinence syndrome and for mood disturbance that are not themselves liable to misuse of dependence. Finally, it is suggested that the syndrome of pathological intoxication is a fictitious state that should be discarded from the descriptive literature.

Certificated incapacity and unemployment in alcoholics.

Seventy-three male alcoholics permitted information to be obtained from official sources about time recorded as lost from work in receipt of sickness or unemployment benefits and about their weekly state insurance contributions. The average yearly time loss was 121-7 working days per person, comprising an average yearly loss through sickness of 86-1 and through unemployment of 35-6 working days respectively. By contrast the recorded national sickness loss for men in a comparable twelve months period averaged 15-9 working days per person. Thirteen alcoholics showed over five years, prolonged deficiency in work attendance. State benefits to the subjects, over twelve months during the early 1970s, totalled pounds 18,434.80. Diagnoses on their medical certificates underestimated incapacity from alcoholism.