bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychiatric medication prescriptions increasing for college students above and beyond the COVID-19 pandemic
Authors: Marconi Agustina M. , Myers Ursula S. , Hanson Bjorn , Nolan Sarah , Sarrouf Elena Beatriz
Published: November 2023

Psychiatric medication prescriptions for college students have been rising since 2007, with approximately 17% of college students prescribed medication for a mental health issue. This increase mirrors overall increases in both mental health diagnoses and treatment of university students. As psychiatric medication prescriptions for college students were increasing prior to pandemic, the goal of this study was to compare these prescriptions over the years, while accounting for the added stressor of the COVID-19 pandemic. This study utilized cross-sectional, retrospective data from a cohort of college students receiving care from the university’s health service. We examined prescriptions for mental healthcare from 2015 to 2021. There was a significant increase in the percentage of psychiatric medication prescriptions in 2020 (baseline 15.8%; threshold 3.5%) and 2021 (baseline 41.3%; threshold 26.3%) compared to the historical baseline average for the whole sample and as well as for female students (2020 baseline 21.3% and threshold 4.6%; 2021 baseline 55.1% and threshold 33.7%). Within these years, we found higher trends for prescriptions in April–May as well as September–December. Overall, we found that psychiatric medication prescriptions have continued to rise through the years, with a large increase occurring during the pandemic. In addition, we found that these increases reflect the academic year, which is important for university health centers to consider when they are planning to staff clinics and plan the best way to treat college students with mental health difficulties in the future.
Utilization of images and three-dimensional custom-made nostril retainer fabricate for patients with cleft lip and cleft lip nose deformities at Siriraj Hospital: preliminary phase
Authors: Chaikangwan Irin , Yodrabum Nutcha , Kusakunniran Worapan , Tachavijijaru Rachata , Aojanepong Chongdee
Published: November 2023

A prospective study utilizing image analysis to assess nostril openings in post-operative patients with cleft lip and cleft lip nose deformities. This preliminary study seeks to employ two-dimensional (2D) images to fabricate a custom-made nostril retainer. This study was performed at Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand. This study included 30 healthy volunteers and 15 patients with cleft lip and cleft lip nose deformities. The nostril opening width and height for all participants were measured, and photographs were taken. An image analysis application was used to fabricate a three-dimensional (3D) custom-made nostril retainer. The mean differences between the direct measurements of the nostril aperture and the measurements obtained through the program did not exceed 2 mm in terms of nostril height, width, or columella. Two-dimensional photographs can be used to create a custom-made, three-dimensional nostril retainer. This retainer allows post-operative patients to maintain their nares without needing to visit the hospital, thereby reducing the cost of care.
Water quality, geochemistry and human health risk of groundwater in the Vyeboom region, Limpopo province, South Africa
Authors: Mutileni Ntwanano , Mudau Mulalo , Edokpayi Joshua Nosa
Published: November 2023

This study focuses on the evaluation of trace metals as well as microbial contamination of groundwater. Groundwater samples were collected from 17 boreholes. The microbial quality was tested using membrane filtration method. Higher levels of contamination for both E. coli and total coliform was recorded in the wet season. Majority of the boreholes had nitrate levels above the regulatory guideline value of the World health Organisation and the South African National Standards. The water type was established by Piper plot which showed the predominance of a magnesium bicarbonate water type, with alkaline earth metals dominating the alkali metals, as well as the weaker acids (bicarbonates) dominating the stronger ones (Sulphates and chlorides). Most of the trace metals detected were in compliance with the regulatory standard except for aluminium (0.41–0.88 mg/L). The hazard quotient and Hazard indice exceeded 1 mostly for children in both season which implies a possible non-carcinogenic health risk is associated with the continuous consumption of the water resource. The estimations of carcinogenic risk (CRing) for Cr and Pb exceeded the carcinogenic indices of 10−6 and 10−4 which could pose adverse effects on human health for both children and adults. Therefore, it is recommended that measures should be implemented to reduce the risk.
Glutamate secretion by embryonic stem cells as an autocrine signal to promote proliferation
Authors: Teng Lin , Qin Qin , Zhou Ziyi , Zhou Fei , Cao Chunyu , Yang Jian , Ding Jiawang
Published: November 2023

Glutamate, the major excitatory neurotransmitter in the central nervous system, has also been found to play a role in embryonic stem (ES) cells. However, the exact mechanism and function of glutamatergic signaling in ES cells remain poorly understood. In this study, we identified a glutamatergic transmission circuit in ES cells that operates through an autocrine mechanism and regulates cell proliferation. We performed biological analyses to identify the key components involved in glutamate biosynthesis, packaging for secretion, reaction, and reuptake in ES cells, including glutaminase, vesicular glutamate transporter, glutamate N-methyl-d-aspartate (NMDA) receptor, and cell membrane excitatory amino-acid transporter (EAAT). We directly quantified the released glutamate signal using microdialysis-high performance liquid chromatography-tandem mass spectrometry (MD–HPLC–MS–MS). Pharmacological inhibition of endogenous glutamate release and the resulting tonic activation of NMDA receptors significantly affected ES cell proliferation, suggesting that ES cells establish a glutamatergic autocrine niche via releasing and responding to the transmitter for their own regulation.
Acceleration of high-quality Raman imagingviaa locality enhanced transformer network
Authors: Weng Shizhuang , Zhu Rui , Wu Yehang , Wang Cong , Li Pan , Zheng Ling , Liang Dong , Duan Zhangling
Published: November 2023

Raman image super-resolution was performed by a locality enhanced and lightweight transformer network, accelerating high-quality Raman imaging.
Energetics of high temperature degradation of fentanyl into primary and secondary products
Authors: Poudel Bharat , Monteith Haley L. , Sammon Jason P. , Whiting Joshua J. , Moorman Matthew W. , Vanegas Juan M. , Rempe Susan B.
Published: November 2023

To aid the development of a sensor to detect illicit fentanyl, a synthetic opioid, we mapped the thermodynamic driving forces for bond breaking at potential thermal degradation points.
Fragmentation channels of non-fullerene cationic carbon clusters
Authors: Ferrari Piero , Hansen Klavs , Lacinbala Ozan , Janssens Ewald , Lievens Peter
Published: November 2023

The unimolecular fragmentation channels of highly excited cationic carbon clusters have been measured with a time-of-flight mass spectrometer after photofragmentation.
Synthesis of copper naphthalocyanine/graphene oxide composites as anode materials for lithium-ion batteries
Authors: Li Qiuya , Li Bin , Lv Dongjun , Wu Ping , Tang Qiwei , Zhang Tianyong , Jiang Shuang , Zhang Ning
Published: November 2023

Schematic illustration of the CuNc/GO composite synthesis procedures.
Advanced nano-bifunctional electrocatalysts in Li–air batteries for high coulombic efficiency
Authors: Zhao Jinyu , Pathak Rajesh , Zhao Zhenxin , Chen Xu , Saud Madan Bahadur , Li Hansheng , Wu Fan , Qiao Quinn , Elam Jeffrey W. , Wang Xiaomin
Published: November 2023

This article focuses on the major obstacle of sluggish ORR and OER kinetics of the cathode in LABs and reviews the main advances of the major designing principles of various nanoscale bifunctional electrocatalysts, and the relation to the enhancing OER/ORR catalytic activity.
Created from Animals
Authors: Rachels James
Published: November 2023

Since the Origin of Species was first published, Darwinism has been attacked for undermining traditional morality. In particular, because it emphasizes the kinship between humans and other animals, Darwinism seems incompatible with the traditional idea of human dignity - that human life has a special value, while other animals may be sacrificed for any purpose that humans choose. This book argues that Darwinism does undermine the traditional idea of human dignity; however, this is not a reason for rejecting Darwin's outlook. Instead, it is a reason for rejecting human dignity and replacing it with a better moral view, a more enlightened ethic regarding both the value of human life and our treatment of nonhuman animals. This important book, presenting Darwin's scientific and non-scientific views as one united theory, will stimulate all those interested in evolution, morality, religion, and animal rights to re-examine their views.
Darwin’s Discovery
Authors: Rachels James
Published: November 2023

CHARLES DARWIN and Karl Marx, the two great revolutionaries of nineteenth-century thought, were almost exact contemporaries. Their deaths in 1882 and 1883 were separated by only a few months. For more than three decades, while writing their most important works, they lived sixteen miles apart, Marx in London and Darwin at his home in the Kentish village of Downe. But they never met, which is not surprising, considering how different were their lives and personalities. Marx spent much of his life in abject poverty, unable at times to feed his family. Because of his political activities, he was chased from country to country. Above all Marx was preoccupied with the great public events of his time: with industrialization, with political revolution, and with the vast changes he saw taking place in society. Darwin, by contrast, was oblivi ous to such matters. Born into a life of privilege, he would have a tranquil existence, rooted in one place, surrounded by servants and a loving family: the very picture of a nineteenth-century English gentleman. His revolution would be of a different sort.
Must a Darwinian be Sceptical about Religion?
Authors: Rachels James
Published: November 2023

BISHOP WILBERFORCE believed that The Origin of Species was ‘absolutely incompatible’ not only with the history of origins given in the Bible, but with Christianity’s ‘whole representation of the moral and spiritual condition of man’. Like Wilberforce, many religious conservatives continue to condemn evolutionary ideas because they see them as contradicting revealed truth. In 1987 the largest Protestant denomination in the United States, the Southern Baptist Convention, became the latest in a long line of religious bodies to denounce Darwinism, when it officially adopted the view that Adam and Eve were real people and prohibited the teaching of anything else in its theological seminaries.
How Different are Humans from Other Animals?
Authors: Rachels James
Published: November 2023

IT has always been difficult for humans to think objectively about the nature of non-human animals. One problem, frequently remarked upon, is that we tend to anthropomorphize nature and see animals as too much like ourselves. An opposite but less frequently noticed difficulty is connected with the fact that, even as we try to think objectively about what animals are like, we are burdened with the need to justify our moral relations with them. We kill animals for food; we use them as experi mental subjects in laboratories; we exploit them as sources of raw materials such as leather and wool; we keep them as work animals-the list goes on and on. These practices are to our advantage, and we intend to continue them. Thus, when we think about what the animals are like, we are motivated to conceive of them in ways that are compatible with treating them in these ways. If animals are conceived as intelligent, sensitive beings, these ways of treating them might seem monstrous. So humans have reason to resist thinking of them as intelligent or sensitive.
Maturity, 1860-1920
Authors: Hunt Peter
Published: November 2023

Conventionally, the period between the publication of Kings¬ ley’s The Water Babies (1862), Carroll’s Alice’s Adventures in Wonderland (1864), and the First World War has been regarded, as we have seen, as the first golden age of children’s books.
Setting global priorities for strategies to control diarrhoeal disease: the contribution of cost-effectiveness analysis
Authors: Phillips Margaret
Published: November 2023

Agencies involved in health-programme policy, planning, and implementation continually face the problem of choosing between alternative approaches to improve the health of their populations. In the context of increasingly severe financial constraints, ‘value for money’ is recognized as an important criterion for choice, and countries are now paying more attention to the cost-effectiveness of their health programmes. However, it is difficult, time-consuming, and costly to evaluate all alternative investments each time a decision on programme development has to be made. There are clearly advantages in being able to identify health strategies which can be widely recommended even if their detailed implementation needs to be adapted to local circumstances. Such was the thinking behind, for example, the advocacy of selective primary health care (Walsh and Warren 1979), and UNICEF’s promotion of GOBI-FFF − growth monitoring, oral rehydration therapy, breast-feeding, immunization, family planning, female education, and food supplementation.
Methods of exposure measurement
Authors: Armstrong Bruce k. , White Emily , Saracci Rodolfo
Published: November 2023

Methods used for the measurement of exposure in epidemiology range from objective methods of measurement of fixed human attributes (e.g. blood type) that are as precise and valid as any in biomedical science, to methods that depend totally on the imperfect capacity of human beings to recall information. Epidemiological practice is weighted heavily towards the second of these two extremes. Frequently, past exposure is important and there are usually no records that can provide the data required. Much of modern epidemiology deals with lifestyle. The subjects, recollections of their behaviour, or those of other people close to them, may be the only comprehensive evidence we have about exposure. Recent methodological work has emphasized the development of objective methods of exposure measurement (e.g. ‘molecular epidemiology’; Perera and Weinstein 1982) and such methods are increasingly being used for validation purposes, if not for the measurement of exposure in all subjects (see Chapter 4)
Validity and reliability studies
Authors: Armstrong Bruce k. , White Emily , Saracci Rodolfo
Published: November 2023

The serious adverse effects of the use of invalid exposure measurements have been described in Chapter 3. Selecting or developing an accurate measurement instrument is obviously a critical step in designing an epidemiological study. First, the available literature on the validity and reliability of instruments which measure the exposure of interest should be reviewed. Then, if a new instrument is to be developed which differs substantially from other methods, its reliability or, preferably, its validity should be assessed.
The cross-sectional study
Authors: Olsen Jørn , Merletti Franco , Snashall David , Vuylsteek Karel
Published: November 2023

In a cross-sectional study the occurrence (prevalence) of the disease under study for the ‘exposed’ is compared with the same occurrence in the non-exposed. The exposure and disease status is examined for the same time period. We do not have data to establish exposure status before the onset of the disease. In a cross-sectional study the present work situation and present symptoms or diseases are recorded. Such a study can be carried out for all the workers in the factory, a particular section, or a sample of the workers. Data may be presented in a similar way as before (p. 27), but prevalence ratios (PR) are estimated and not relative risks, Table 4.
Byssinosis and chronic bronchitis in a flax-mill
Authors: Olsen Jørn , Merletti Franco , Snashall David , Vuylsteek Karel
Published: November 2023

In January 1965 a member of a trade union was delegated by his organization to ask for advice on an alleged health problem in two flax-weaving mills. As the plants had at that time no organized health service, the workers union took the initiative and made contact with the occupational health department of the nearby medical faculty. The two weaving mills processed dry spun flax producing heavy linen canvas for tent material; they had been in operation for about 15 years. Many, but not all, of the workmen in the plant complained of an irritating cough and wheezing which they said was caused by the flax dust. The plant owners, on the other hand, complained of a disturbingly high absence rate-especially on Mondays-and a huge turnover of staff. They produced a list of 194 persons who had left the plant in the last 15 years.
Clustering in time and space
Authors: Little Julian , Elwood Mark
Published: November 2023

As with any other relatively uncommon event, the occurrence of births of infants with neural tube defects close to each other in time or in geographical location, or both, will tend to attract attention and suggest that further investigations could determine a common cause of the cluster of events, although it is also obvious that such clusters will occur by chance alone. The recognition and investigation of clusters of congenital anomalies, and particularly the assessment of whether the occurrence of clustering or a particular cluster is purely a chance phenomenon, leads to considerable methodological and practical difficulties. Although all studies must have boundaries in both time and space, they can concentrate on clustering in time, in space, or with regard to both. Thus for a population of births defined by a geographic area and a total time period, studies can assess whether affected births tend to occur closer to each other in space than would be expected by chance alone (space clustering), or whether such births occur close together in time (time clustering), or whether such events occur close together in both time and space (time-space clustering).
Smoking and oestrogen-related sites. Data from American Cancer Society Studies
Authors: Garfinkel Lawrence , Boffetta Paolo
Published: November 2023

Data from two American Cancer Society prospective studies-Cancer Prevention Study I, 1959-72 (CPS I), and Cancer Prevention Study II, 1982-6 (CPS ]])-were used for an analysis of cigarette smoking and oestrogen-related sites of cancer. Smoking and cancer of the colonrectum and of the gall bladder and biliary passage were also evaluated. Smoking was negatively related to endometrial cancer in both CPS I and CPS II, and increased the risk of cervical cancer in CPS I (RR 1.41, 95 per cent CJ 1.20-1.65) and in CPS II (RR 2.27, 95 per cent CJ 1.27-3.74). Breast cancer and ovarian cancer were not related to smoking. Colon-rectum cancer was negatively related in CPS I (RR 0.89, 95 per cent CJ 0.82-0.98) but positively related in CPS II (RR 1.16, 95 per cent CJ 0.99-1.37). Cancer of the biliary passages was related to smoking in CPS I (RR 1.81, 95 per cent CJ 1.19-2.63) but too few deaths in smokers occurred in CPS II to see if there was any relationship. Adjusting for known risk factors did not substantively change the relative risk ratios.
Smoking and inflammatory bowel disease
Authors: Logan Richard F A
Published: November 2023

Despite considerable research, the aetiology of inflammatory bowel disease (IBD) remains disappointingly obscure. For both diseases, the most widely accepted hypothesis broadly involves an infective agent(s) which triggers an abnormal immune response (Kirsner and Shorter 1982). Until recently the only environmental factor that had been demonstrated with any consistency was increased refined sugar consumption by patients with Crohn’s disease (Persson et al. 1987).
Smoking and endogenous sex hormones in men and women
Authors: Barrett-Connor Elizabeth
Published: November 2023

Studies of endogenous hormone levels have confirmed that cigarette smoking can have important hormonal effects. Circulating levels of the adrenal hormones androstenedione and dehydroepiandrosterone sulphate have repeatedly been found to be elevated in smokers. Oestradiol and oestrone levels do not appear to be related to smoking in women, but may be increased in men who smoke. The data regarding testosterone are variable. The net effect of these changes may be that smoking has an androgenic influence in women and an oestrogenic influence in men.
Supplying the system—analysis of manpower, physical resources, and socio-economic development
Authors: Ellencweig Avi Yacar
Published: November 2023

The modular approach is illustrated by the macro-model of health systems as shown in Chapter 2. Those modules of a health system that enable it to operate and that fuel its activities are its inputs. In this chapter we shall examine the content and significance of these input modules which include both resources and the socio-economic environment as discussed at the end of Chapter 2.
New horizons for systems outcomes: effectiveness, efficiency, equity, and quality
Authors: Ellencweig Avi Yacar
Published: November 2023

In Chapter 7 we delineated the concept and measurement of outcomes related to the health status of the population. We primarily discussed implications for better health, selecting only those variables measurable in the context of a population. In fact, all the health status measures described in Chapter 7 could be examined in the absence of a health care system. However, since health care systems are designed to provide their own effects on health status, it is appropriate to study the health systems outcomes, that is, how health care systems were successful in mobilizing their resources and in optimizing their processes for better health. Here we suggest four concepts for the measurement of the outcomes of a health care system: effectiveness, efficiency, equity, and quality. We shall explore possible definitions for these four concepts and consider their relevance to our discussion. After we elaborate on each concept, we suggest appropriate indicators for it.
Limitations of cross-national and cross-regional comparisons of health systems
Authors: Ellencweig Avi Yacar
Published: November 2023

Until now, we have focused on presenting the various modules that make up a health system. After examining the conceptual basis for each module, we identified indicators for measuring the phenomena in each module and also examined how these phenomena change over time. Deliberately, we avoided the crucial question: did we choose and use indicators appropriately? This chapter is aimed at answering this question, and we shall do that in a two-stage process. First we shall examine it methodologically. We shall consider methodological problems and how they affect the use of the modular approach in cross-national comparisons. Then, by suggesting possible remedies, we shall attempt to solve these methodological problems.
Integration of modules into a comprehensive model—a three-country example
Authors: Ellencweig Avi Yacar
Published: November 2023

In Chapter 10 we applied our model to multi-country comparisons using a small number of modules. Alternatively, we can compare a few countries on a broad basis using a larger number of modules. In Chapter 11, we shall explore the potential for the comparability over a broad range among three different representative health systems. We have chosen the Canadian health system as an example of a fully developed national health system. The Israeli health system is an example of a developed national health system which in some areas faces the problems of developing nations. The Nigerian health system is an example of the health system of a developing nation.
Health, Prevention and Economics
Authors: Cohen David R , Henderson John B
Published: November 2023

Prevention is better than cure, it is said, but is it more efficient? In the quest for improvements in health and life expectancy, and reductions in the growth of health care costs, attention has focused on the cost-effectiveness of preventive over curative medicine. Economics adds an essential dimension to the analysis of prevention policy that extends far beyond the study of comparative costs. The aim of this book is to give, for the first time, a comprehensive overview of the economics of prevention. It examines the scope of economics; the impact of the economy on avoidable ill-health, and of prevention on the economy; the economic rationale for provision of preventive services and regulation of hazardous activities; the cost-benefit approach and the nature of efficiency in prevention; the practice of economic appraisal; economic influences on the demand for hazardous commodities and screening services; theories of preventive behaviour; national prevention programme budgeting and priority setting; and the potential contribution of health economics.
Health, prevention and economics
Authors: Cohen David R , Henderson John B
Published: November 2023

Prevention is currently fashionable, and in some ways this is unfortunate. Being fashionable is not conducive to rational debate: it disposes people to take up extreme positions. Some argue that prevention is always better than cure, that it alone in the realm of health care is deserving of greater priority, or even that curative care could be dispensed with if only greater efforts were devoted to prevention. Others argue that prevention is ineffective, that trying to change behaviour is futile and elitist, or that the sacrifices involved are too great. This book tries to stand back from heated arguments and unreasoned positions. Its aim is to help to inform the more tempered and rational debate that is replacing them.
Towards a prevention strategy
Authors: Cohen David R , Henderson John B
Published: November 2023

For over a decade there have been explicit policy statements calling for a shift of emphasis away from treatment and cure and toward prevention as part of a new health strategy. Both the UK and the US governments, for example, have espoused an overall, comprehensive prevention policy as the way forward in trying to reduce morbidity and mortality (Department of Health and Social Security 1977; Department of Health, Education, and Welfare 1980). With so much having been said, it is reasonable to ask why more hasn’t been done.
Equity in the finance of health care: methods and findings
Authors: Doorslaer Eddy Van , Wagstaff Adam
Published: November 2023

For reasons indicated in the previous chapter, the analysis of equity in the finance of health care starts from the premise that payments for health care ‘ought to be positively related to ability to pay, rather than to the receipt of care. This chapter summarizes the evidence on the progressivity of health care finance in 10 OECD countries. Evidence is presented on the progressivity of each country’s financing system overall, as well as on the progressivity of each of its constituent parts. The chapter begins with a brief overview of the principal differences between the health care financing systems of the countries concerned. It then outlines the methods used to measure progressivity, as well as the data, variable definitions and incidence assumptions used in the empirical analysis. The chapter then goes on to discuss the principal findings of this part of the project. The final section contains a summary and discussion.
United States
Authors: Gottschalk Peter , Wolfe Barbara
Published: November 2023

This chapter aims to identify the distributional burdens of paying for health care in the US and the distribution of the beneficiaries of that system. Our focus on who pays and who benefits is motivated by two issues that have dominated discussions in the US in recent years: (1) the lack of universal insurance cover; and (2) the rapid increase in medical care costs that have led to medical expenditures accounting for more than 12 per cent of GNP. The thrust of much of this discussion is that high costs may have led to limited access for those who are not covered by public or private insurance. If it is the (non-elderly) lower-middle class that are caught between having incomes too high for public insurance but too low to afford private insurance then their access is limited by income. Added to this are those with low income not insured by public coverage, who are also likely to be caught. Furthermore, if public insurance is largely financed by the middle class, then they are the ones paying for the services they are the least likely to utilize.
Equity in Health Care: the Role of Ideology
Authors: Williams Alan
Published: November 2023

According to my dictionary an ideology is ‘a body of ideas, usually political and/or economic, forming the basis of a national or sectarian policy’. It usually also has a visionary characteristic, i.e., it is about the nature of a ‘good’ society, and it defines something to strive for, even though we do not expect ever to see it fully attained.
Factors influencing wound healing
Authors: Mulder G D , Brazinsky B A , Harding K G , Agren M S
Published: November 2023

Traditionally, the elderly are classified as those individuals 65 years of age and older. This section addresses the effect of age-associated skin changes, peripheral vascular disease, diabetes, musculoskeletal diseases, infection, drugs, and nutrition on the wound healing process.
Clinical aspects of healing specialized tissue
Authors: Robson M C , Sampson J A G , Vickery C J , Leaper D J , Irvin T T , Wainwright A M , Smith E J , Whiston R J , Lane, I F , Feneley R C L
Published: November 2023

The skin of man is a large organ comprising a sheet-like investment of the whole body which adapts admirably to its contours and neatly conforms to its movements (1). However, it is more than just the physical exterior of the body being an interface with the environment. It serves as an organ of pro tection, controls the invasion of microorganisms, rations fluid gain or loss, regulates temperature, protects against injury from radiation and electricity, as well as providing immuno logic surveillance (2). At the same time, the skin contains a vasculature and sweating system uniquely adapted to the thermoregulatory demands of the organism, and an extensive neuroreceptor network, which serves as a finely tuned array of complex transducers of environmental information. Each of these functions is specifically related to a cell or areas within the skin.
Health, Primary Health Care, and the management challenge
Authors: Collins Charles
Published: November 2023

In Chapter 1 the need to understand the policy context of management and organizations was stressed. In the absence of universal recipes of good management, we have to understand how different systems of management and organizations are required in different contexts. The policy pursued by an organization is an important factor to be taken into account when developing management and organizations. This book is primarily interested in developing health management and organizations within the context of a Primary Health Care (PHC) policy.
lntersectoral coordination
Authors: Collins Charles
Published: November 2023

The multisectoral approach to health clearly states that, in addition to health services, health status is determined by a range of economic, social, and environmental factors. We might mention education, housing, food production and nutrition, water, sanitation, and income levels. Therefore, when we seek to manage and determine health, we should be concerned with more than the management of health services. Attention should be paid to, for example, the management of water and sanitation services, education, and housing. The health of a population is much more than the concerns of the MoH. It requires the participation of sectors that have health implications and are involved in the broader development tasks. In this chapter we shall look at the links between the management of health services and the management of health related sectors. Our concern is with intersectoral cooperation and coordination for health-the constraints and means for its potential development in management terms.
Considering abortion
Authors: Furedi Ann
Published: November 2023

No woman wants to have an abortion any more than she wants to have any other kind of operation. But just as a tonsillectomy may be considered the best solution for a woman with badly infected tonsils, so for some women an abortion may seem to be the best solution to an unplanned pregnancy. For some women the decision to end an unplanned pregnancy flies in the face of deeply held beliefs and principles, yet they may still feel it to be the only acceptable solution to their personal situation. Few women decide to have an abortion lightly. Even those women who find the very idea of motherhood appalling tend to think again when they discover they are pregnant. After all, most of us grow up believing we are destined to be mothers eventually, and many women take a certain pride in knowing that they are capable of motherhood—even if they do not wish to exercise their capacity for it now.
Considering motherhood
Authors: Furedi Ann
Published: November 2023

An unplanned pregnancy is not necessarily an unwanted pregnancy, and even those that are initially undesired may become wanted as they progress. It is not possible to generalize about why some women decide to keep their children and others do not. Women’s decisions about pregnancy reflect the broader circumstances of their lives. The fact that, according to a recent report on unplanned pregnancy1, marriage is an important factor in determining whether a woman with an unplanned pregnancy continues it or has an abortion, may reflect the fact that for many couples marriage implies a permanent commitment and consequently a suitable environment into which to bring a child. Often couples marry with the intention of ‘starting a family soon’. An accidental pregnancy in this situation may simply mean bringing such a decision forward.
The objectives of preventive medicine
Authors: Rose Geoffrey
Published: November 2023

Few diseases are the inescapable lot of humanity, for a problem that is common in one place will usually prove to be rare somewhere else. Cervical cancer is twenty times comminer in Colombia than in Israel, 10 per cent of Indian children die before their first birthday whereas in Western countries 99 per cent of babes survive, and according to UK census figures 3.1 per cent of adults in Wales report that they are permanently sick, compared with only 1.2 per cent of residents in southeast England. There is no known biological reason why every population should not be as healthy as the best.
Psychiatric and psychological approaches to the treatment of chronic pain: concepts and individual treatments
Authors: Benjamin Sidney , Main Chris J
Published: November 2023

In the first of two chapters, Dr Benjamin and Dr Main offer observations concerning the treatment of patients with chronic pain, which are relevant to the treatment of the other syndromes described in this book.

Patients with chronic pain (especially those attending pain clinics) may be regarded as having both physical and psychiatric disorder and successful treatment depends on understanding and treating both. Psychological treatment requires the identification of any specific and treatable mental disorder together with behavioural assessment of the ways in which pain and associated disability may be modified. The latter includes a full assessment of the role of care givers.
Dysmorphophobia in plastic surgery and its treatment
Authors: Goodacre Tim E E , Mayou Richard
Published: November 2023

Dr Goodacre and Dr Mayou suggest that the aetiology of dysmorphophobia and the general approach to management has much in common with other functional somatic symptoms. Since Goodacre is a plastic surgeon, their chapter is largely written from a surgical perspective. However, the general principles of management also apply to dysmorphophobia in other settings.

The authors begin by reviewing the psychology of normal appearance and the role of aesthetic surgery in general. It is apparent that many patients, whose appearance is not regarded as abnormal by others, obtain great psychological benefit from surgery. In contrast, a small proportion of patients have a very poor outcome and it is this subgroup who attracted the interest of psychiatrists.
The treatment of somatic symptoms in the elderly
Authors: Pearce Jane , Morris Charles
Published: November 2023

The diagnosis and management of somatic symptoms in the elderly has attracted little attention. However, Drs Pearce and Morris show that there is considerable evidence that such symptoms are at least as common as in younger people and are often associated with considerable disability and use of medical resources.

The high prevalence of physical disease in the elderly makes assessment difficult and means that an interaction of behavioural, physical and psychological factors is extremely common. Presentation and course are also substantially affected by social circumstances and by the reaction of families, friends, and other carers. Adequate assessment and treatment depend upon the giving of full weight both to physical and psychological factors as well as to social influences.
Reactive arthritis and Reiter’s syndrome-the clinical spectrum
Authors: Calin Andrei
Published: November 2023

Reactive arthropathy and Reiter’s syndrome are two terms that are used more or less interchangeably. The latter defines a triad or more of features, while the former relates to the inflammatory joint process and relationship to infection. In theory, reactive arthropathy may be defined as an inflammatory arthropathy distant in time and place from the original inciting infection, which is usually in the bowel or genitourinary tract. More recently, we have come to suspect that respiratory organisms can also precipitate disease and, of more importance, we accept that the synovial joint is not free of bacterial insult. As discussed elsewhere, there is growing evidence that fragments of organisms and antigenic determinants are found within the joint cavity or synovial tissues. The importance of this phenomenon and the relationship to potential antibiotic therapy remains unclear but of paramount interest and importance.
HLA-B27, ankylosing spondylitis, and the spondyloarthropathies
Authors: Wordsworth Paul , Brown Matthew
Published: November 2023

Ankylosing spondylitis is one of a group of conditions thought to have an autoimmune pathogenesis, which also includes several other rheumatic disorders, such as rheumatoid arthritis and juvenile chronic arthritis. They are characterized by disordered immunological responses, causing tissue-specific inflammation and damage, and by their striking immunogenetic associations (Wordsworth 1995). In 1973 the description of a very strong association between HLAB27, one of the immune response genes, and ankylosing spondylitis (Brewerton et al. 1973a; Schlosstein et al. 1973) prompted enormous interest in the immunogenetics of this condition. The odds ratio for HLA-B27 in ankylosing spondylitis is in excess of 100, and is fairly constant across ethnic groups.
Disease and outcome indices/instruments for the spondylarthropathies
Authors: Kennedy L Gail
Published: November 2023

Every disease requires some method of assessment. This may be to evaluate aspects such as disease status, progression, or response to treatment. Irrespective of the reason for performing the analysis, the method used has to comply with certain standards.
The Practice Skills Seminars
Authors: Hope R A , Fulford, K W M , Yates Anne
Published: November 2023

Introduction This chapter describes the 11 seminars which make up the core of the Practice Skills course. An overview of the tutorials in General Communication Skills is given in Chapter 4. The seminar topics are listed on the next page. For each seminar we provide: setting out: the nature of the seminar its position in the clinical course number of students These describe how the seminar is set up and run, including teaching aids, methods and materials, and a detailed seminar plan. Case vignettes, summaries of the law, etc, as used in the seminar or to take away. The information given on each seminar is intended to be sufficiently comprehensive to allow readers to prepare and deliver their own seminars, picking and choosing from our materials as desired.
Tutorials in General Communication Skills
Authors: Hope R A , Fulford, K W M , Yates Anne
Published: November 2023

This part of the programme was devised by Theo Schofield, William Rosenberg and Tony Hope The Practice Skills Project main teaching consists of two sets of seminars: 1) the Practice Skills Seminars desribed in detail in Chapter 3 of this Manual and, 2) ten small group tutorials which focus on basic communication skills. These two teaching programmes complement each other. Issues of communication are part of the core seminars, and ethical and legal issues arise in the course of the communication skills tutorials. But the focus of the two programmes and the balance of teaching methods are different. In this chapter we outline briefly the content of the communication skills tutorials and the approach to the teaching. Further details are to be found in: Schofield T., Hope T., and Rosenberg W. (1996). Communication in Clinical Practice. Oxford University Press, (in preparation).
Macrocephaly
Authors: Baraitser Michael
Published: November 2023

It is important to know whether the large head has been present from birth, whether it is growing parallel to the centile, or is crossing the centile. Hydrocephalus should be excluded in the latter situation. If the patient has hydrocephalus, then the sex of the child is important. If female, and there is no obvious cause, then recurrence risks are small (2%). If the affected child is male then one should ascertain whether the hydrocephalus is secondary to aqueduct stenosis or not. If it is, the recurrence risks are 12% to male sibs. If not, the risks are small (2-3%).
Paroxysmal disorders
Authors: Baraitser Michael
Published: November 2023

Abstract: This is also called the syndrome of Mount and Reback, who first described the condition in 1940. Attacks can be provoked by alcohol or stress and therefore differ from the kinesigenic group (see below) in which the athetosis or dystonia is provoked by movement. The onset is mostly in childhood and the paroxysms can be severe enough to throw the child to the ground. Attacks can last many hours but short duration attacks have been reported (Demirkiran and Jankovic, 1995). There are some families in which coffee and fatigue have been triggers. The attacks are not influenced by anti-epileptic medication.
Cerebral tumours
Authors: Baraitser Michael
Published: November 2023

Abstract: Most cerebral gliomas are spontaneous events and familial aggregation is rare. When this does occur it is usually confined to twins, or first degree relatives, and threegenerational glioma families are very uncommon. Central neurofibromatosis should always be excluded. There are, in addition, the so-called ‘cancer families’ stretching over many generations in which cerebral gliomas might be a part of the general predisposition to develop a cancer.
Sleep and speech disorders
Authors: Baraitser Michael
Published: November 2023

Abstract: The narcoleptic syndrome consists of a combination of narcolepsy (a sudden irresistible urge to sleep), cataplexy (an akinetic state provoked by excitement), sleep paralysis (on waking), and hypnagogic hallucinations. The clinical diagnosis may be supported by the finding of REM-onset sleep (within the first 30 minutes). The diagnosis is usually straight-forward on clinical grounds, but whereas sleep paralysis is non-specific, it is difficult to sustain a diagnosis without cataplexy (Parkes et al., 1995). ‘Jelly attacks’ with laughter, or in the anticipation of laughter, is how it is often described, and the muscles around the face might jerk.
The spinal muscular atrophies
Authors: Baraitser Michael
Published: November 2023

The spinal muscular atrophies should be divided into types 1, 2, 3 and 4; but this classification is mostly of prognostic significance as 95% of types 1, 2, and 3 have detectable deletions of the same gene.
Animal Models of Schizophrenia
Authors: Lipska Barbara K , Weinberger Daniel R
Published: November 2023

Animal models are commonly used in medical research as convenient and often the only available tools for studying pathophysiological mechanisms of disease and, most importantly, for designing new treatment and prevention strategies.
Legal aspects of wound care
Authors: Wardrope Jim , Edhouse June A
Published: November 2023

Working in the A&E department is almost certainly going to bring the junior doctor into contact with the police and legal system, often for the first time. The police or solicitors may require patient details, either for criminal prosecutions in assault cases or civil actions in injury cases.
Anaesthesia
Authors: Wardrope Jim , Edhouse June A
Published: November 2023

Adequate wound examination and management is very difficult unless good analgesia and anaesthesia are achieved. The choice of anaesthetic will depend on many variables. An ‘easy’ eyelid wound in a strong, unreasoning three-yearold may be impossible to suture without general anaesthesia, while a large thigh wound may be very adequately treated using local techniques. If you foresee problems in obtaining adequate operating conditions using simple techniques, seek advice.
Hand wounds
Authors: Wardrope Jim , Edhouse June A
Published: November 2023

Anatomy Know it like the back (and front) of your hand. History How? When? Where? Dominant hand? Occupation? Hobbies? Glass and knives cut nerves and tendons.
Neck and trunk wounds
Authors: Wardrope Jim , Edhouse June A
Published: November 2023

Neck wounds Get senior help and secure the airway. Control bleeding by direct pressure. Do not explore these wounds in the A&E department. Chest wounds Treat shock aggressively and get immediate surgical help. Tension pneumothorax: treat on clinical suspicion. Cover sucking chest wounds.
The state of the art: clinical implications for cancer patients and directions for future research
Authors: Cunningham A J
Published: November 2023

This final chapter was requested as a general overview of the field, with some reference to the other papers, and some speculation on profitable directions for research, the emphasis being on clinical implications. It will thus consider broad trends rather than details. Inevitably it will be an expression of personal views, so the author’s background and biases need to be acknowledged. I began doctoral training for a research career in immunology in 1964, at which time it was widely believed that control of cancer would soon be achieved through our rapidly growing knowledge of the immune system. By the early 1980s, this goal seemed as far out of reach as ever, and for this and other reasons I moved to research in health psychology, which seemed to me to have more promise for helping people with cancer. In 2001, despite many advances in knowledge of immunological mechanisms, significant deliberate control of most human cancers through this avenue is still not possible.