bluuebunny/crossref_metadata_2025 huggingface dataset:
Results of Symptom Validity Testing in Portuguese Prison Inmates: The Influence of Educational Level, Age, and Conviction Status
Authors: Silva Emanuel , Merten Thomas , Venâncio Ana Cláudia , Pinheiro Débora , Alberto Isabel M. , Simões Mário R.
Published: November 2023

Current guidelines for psychological assessment recommend the use of multiple validity measures in an evaluation protocol, particularly in forensic settings. As such, self-report instruments which detect distorted symptom reporting have become essential. We studied a pooled sample of 240 male inmates with the Self-Report Symptom Inventory (SRSI), the Structured Inventory of Malingered Symptomatology (SIMS), and the Symptom Validity Scale–Version 2 (EVS-2). Concurrent validity was analyzed via correlations between all three symptom validity tests (SVTs), revealing strong associations (rho ranging from .72 to .79), and ROC analyses yielded areas under the curve (AUC) values over .9 for every model. Base rates of SVT failure ranged from 7.9 to 13.3% using the most conservative cutoff scores, although true and false positive rates were not established. Education was shown to have a statistically significant effect on the mean results of the three SVTs (rho ranging from − 162 to − 283), associating lower educational levels with more bogus symptom endorsement. The influence of age and conviction status (pre-trial vs. post-trial) on the SIMS results was statistically significant as well (rho estimates of .171 and − 232). With data showing robust construct validity and excellent predictive accuracy, the instruments were shown to be adequate for use in the Portuguese prison context, but further research is required, in particular using forensic inpatients and clinical populations, and including systematic data on the presence of mental disorders.
Using Explainability to Inform Statistical Downscaling Based on Deep Learning Beyond Standard Validation Approaches
Authors: González‐Abad Jose , Baño‐Medina Jorge , Gutiérrez José Manuel
Published: November 2023

Deep learning (DL) has emerged as a promising tool to downscale climate projections at regional‐to‐local scales from large‐scale atmospheric fields following the perfect‐prognosis approach. Given their complexity, it is crucial to properly evaluate these methods, especially when applied to changing climatic conditions where the ability to extrapolate/generalize is key. In this work, we intercompare several DL models extracted from the literature for the same challenging use‐case (downscaling temperature in the CORDEX North America domain) and expand standard evaluation methods building on eXplainable Artificial Intelligence (XAI) techniques. Specifically, we introduce two novel XAI‐based diagnostics—Aggregated Saliency Map and Saliency Dispersion Maps—and show how they can be used to unravel the internal behavior of these models, aiding in their design and evaluation. This work advocates for the introduction of XAI techniques into deep downscaling evaluation frameworks, especially when working with large regions and/or under climate change conditions.
The invisible witness: air and dust as DNA evidence of human occupancy in indoor premises
Authors: Fantinato Chiara , Fonneløp Ane Elida , Bleka Øyvind , Vigeland Magnus Dehli , Gill Peter
Published: November 2023

Humans constantly shed deoxyribonucleic acid (DNA) into the surrounding environment. This DNA may either remain suspended in the air or it settles onto surfaces as indoor dust. In this study, we explored the potential use of human DNA recovered from air and dust to investigate crimes where there are no visible traces available—for example, from a recently vacated drugs factory where multiple workers had been present. Samples were collected from three indoor locations (offices, meeting rooms and laboratories) characterized by different occupancy types and cleaning regimes. The resultant DNA profiles were compared with the reference profiles of 55 occupants of the premises. Our findings showed that indoor dust samples are rich sources of DNA and provide an historical record of occupants within the specific locality of collection. Detectable levels of DNA were also observed in air and dust samples from ultra-clean forensic laboratories which can potentially contaminate casework samples. We provide a Bayesian statistical model to estimate the minimum number of dust samples needed to detect all inhabitants of a location. The results of this study suggest that air and dust could become novel sources of DNA evidence to identify current and past occupants of a crime scene.
Domestication and breeding objective did not shape the interpretation of physical and social cues in goats (Capra hircus)
Authors: Nawroth Christian , Wiesmann Katrina , Schlup Peter , Keil Nina , Langbein Jan
Published: November 2023

Artificial selection by humans, either through domestication or subsequent selection for specific breeding objectives, drives changes in animal cognition and behaviour. However, most previous cognitive research comparing domestic and wild animals has focused on companion animals such as canids, limiting any general claims about the effects of artificial selection by humans. Using a cognitive test battery, we investigated the ability of wild goats (non-domestic, seven subjects), dwarf goats (domestic, not selected for milk production, 15 subjects) and dairy goats (domestic, selected for high milk yield, 18 subjects) to utilise physical and social cues in an object choice task. To increase the heterogeneity of our test samples, data for domestic goats were collected by two experimenters at two research stations (Agroscope; Research Institute for Farm Animal Biology). We did not find performance differences between the three groups in the cognitive test battery for either physical or social cues. This indicates that for a domestic non-companion animal species, domestication and selection for certain breeding objectives did not measurably shape the physical and cognitive skills of goats.
Improved artificial intelligence discrimination of minor histological populations by supplementing with color-adjusted images
Authors: Hatta Satomi , Ichiuji Yoshihito , Mabu Shingo , Kugler Mauricio , Hontani Hidekata , Okoshi Tadakazu , Fuse Haruki , Kawada Takako , Kido Shoji , Imamura Yoshiaki , Naiki Hironobu , Inai Kunihiro
Published: November 2023

Despite the dedicated research of artificial intelligence (AI) for pathological images, the construction of AI applicable to histopathological tissue subtypes, is limited by insufficient dataset collection owing to disease infrequency. Here, we present a solution involving the addition of supplemental tissue array (TA) images that are adjusted to the tonality of the main data using a cycle-consistent generative adversarial network (CycleGAN) to the training data for rare tissue types. F1 scores of rare tissue types that constitute < 1.2% of the training data were significantly increased by improving recall values after adding color-adjusted TA images constituting < 0.65% of total training patches. The detector also enabled the equivalent discrimination of clinical images from two distinct hospitals and the capability was more increased following color-correction of test data before AI identification (F1 score from 45.2 ± 27.1 to 77.1 ± 10.3, p < 0.01). These methods also classified intraoperative frozen sections, while excessive supplementation paradoxically decreased F1 scores. These results identify strategies for building an AI that preserves the imbalance between training data with large differences in actual disease frequencies, which is important for constructing AI for practical histopathological classification.
Naturally occurring canine laminopathy leading to a dilated and fibrosing cardiomyopathy in the Nova Scotia Duck Tolling Retriever
Authors: Bannasch Danika L. , Oertle Danielle T. , Vo Julia , Batcher Kevin L. , Stern Joshua A. , Kaplan Joanna L. , Li Ronald H. L. , Madden Indiana E. , Christen Matthias , Leeb Tosso , Joshi Nikhil
Published: November 2023

Dilated cardiomyopathy (DCM) is characterized by decreased systolic function and dilation of one or both ventricles, often leading to heart failure or sudden death. Two 10-month-old sibling Nova Scotia Duck Tolling Retrievers (NSDTR) died acutely with evidence of dilated cardiomyopathy with myocardial fibrosis. Association analysis using two cases and 35 controls identified three candidate regions homozygous in the two cases. Whole genome sequencing identified a frameshift deletion in the LMNA gene (NC_049228.1:g.41688530del, NP_001274080:p.(Asp576ThrfsTer124)). Three retrospectively identified NSDTRs with sudden death before 2 years of age and severe myocardial fibrosis were also homozygous for the deletion. One 5 year old with sudden death and myocardial fibrosis was heterozygous for the deletion. This variant was not identified in 722 dogs of other breeds, nor was it identified to be homozygous in 784 NSDTR. LMNA codes for lamin A/C proteins, which are type V intermediate filaments that provide structural support to the nuclear membrane. In humans, LMNA variants can cause DCM with sudden death as well as diseases of striated muscles, lipodystrophy, neuropathies, and accelerated aging disorders. This frameshift deletion is predicted to affect processing of prelamin A into lamin A. Pedigree analysis in the NSDTR and functional evaluation of heterozygotes is consistent with a predominantly recessive mode of inheritance and possibly low penetrance in heterozygotes in contrast to people, where most pathogenic LMNA variants are dominantly inherited.
A multifunctional hydrogel dressing with high tensile and adhesive strength for infected skin wound healing in joint regions
Authors: Zhang Chen , Liu Kaiyue , He Yuanmeng , Chang Rong , Guan Fangxia , Yao Minghao
Published: November 2023

A multifunctional hydrogel dressing with high tensile and adhesive strength and photothermal antibacterial properties based on PVA, borax, TA and Fe3+ was developed for infected skin wound healing in joint regions.
Porphyrin–anthracene covalent organic frameworks for sustainable photosterilization
Authors: Guo Jing-Xuan , Gao Xue-Mei , Gu Tian-Yue , Li Hao-Ze , Chen Li-Jian , Zhao Xu , Yan Xiu-Ping
Published: November 2023

A porphyrin–anthracene covalent organic framework for continuous release of singlet oxygen through both photosensitization and cycloreversion pathways was constructed for photosterilization and bacterial-infected wound healing.
Versicherte mit Erwerbsminderungsrisiko: Identifikation, Analyse der
Inanspruchnahme eines Beratungsangebots und Darstellung der gesundheitlichen und
beruflichen Situation – Eine Querschnittstudie
Authors: Passier Ines , Kröger Christoph , Kobelt-Pönicke Axel
Published: November 2023

Ziel der Studie Die vorliegende Studie untersucht vergleichend Versicherte
mit moderatem und hohem Erwerbsminderungsrisiko der Deutschen Rentenversicherung
Braunschweig - Hannover (DRV BS-H), die mittels des Risikoindex
Erwerbsminderungsrente (RI-EMR) identifiziert wurden. Die Versichertengruppen
werden hinsichtlich ihrer Inanspruchnahme eines telefonischen Beratungsangebots
beschrieben. Die Auswertung der an der gleichen Stichprobe erfolgten
Fragebogenerhebung beschreibt die gesundheitliche und berufliche Lebenssituation
der Versichertengruppen, zeigt Bedarfe hinsichtlich
Rehabilitationsmaßnahmen auf und gibt Implikationen für die
Praxis.

Methode Es handelt sich um eine Querschnittstudie. Die Teilnehmer
generierten sich aus einer Zufallsstichprobe der Gesamtversicherten der DRV
BS-H. 1778 Versicherte wurden mit dem Angebot zur Inanspruchnahme eines
telefonischen Beratungsgesprächs und zwecks Teilnahme an der
Fragebogenerhebung angeschrieben. Der Fragebogen erfasste u. a.
Beschwerden und Beeinträchtigungen der Versicherten durch
Kontextfaktoren nach ICF. Erwerbstätige wurden zu ihren Belastungen am
Arbeitsplatz befragt, nicht-Erwerbstätige zu ihrer Motivation zur
Rückkehr in die Erwerbstätigkeit (RTW). 157 (9,8%) der
erreichten Versicherten antworteten auf das Angebot des
Beratungsgesprächs, 391 (24,5%) nahmen an der Fragebogenerhebung
teil. Die durchgeführten Beratungen wurden deskriptiv ausgewertet. Die
Fragebogendaten wurden vergleichend analysiert (ANOVA, χ2-Test).

Ergebnisse Das Angebot des telefonischen Beratungsgesprächs konnte
weniger zielführend umgesetzt werden als erwartet. Versicherte mit hohem
RI-EMR zeigten vergleichsweise deutliche psychische Beschwerden sowie
Belastungen und Beeinträchtigungen durch Kontextfaktoren.
Nicht-erwerbstätige Versicherte beider Risikogruppen zeigten sich
bezüglich einer möglichen Rückkehr in die
Erwerbstätigkeit mehrheitlich im motivationalen Stadium der
Absichtsbildung.

Schlussfolgerung Dem grundsätzlichen Ziel des frühzeitigen
Einsatzes von Hilfsangeboten für prognostisch
teilhabeeingeschränkte Versicherte steht das Problem gegenüber,
dass bei der Anwendung der Routinedaten der DRV und somit des RI-EMR
Verzögerungen entstehen. Es gilt zu diskutieren, inwiefern
Sozialleistungsträger zukünftig besser zusammenarbeiten
können, um ihre Versicherten frühzeitiger zu erreichen. Die
Passung bestehender Angebote zur Verbesserung der Teilhabe unter den gegebenen
teils komplexen Problemlagen der Versicherten aber auch mit Blick auf die
bestehende Motivationslage sollte differenziert betrachtet werden.
Uses and Abuses, Themes and Variations
Authors: Hunt Peter
Published: November 2023

The picture of children’s literature that emerges from 300 years of history is one of a literature divided between entertainment and edification, and criticism today is divided along the same lines.
Conclusion: Stalking the Perfect Children’s Book
Authors: Hunt Peter
Published: November 2023

The ideas surrounding children’s literature are as rich and complex as the books themselves-but is there a central, Platonic ideal of the children’s book around which the ideas circle, or through which they intersect? The historical survey might give some clues: some of the most obvious recurrent features that we have seen include strong nostalgic/nature images; a sense of place or territory; egocentricity; testing and initiation; outsider/insider relationships; mutual respect between adults and children; closure; warmth/security-and food; and, perhaps most important, the relationship between reality and fantasy. Are any of these, or any combination, of the essence? In many ways, the use of fantasy is at the heart of the adult-child relationship in literature.
Health-sector disparities in Peru
Authors: Zschock Dieter K
Published: November 2023

This chapter summarizes some of the major findings of a comprehensive study, the Health Sector Analysis of Peru (HSAP), carried out in 1985−6 by a team of Peruvian and international researchers (HSAP 1986). The HSAP was designed to test the premiss − shared by Peruvian health-sector authorities and foreign aid officials − that current patterns of resource-allocation in the country’s health sector were inappropriate for the implementation of the Peruvian government’s major health-sector policy goal: to make primary health care (PHC) and essential hospital services geographically and financially accessible to all Peruvians within the five-year term of the government elected in 1985. The HSAP also examined the impact of the previous government’s reduction of its financial commitment to health care in response to Peru’s serious economic recession of 1982−3. This reduction came at a time when the need for health services was greater than ever before, and as foreign donors were attempting to assist the government in implementing its policy of expanding primary health care (PHC) coverage.
Household participation in financing of health care at government health centres in Rwanda
Authors: Shepard Donald S , Carrin Guy , Nyandagazi Prosper
Published: November 2023

Rwanda is a small landlocked country in Eastern Africa with an area of approximately 26000 sq.km. and an estimated population of 6.9 million persons in 1989. With a 1989 per capita Gross National Product (GNP) of US$320, Rwanda is classified amongst the poorest countries in the world. Like many developing countries, it faces a serious and growing problem in the financing of its government health services, as new initiatives have outstripped resources.
Cost-effectiveness analysis of chemotherapy regimes of schistosomiasis control
Authors: Prescott Nicholas
Published: November 2023

Schistosomiasis is one of the most widespread human parasitic infections, and is generally regarded as second only to malaria in terms of public health importance in developing countries. More than 200 million rural people are infected in Asia, Africa, South America, the Caribbean, and the Middle East, and prevalence is increasing with agricultural development and the expansion of the irrigated land area. These considerations have justified implementation of several national control programmes (WHO 1985).
The productivity of manpower and supplies in public health services in Java
Authors: Berman Peter , Sakai Suomi
Published: November 2023

Public-sector health services in developing countries are widely perceived to be inefficient. Observers often note the evidence of inefficiency, such as low productivity with low patient loads, and staff idle during working hours; and poor practices in use of pharmaceuticals. A World Bank policy study on health-care financing in developing countries reinforced this perception when it identified ‘internal inefficiency − wasteful public programs of poor quality’ as one of the ‘three main problems in the health sector’ (World Bank 1987).
Response rates and their maximization
Authors: Armstrong Bruce k. , White Emily , Saracci Rodolfo
Published: November 2023

In epidemiology and survey research in general, the word response has several meanings. Two of them are relevant to exposure measurement:

The emphasis of this book is on the first of these obtaining responses with minimum error at the level of the individual subject. In epidemiology, however, we are concerned not just with individual subjects, but with the wider populations that they represent. Our inferences about population exposures may be affected by two sources of error additional to those that affect the data obtained from individual subjects: random sampling error and selection bias. Random sampling error occurs when statistics derived from the sample are not equal to the underlying population parameters because, by chance, members of the sample do not accurately represent the population as a whole. Selection bias occurs when statistics in the sample are not equal to the population parameters because the sample is not a true random sample of the population. Our attention in this chapter is directed to selection bias.
Progress in the biology of aging
Authors: Finch Caleb E
Published: November 2023

This paper describes some major trends and major gaps in knowledge in biogerontology. In its focus on humans and animals. it cannot be comprehensive. Three areas are growing spectacularly: physiology—pathology, biochemistry—cell biology, and molecular genetics. A major theoretical theme in biogerontology has concerned the possible accumulation of random damage in the genetic apparatus, as hypothesized from various mechanisms by Harmon, Szilard, Medvedev, Orgel, Burnet, and others. However, many types of recent evidence do not support random genomic damage as a prominent cause of age-related dysfunction at either the cell or organ level, though the age-related increase of cancer may involve cumulative effects from mutations over the lifespan. Consequences of limited cell proliferation are another major theme in all three areas, drawing from the finite replication of diploid human fibroblasts in vitro. While many mammalian cells show clonal senescence through a finite number of cell cycles in vitro and in vitro, the role of this phenomenon in age changes in vivo is not generally established. The impaired proliferation of cultured human lymphocytes could be a related phenomenon, and there may also be indirect consequences from limited clonal proliferation during development (e.g. through the inability to replace damaged neurones in the adult brain). Physiological—pathological changes are being analysed from the molecular level upwards. A remarkable diversity of age changes can be manipulated through diet, hormones, and drugs. These laboratory and clinical manipulations provide powerful tests of hypotheses about the many different types of cell and molecular mechanisms in aging. Suffice it to say that few biologists expect a comprehensive theory of biological aging and that most recognize a multiplicity of mechanisms.
Strategy for evaluating a national health system
Authors: Cumper George E
Published: November 2023

In the health field, the term evaluation covers a wide range of activities, from clinical audit in hospitals through cost-benefit and cost-effectiveness analysis of projects to national sector reviews by international agencies. Broadly, it can be defined as the comparison of the performance of an individual or institution with the standards appropriate to its function. Seen as part of the process of management, it carries the implication that any divergence is to lead to corrective action. When applied at the national level, this innocent-sounding definition raises certain difficulties which have to be solved before effective evaluation can take place.
Standards for health system evaluation
Authors: Cumper George E
Published: November 2023

Evaluation requires not only that we assemble information on how the national health system performs, but also that we find clear and appropriate norms and standards against which its performance can be judged. (We use ‘norm’ and ‘standard’ here as roughly equivalent, the former being more often quantitative-’three hospital beds per thousand population’-and the latter qualitative-’the mother’s blood pressure to be checked on each antenatal visit’.)
The case-control study
Authors: Olsen Jørn , Merletti Franco , Snashall David , Vuylsteek Karel
Published: November 2023

If a cluster-that is an unusual gathering of a specific disease, usually within a rather short time span-occurs at a given work site, this might of course be due to chance, but it could also be the result of a given set of exposures. For the work-place detective facing an outbreak of disease, the chance explanation is the last conclusion to be reached. If all other explanations have been ruled out, chance might remain as the last likely explanation, but other possible explanations should be considered and excluded first. Or, in the words of that excellent detective, Sherlock Holmes ‘When you have eliminated the impossible whatever remains, however improbable, must (may) be the truth’.
Problems
Authors: Olsen Jørn , Merletti Franco , Snashall David , Vuylsteek Karel
Published: November 2023

It is often better to have no study than a poor study, because it is better to have an open mind than biased evidence, so do not start a study if you re not going to have confidence in the results. If you as the detective do not believe in the evidence, neither should the court. There are many possible flaws in research and you should be familiar with some of them, much as the detective should know that burglars often leave false clues. Problems arise in many phases of research; when the study subjects are selected, when information is collected, and when data are analysed. 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.
Mortality studies
Authors: Olsen Jørn , Merletti Franco , Snashall David , Vuylsteek Karel
Published: November 2023

The aim of preventive medicine is to stop the cause of illness as soon as possible. So, if the study group itself is to benefit from the results, the disease state should be in an early phase. Many published reports in occupational medicine concern mortality studies. In a follow-up study, the mortality due to a specific disease can be studied. If mortality rates among the exposed are compared with (divided by) the mortality rate for non-exposed, relative mortality rates are calculated (instead of relative morbidity rates). Often you find the term SMR (standardized mortality ratio) used in these studies, meaning that the rates are adjusted (standardized) for age-differences in the two groups compared. The SMR value gives the excess mortality in percentages. An SMR value of 130 means an excess mortality rate among the exposed of 30 percent.
Classification, anatomy, and embryology
Authors: Elwood Mark , Elwood Harold , Little Julian
Published: November 2023

The classification of neural tube defects is complex. Consideration of their embryology and anatomy indicates a great variety of manifestation while more recent chromosomal and genetic studies point towards some degree of aetiological heterogeneity (Holmes et al. 1976; Toriello and Higgins 1985). For anencephalus, the conventional clinical classification includes the many anatomical variations outlined by Naftagas (1925), Fig. 2.1. A detailed review of the anatomy of anencephalus is given by Lemire et al. (1978). Anencephalus affects structures derived from or associated with the cephalic end of the neural tube. Other cephalic conditions appear as herniation of brain tissues through a defect in the skull-these include cranial meningocoele and cranium bifidum, encephalocoele, and hydrencephalocoele, containing respectively meninges only, meninges and brain tissue, or meninges, brain tissue, and part of the ventricular system. It is possible that cranial meningocoele and encephalocoele are part of the same disordered growth process although they are much rarer than and often clinically distinct from anencephalus (Ingraham 1944).
Antenatal screening and diagnosis
Authors: Wald Nolichas , Cuckle Howard
Published: November 2023

Antenatal screening and diagnosis of neural tube defects is carried out by ultrasound examination and alpha-fetoprotein (AFP) measurement in maternal serum or amniotic fluid. Amniotic fluid acetylcholinesterase (AChE) determination is an additional diagnostic test. Anencephalus can readily be detected by means of ultrasound alone with a negligible false-positive rate. The ultrasound examinations, usually performed early in the 2nd trimester of pregnancy, are carried out either selectively on women who are known to be at high risk of having a pregnancy with a neural tube defect, or routinely on all women receiving antenatal care. (In this chapter women known to be at high risk of having a neural tube defect pregnancy are those who have a raised serum AFP level or those with a positive family history, usually having had a previous pregnancy associated with a neural tube defect.) In a recent summary of the literature including nine studies, all 207 cases of anencephalus were detected in women who had an ultrasound scan because they were at high risk (Wald et al. 1991a). More than nine out of ten anencephalic pregnancies are associated with raised maternal serum AFP levels so that centres performing routine maternal serum AFP screening followed by ultrasound on those who have raised levels will detect nearly all affected pregnancies. While the performance of a routine ultrasound examination in the detection of neural tube defects is poorly documented, the detection rate for anencephalus is likely to be close to 100 per cent. A positive ultrasound scan is usually sufficient to offer a woman a termination of pregnancy without the need to perform a diagnostic amniocentesis.
The current situation of Village Health Worker programmes in China
Authors: Kan Xuegui
Published: November 2023

In the late 1950s the Chinese created and began to use ‘barefoot doctors’ in an attempt to extend the basic preventive, promotive, and curative health services to the under-served rural population. It was hoped to provide a bridge between the community and the professional health service, to mobilize community resources and thereby overcome the difficulties in government health resources, and ultimately, to achieve more improvement in the health status of the people at a cost that the country could afford. Today, an impressive improvement in the health status of the Chinese people has indeed been made, with life expectancy of nearly 70 years, and irtfant mortality about 35 per 1000 live births, despite fairly low per capita income. Although many factors could have contributed to this achievement (for example, improvements in nutrition, education, housing, sanitation, and other policies in the health sector, such as the use of traditional medicine and family planning), the use of village health workers (VHWs) can at least be considered as one of the contributing factors. (For the purposes of this chapter VHWs include only barefoot doctors and their successors-village doctors and health aides.)
Community health work: India’s experience
Authors: Desai P B
Published: November 2023

The purpose of this contribution is to reflect on the steps taken in India in the direction of universalizing access to primary health care (PHC) through a large cadre of what are called community health workers (CHWs). The creation of this cadre was initiated by the first ever non-Congress government, that of the Janata Party, on 2 October 1977 (the birthday of M. K. Gandhi, the ‘Father of the Nation’). On that day, the government introduced their Rural Health Scheme, which was projected as a measure designed to place ‘people’s health in people’s own hands’.
The limits of participation in health: brigadista programmes in Nicaragua
Authors: Coyle Edward , Davey Smith George , Sandiford Peter
Published: November 2023

The development of health services in Nicaragua following the popular revolution in 1979 has particular international relevance, since this period coincides with the programme for primary health care (PHC) launched by the World Health Organization and UNICEF at the Alma-Ata Conference (WHO 1978a). PHC was an essential component of the WHO programme for ‘Health for All by the Year 2000’. For developing countries community health workers (CHWs) were seen to be ‘the most realistic solution for attaining total population coverage with essential health services’. The origin of CHWs from the communities they served, and the continuous participation of the community in the quest for health, were advanced as key elements in this strategy.
Introduction
Authors: Wagstaff Adam , Doorslaer, Eddy Van , Rutten Frans
Published: November 2023

Health care reform looks set to stay high on the policy-making agenda during the 1990s. Some reforms that were planned during the 1980s have already begun to be implemented. These include the so-called internal market programme in the UK, the move from fee-for-service to capitation payments for general practitioners’ low-income patients in Ireland, and the switch from social insurance to tax financing in Spain. Other reforms are likely to follow elsewhere. The current Secretary of State in the Netherlands seems determined to push for a gradual implementation of a diluted version of the 1988 ‘Dekker Plan’ (see van de Ven 1990). The Swiss look set to vote in favour of a referendum proposing a large increase in the role of taxation in the financing of health care. In addition, reforms to the American health care system look increasingly likely, as health care costs and the number of uninsured continue to rise remorselessly.
Equity in the finance and delivery of health care: concepts and definitions
Authors: Wagstaff Adam , Doorslaer Eddy Van
Published: November 2023

Equity, like efficiency, is a goal that is pursued by policy-makers in all types of health care system. But what is equity? How should it be defined? And how is it to be measured? Answers to these questions are far from self-evident but are clearly required if meaningful cross-country comparisons are to be performed. This chapter addresses the first two of these questions. The third is addressed in Chapters 3 and 4, which also summarizes the methods and results of the COMAC-HSR study.
Equity in health care and health care financing: evidence from five developing countries
Authors: Baker Judy L , Gaag Jacques van der
Published: November 2023

It is often argued that a country’s per capita income is a poor indicator of the welfare of its population. One objection to this average measure is that it ignores distributional aspects. For example, a country with a relatively high per capita income can still have large numbers of poor people due to a highly skewed income distribution. Average per capita income says nothing about the living conditions of these people.
Experimental models in wound healing
Authors: Ehrlich H P , Gottrup F
Published: November 2023

Tissue injury resulting in irreversible cell death and connective tissue disruption initiates the repair process. The number of causes that produce tissue injury and tissue loss outnumber the responses the host has to repair the defect. In a superficial injury, where only the epidermal surface is damaged and destroyed (such as a sun burn), the repair process is limited to cellular replacement. Through a process of epidermal cell migration and duplication, the defect is resurfaced in a regen erative manner in the absence of scarring. In contrast, with deeper tissue loss where the connective tissue matrix is de stroyed, healing occurs by scarring with the introduction of new cell populations residing in a newly constructed connec tive tissue matrix and having a new blood supply.
Clinical trials and statistics
Authors: Leaper D J , Mulder G D
Published: November 2023

The rapid increase in attention focused on wound repair during the past two to three decades has paralleled an increased demand for clinical trials examining efficacy and safety of new wound care devices, pharmaceuticals, and other products. Fierce competition has necessitated the implementation of clinical trials which need to be completed with a large patient population in a relatively short time frame. Subsequently, the quality of science and research have been compromised to some extent for the sake of obtaining, questionably valid, published results.
Introducing management and organizations
Authors: Collins Charles
Published: November 2023

There is no easy route to developing management skills, yet neither is it an impossible task. To the health professional, management is often a new activity for which they have had little opportunity to reflect upon. The objective of this first chapter is to develop precisely that reflection. Management and the structuring of organizations has to be placed upon firm foundations for them to be effective. This may be done by facing up to some of the most common and basic questions that a manager faces in his or her work.
Grouping work in the Ministry of Health
Authors: Collins Charles
Published: November 2023

Jobs within an organization do not operate in isolation from one another but are brought together in divisions, departments, units, sections, and groups. In the previous chapter we looked at vertical differentiation in the work levels, spans of control and the overall shape of an organization. Here we shall be looking at the horizontal process of differentiation in an organization, i.e. grouping activities together in the most appropriate fashion. The two forms of differentiation—vertical and horizontal—are related and may be analysed in a series of organizational design problems.
Unplanned pregnancy: your choices
Authors: Furedi Ann
Published: November 2023

This book is written for all women who find themselves unexpectedly pregnant and want information and advice on the available options facing them. It explains what will be inolved if the woman decides on adoptions, abortion, or motherhood. It also discusses why unplanned pregnancies occur and what happens to a woman's body in early pregnancy. The whole book is brought to life iwth many extracts from interviews with women who have had unplanned pregnancies talking about their varied experiences and the choices they took.
Discovering you are pregnant
Authors: Furedi Ann
Published: November 2023

There are women who claim to have known that they were pregnant even before they missed their first period. Some even insist that they knew immediately they conceived, while some books on pregnancy adopt the tone that although there may be many times in your life when you think might be pregnant, you will know beyond doubt when you are.
Some implications of population change
Authors: Rose Geoffrey
Published: November 2023

Society seeks to distance itself from its deviants, either physically (as by segregating those with mental illness or AIDS), or by categorizing them (‘hypertensives’, ‘depressives’, ‘hooligans’), or by denying responsibility for their problems (such as obesity, poverty-related illness, alcoholism, or violence). Yet in truth the deviants are simply the tail of the population’s own distribution; they belong to each other and society is one, whether it likes it or not. There now follows an explanation of these interrelations between the population and its deviants, and the health implications for the deviants of changes in the population. This will be followed by consideration of the health implications of such changes for the population as a whole.
In search of health
Authors: Rose Geoffrey
Published: November 2023

The Romans’ ideal for personal health was mens sana in corpora sano—a healthy mind in a healthy body. The comparable ideal for those concerned with public health would be ‘a healthy life-style in a healthy environment’. The occurrence of most diseases relates to what people eat and drink, to their daily activities, and to their physical and social environment. Some individuals are particularly susceptible to the harmful consequences of impaired circumstances, and in such cases it is appropriate to seek (or offer) a focused relief, but if either the causes or the susceptibility are wide spread, then a more general change is necessary.
Psychosomatic disorders: historical perspectives
Authors: Porter Roy
Published: November 2023

The historian Roy Porter provides a historical background to the major and more recent themes of the remainder of the book. He describes examples from the sixteenth to nineteenth centuries of attempts by physicians, philosophers, and others to explain and categorize in medical and philosophical terms what, in this book, are described as functional somatic symptoms. None of these have satisfactorily resolved fundamental difficulties in understanding the mind-brain relationship.
Psychological treatment and the health care system: the chaotic case of back pain. Is there a need for a paradigm shift?
Authors: Main Chris J , Benjamin Sidney
Published: November 2023

In the second of their two chapters, Dr Main and Dr Benjamin examine the social context of treatment. They begin by discussing the ways in which occupational, financial, and other social factors contribute to the aetiology and influence the prognosis of chronic pain and then consider the various types of pain management programmes. The section on treatment guidelines is concerned particularly with specialist programmes. The final section makes recommendations for service development in terms of community education, improved health care delivery, and changes in health care policy. The issues discussed in this chapter are relevant to the provision of care for all the functional somatic syndromes discussed in this book. They are considered further in Chapters 21 and 22.
Management in primary care
Authors: Gask Linda
Published: November 2023

In this chapter Dr Gask describes the high prevalence of functional somatic symptoms in primary care settings and outlines those factors which predict poor out come. She also describes a practical model for the detection, acknowledgement, and management of functional somatic symptoms which can be easily learned and used in primary care. Finally, the management of chronic somatization in primary care is described and the importance of shared care between the psychiatrist and primary health care team is emphasized.
Examination and assessment
Authors: Hope R A , Fulford, K W M , Yates Anne
Published: November 2023

Appraisal of student learning - whether by formal examination or general clinical assessment - is essential to the successful development of training in practice skills: It motivates students, particularly those with little natural aptitude or interest It signals the importance of practice skills. So long as knowledge and technical skills are appraised, so must practice skills It provides essential feedback on the success of the course (see Appendix 11, How to Develop a New Seminar ) It is sometimes argued that it is impossible to ‘test’ practice skills (especially ethics). As with assessing other aspects of clinical competence, there are difficulties, and this is certainly an area in need of further development. However, several studies, and our own pilot work, suggests that with appropriate methods, all aspects of practice skills can be assessed no less reliably than other more technical aspects of clinical practice.
Introduction
Authors: Baraitser Michael
Published: November 2023

Over the past five years there has been a revolution in clinical neurogenetics that has effected the way neurology is practised. This is substantially due to developments in molecular biology. What began as a small number of diseases which were mapped when the last edition of this book was written, has now swelled to a volume of diseases which are not only mapped but in which mutations can be analysed. With these advances have come problems in the nomenclature. Diseases like DRPLA (see p. 270), almost unheard of by the majority of neurologists, are now over-represented in the literature and have a high profile, because molecular biology has found a way of diagnosing these diseases by simple measures. Neurologists who had gradually come to terms with the demise of Charcot-Marie-Tooth disease in favour of ‘hereditary motor and sensory neuropathy type l’, etc have now seen the return of Charcot-Marie-Tooth in a abbreviated form. We now have CMTlA, CMTlB, CMT2, etc., as more and more heterogeneity is identified and disorders need new names. The cerebellar ataxias are now SCA1-SCA5;
Neurocutaneous disorders
Authors: Baraitser Michael
Published: November 2023

Abstract: This common autosomal dominant condition occurs in about one in 3000 individuals. The manifestations are protean and well-known. The most common presenting features are cafe-au-lait patches (more than six, greater than 1.5 cm in diameter) and peripheral neurofibromata. Fois et al. (1993) investigated the diagnostic significance of cafeau-lait spots. Of children ascertained with typical cafe au lait spots of significant number 57% went on to develop definite NFl, and in the remainder of the patients the diagnosis was highly likely. Complications can include optic nerve gliomas, macrocephaly, short stature, scoliosis, pseudarthrosis of the tibia, hypertension due to renal artery stenosis, phaeo-chromocytoma, neurofibrosarcomas, meningiomas, and acoustic neuromas. The latter may be confined to the so-called central form of the disease (type 2, seep. 109).
Dementia
Authors: Baraitser Michael
Published: November 2023

Most genetisists will be faced with a clinical and radiological suggestion of the disease and only rarely will there be post-mortem confirmation in the form of senile plaques and neurofibrillary tangles. Other diseases such as prion protein disease, Pick’s dementia, frontal lobe dementia, and muti-infarct dementia must be excluded.
Anterior horn cell disorders
Authors: Baraitser Michael
Published: November 2023

Abstract: The mean age of onset in the familial type of motor neurone disease is about 45 years, and it therefore has an earlier age of onset than the more frequent, sporadic types. The clinical picture can be secondary to lymphomas, plasma cell dyscrasias, insulin secreting tumours, HIV, hyperthyroidism, hyperparathyroidism, and heavy metal poisoning such as mercury (Scully et al. 1995). Minor sensory signs might occur in about 20% of cases, and this is not surprising as the posterior columns as well as the spinocerebellar tracts are commonly found to be affected at post-mortem. This entity includes primary lateral sclerosis as there have been patients diagnosed as such who, after many years, develop amyotrophic lateral sclerosis (ALS).
The neuropathies
Authors: Baraitser Michael
Published: November 2023

HMSN type I—refers to those families with markedly slow conduction velocities: (a) those linked to 17p (mostly duplications) and those with mutations at the PMP 22 gene on 17p; those linked to chromosome 1 (the myelin protein zero gene); HMSN type II—the axonal type with only moderately slowed conduction; HMSN type III—(a) classic Dejerine-Sottas disease with onion bulb formation; (b) with amyelination; (c) with basal lamina onion bulb formation; HMSN type IV—Refsum’s disease; HMSN type V—with spasticity; HMSN type VI—with optic atrophy/deafness; HMSN X-linked.
Mitochondrial disorders
Authors: Baraitser Michael
Published: November 2023

Those conditions in which a major single deletion is found will have only small recur rence risks. Kearns-Sayre syndrome, Pearson’s disease, and chronic progressive external ophthalmoplegia fall into this category; but, Kearns-Sayre can rarely be caused by a duplication and it might be dominantly inherited.
Cortical Pathology: a New Generation of Quantitative Microscopic Studies
Authors: Benes Francine M
Published: November 2023

In the past 15 years, a wide variety of approaches have been adopted to the study of the neuropathology of schizophrenia. The quest has been given new hope as increasingly sensi tive and quantifiable microscopic techniques, such as cell counting, immunocytochemistry, receptor binding autoradiography, and in situ hybridization have been applied. Exciting possibilities have begun to develop regarding the underlying histopathology of the cerebral cortex in schizophrenia; however, caution is needed because of the preliminary nature of all the results.
Gliosis and its Implications for the Disease Process
Authors: Roberts Gareth W , Harrison Paul J
Published: November 2023

In a disorder notable for its neuropathological complexity and obscurity, gliosis has been called the “ost inscrutable lesion” (Bruton et al., 1990). Establishing if gliosis is present in schizophrenia has been one of the key questions addressed in contemporary studies, because of the significant implications which it has for understanding the nature of the disorder. Put simply, gliosis would equate with a progressive, neurodegenerative process, as Kraepelin believed was the case. Conversely, an absence of gliosis, in the presence of macroscopic (Chapter 1) and cytoarchitectural (Chapters 2 to 4) alterations, can be construed as supportive of a neurodevelopmental disease process (Chapter 8). This chapter reviews the evidence and concludes that gliosis is indeed not a feature of the brain in schiz-ophrenia. The caveats to, and interpretation of, this important negative result are then discussed.