Peripartum HIV seroconversion: a cautionary tale.
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Biomedical subjects
Publications and source records attributed to J S Berkeley.
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A street survey was conducted in Glasgow to find out the level of public knowledge of and attitudes to hospices generally and two local hospices. The level of knowledge was not high, though attitudes to hospices were positive. Those few respondents with unfavourable attitudes had little knowledge of hospices generally and knew little about the local hospices. The factors associated with level of knowledge and attitudes were different for the two local hospices. The media and the collection of money for hospices were the main source of knowledge.
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I describe a systematic method of planning primary medical services for Bhutan in the light of the needs of the community and coping with current problems which include an infant mortality rate of 153. Objectives were defined which included decentralizing decision taking as much as possible by establishing relatively independent health units consisting of a team of three staff caring for about 10,000 people.I believe that the principle of adapting health services to meet the needs of the local community is equally valid in the United Kingdom.
To provide primary health care in a thinly populated mountainous country with few doctors presents great difficulties. The Royal Government of Bhutan decided to base their primary medical care service on appropriately trained medical auxilliaries. The training programme is described, and the problems of assessing the field activities discussed.
There have been several important changes in the aims and organization of general-practice teaching in Australia in recent years. During a visit to Australia I had the opportunity to see many of these and to discuss others. This report describes the features I found of most interest.
A new 100-bedded hospital was opened in Thimphu, the capital of Bhutan, in 1974. The hospital serves a large district, and also acts as a referral hospital for the rest of the country. This study analyses the first complete year of running the hospital with a full medical staff.
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The existence of cottage hospital beds is historically determined rather than planned, and there is apparently no official ratio for the provision of such beds. A comparative study, in North-east Scotland, of populations with and without access to cottage hospital beds suggests that providing 1.5 beds per 1,000 population is a reasonable basis for future discussion and planning.
In a study in North-east Scotland, nine out of ten patients had a "medical" reason for referral to hospital-in half it was the severity of their illness and in half the need for investigation or special treatment. One out of five patients was in need of intensive nursing care and one out of 20 patients had a social reason for admission to hospital. General practitioners with access to cottage hospital beds would choose to treat over one quarter of their own patients. The choice of hospital was influenced by the doctor's diagnostic certainty.
The 11,360 direct referrals to diagnostic radiological facilities by general practitioners in the Aberdeen area during 1973 were studied. These represented about 12% of the adult radiology performed in the main x-ray departments of the city, and barium meal examinations amounted to half of all such outpatient contrast examinations. Chest x-ray and barium meal examinations were the most frequently used procedures.Some abnormality was detected at 34% of all examinations, and the barium meal examinations requested by general practitioners showed a similar percentage of abnormal findings to those requested by Aberdeen hospital doctors.The average referral rate for all practices was 24.6 per 1,000 practice population per year. Singlehanded general practitioners referred fewer patients for diagnostic radiology than those working in group practices, and rural practitioners referred fewer than urban general practitioners. This trend was emphasized at a distance greater than 15 miles from the city.
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