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Fifty-one cases of severe head injury were studied, all of whom were sufficiently badly injured to need full intensive-care treatment. The outcome was bad, only a quarter of the patients ever getting back to reasonable health, and less than one in ten recovering to full health. Relatives must be warned of the probable outcome, and the difficulties likely to be encountered well before the patient leaves hospital.
It is impossible not to note the small number of epidural anaesthetics given for obstetrics in France. The rarity of centres where it is offered by a team of specially trained anaesthetists and obstetricians contrasts with the increase in demand from the patients themselves. Study of the number of epidural anaesthetics predictable in obstetrics according to the criteria of indication indicates that the procedure could be used in as many as 30 to 50 per cent of deliveries. This implies a need for an increase in the number of anaesthetists, i.e. an increase not so much in the total number as in those trained in obstetrics with experience of epidural anaesthesia. Similar changes are necessary in hospital organisation, in such a way that the place of the anaesthetist in the maternity unit is recognised officially, this recognition being strengthened by routine out-patient consultation with all patients during their pregnancy. The economic aspect of a possible increase in the number of epidural anaesthetics carried out in France and in the number of anaesthetists performing the procedure is envisaged in terms of salaries in the public hospital system, costing of the procedure by the Social Security and the true cost of epidural anaesthesia.
This study examined the elder abuse cases that occurred in Gifu Prefecture, Japan between 1990 and 2000. We conducted a retrospective study of all the cases in which the victim was 65 years or older and autopsied in the Department of Legal Medicine, Gifu University School of Medicine. Fifteen victims were classified as elder abuse victims: five men and ten women. The victims ranged in age from 66 to 87 years (mean age, 74.5 years). The types of abuse were as follows: physical abuse, 13 cases; emotional abuse, five cases; neglect, four cases; and financial abuse, three cases. In eight cases, the victims were subjected to two or more types of abuse. The cause of death of the victims varied with the type of abuse. In the physical abuse cases, subdural hemorrhage was the most common cause, followed by other violence-related deaths and hypothermia. In the neglect cases, the victims died of either starvation or suffocation after the aspiration of food into the airway. In the domestic abuse cases, one of the victim's sons was the most common perpetrator, and little or no income was considered to be a risk factor for perpetrators. In the neglect cases, dementia and difficulty in performing activities of daily living were considered to be risk factors for victims, in addition to living in social isolation.
The relationships between schooling, occupation, symptoms of chronic bronchitis and smoking habits were investigated in 5,000 people. This study was done in conjunction with a mass X-ray screening effort in a district of Budapest. The number of smokers among those with an academic education was 6-7% lower than in the group with primary school education. Symptoms of bronchitis are less common among the smokers in the former group (7%) than among those in the latter group (18%). The incidence of bronchitis was also lower among intellectuals. It is assumed that higher education or a higher cultural level is associated with a healthier and more modern life style, cigarette smoking being only one, albeit the most important, factor involved.
Problems of peculiar relationships between oncologists, society and general public, on the one hand, and cancer patients, on the other, are discussed with respect to breast cancer. It is suggested that if one's right to take care of one's life is to be honored, cancer patients are to have access to more information on their disease must doctor should be prepared to give away more of it in their conversations. Once one is aware of responsibility for one's health, the advantages of an earlier visit to a doctor and, conversely, the tragedy of a belated call become quite apparent. Such awareness is not feasible unless society becomes the patients ally in every-day activities of cancer control. This approach calls for a revision of somewhat out-dated deontological principles as well as measures aimed at getting the public to change their attitudes towards cancer patients. Simultaneously, the medical profession must receive an education in dealing healthy people and cancer patients. The engagement of former cancer patients, who have an experience of a program of social rehabilitation, will make the efforts to cure those who are still sick more meaningful and boost their morale.
High rates of mental morbidity among migrants are common but not universal. Differences in rates may reflect factors in: (a) the country of origin; (b) the actual move; (c) the country of settlement. About 1.8 million people came to Britain in 1950-1970 from the West Indies and Indian subcontinent. They resembled Gastarbeiters in other European countries, except that as Commonwealth citizens they had the right of permanent residence. With their children (many of whom are now adults) they are 3.5% of Britain's population. Britain does not have a liberal cosmopolitan culture in which newcomers are welcomed, and the situation has deteriorated in response to high unemployment, constrained public expenditure, and widening gulfs between income-groups. Minority groups are scapegoated, and racial prejudice is more apparent than ever. Black people face obstacles in education and employment. Immigration laws which curtail the right to live in Britain have created insecurity, which is aggravated by insensitive policing and irresponsible press reporting. Institutions and authorities have been slow to respond to the different needs of new cultures. Riots receive more publicity than the daily violence which black people experience, which includes implicit contempt expressed as negative stereotypes, and explicit physical harassment. In this situation a high incidence of stress-related disporders might be predicted. There has been insufficient community-based research but one study of Indian and Pakistani samples showed them to have less mental and emotional disorder than indigenous controls.(ABSTRACT TRUNCATED AT 250 WORDS)
Studies were carried out in a series of 100 mothers of children with facial clefts who were treated up to the age of 13 to 15 years at the Department for Plastic Surgery. Clefts were used as a model situation for studies into the response of parents--and especially of mothers--to the birth of a child with an inborn malformation. The main results showed: that three quarters of mothers designated the birth of a handicapped child as a mental shock followed by a variety of neurotic symptoms. A certain proportion of mothers suffered from reactive depression which was not diagnosed and therefore not treated. It was confirmed that the poor mental condition of the mother in the predominant part of the series examined persisted up to the adolescence of the affected child and exerted marked negative effects on the mental prosperity of the child. This resulted in a latent or manifest parental attitude of rejection and in the development of mental handicap in their children (impaired self-esteem, impaired sexual identification etc.). The stress situation was increased by factors including manifestation of stigmatization by the familial environment and by the collective of children which had an adverse effect approximately on about three quarters of mothers and children. The discussed forms of medical care and counselling could in the post partum period and later help to reduce the mental stress experienced by the parents, as well as promote the somatic and mental development of the child.
Urinary incontinence is also one of the commonest problems of the Polish society. It is estimated that every sixth woman in Poland suffers from this disease, which can be prevented by using adequate prophylactic measures. This study aimed at the assessment of the state of knowledge of women on the prophylaxis of strain urinary incontinence. Investigations were carried out from May to September 2001 among 194 patients hospitalised on the ward of operative gynaecology of one of the teaching hospitals in Lublin. The criterion of selection of women for the study was lack of symptoms of strain urinary incontinence. The analysis of results allowed to draw the following conclusions: though the knowledge of the term urinary incontinence was declared by nearly half of the respondents (42.8%), about two thirds of them (65.4%) assessed their state of knowledge in this sphere as unsatisfactory; women show great interest (85.7%) in information on urinary incontinence. The favourite forms of information in this sphere are educational materials--brochures, leaflets (58.2%), individual talks with a doctor, midwife (34.8%), demonstration of exercises of the floor of the pelvis (29.9%). The above conclusions enabled to state that the educational success and even doing away with strain urinary incontinence depends on the program of urinary incontinence prophylaxis.
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Onchocerciasis is one of the most serious blinding diseases in the world, affecting between 20 and 25 million people, of whom 200-500 thousand are blind. In Africa more than half of the countries on the continent are affected, the basin of the Volta river containing one of the largest endemic areas. In this area the unique Onchocerciasis Control Program (OCP) is being undertaken, involving Benin, Ghana, Ivory Coast, Mali, Niger, Togo and Upper Volta. In this region, surveys have shown that 14.78% of the population have microfilariae in their skin biopsies, while in hyperendemic villages the figure rises to 75.2%. In such a village the prevalence of blindness rises steeply with age, from 0% under age 20, to over 40% in the over 50 age group. Various environmental factors relevant to the prevalence and incidence of systemic and ocular onchocerciasis are discussed, and pharmacologic treatment modalities are described. Prevention activities, centred around vector control by insecticides, have been dramatically effective.
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OBJECTIVE: Hypertension continues to take its toll on millions of African Americans. Adhering to an eating plan called Dietary Approaches to Stop Hypertension (DASH) can significantly lower blood pressure. This study examined whether problem solving training in addition to education on DASH is more effective than education alone to help African Americans in an urban community college setting solve their own dietary problems and change eating behaviors that could affect blood pressure. METHODS: A randomized, two groups, multiple post-test design was used. All participants (N=78, 59% female) completed a Problem Solving Instrument immediately post-intervention and a follow-up Telephone Interview 2 weeks later. RESULTS: Fewer than half had normal blood pressure on screening. The Experimental Group identified and implemented significantly higher quality solutions to the second of their two problems than the Control Group. The intervention effect was the greatest for participants with blood pressure screenings above normal. CONCLUSION: Problem solving training combined with nutrition information may help African Americans to deal more effectively with dietary problems especially when the problems are complex or less well-defined. PRACTICE IMPLICATIONS: Dietary interventions that include a focus on everyday problem solving as well as knowledge acquisition can be developed in clinical, community health, school, and worksite settings.
Using data from a community survey together with data from a survey of drink-driving offenders, this paper compares the attitudes and knowledge of two matched samples on a number of drink driving issues. The total sample (149 offenders and 149 community sample respondents) were interviewed using a survey instrument containing a number of comparable questions. The offender sample were interviewed by trained interviewers in a face-to-face format, while the general community sample were interviewed using a computer aided telephone interview system. The specific issues dealt with include: a) knowledge of safe drinking and blood alcohol consumption (BAC) levels; b) attitudes towards strategies for avoiding drink driving; and c) general attitudes regarding drink driving. The analysis uses logistic regression to investigate the differences between the responses given by the two samples. The findings illustrate a number of significant differences in knowledge and attitudes between offenders and the general community.
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