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Dr David Moon, head of procurement for the Waste & Resources Action Programme (WRAP), outlines how materials with higher recycled content can be economically sustainable, technically viable and easily available for construction projects in the healthcare sector.
Roentgenographic observations in 19 cases of tooth roots displacement to the maxillary sinus using 4 technics of periapical, topographic, Waters and panoramic projection. It was indicated that, 1). Left maxillary first molar root was forced into the antrum more frequently than the roots of other teeth. 2). Roots were displaced into sinus more frequently in males than females. 3). To identify the root, panoramic and topographic were helpful projection. Waters projection was of little or no value, for the root fragment. However it is useful in that it may provide indirect confirmatory evidence of an antral perforation and reveals the presence of sinus infection.
The International Program on the Health Effects of the Chernobyl Accident (IPHECA) was established by the World Health Organization (WHO) in 1991. Currently, the technical part of IPHECA consists of five projects addressing the following areas of priority health problems or needs: thyroid, hematology, brain damage in utero, epidemiological registry and oral health. Important findings are: 1) a significant increase of thyroid cancer in children in Belarus and Ukraine since 1989, and in Russia since 1992 though not so pronounced. A relationship between detected thyroid cancers and radiation exposure is yet to be established, 2) no increase yet in the incidence of hemoblastoses in the three States, 3) no relationship established between mental retardation and radiation exposure in utero in 4,500 children investigated. The importance of dosimetry and biological indicators of radiation damage has been recognized by IPHECA. Several methods of biological and physical dosimetry are being employed using instrumentation provided by IPHECA. Some preliminary results indicate: 1) unstable aberrations can indicate an integral exposure but it is heavily biased to recent exposures, 2) when comparing healthy persons and patients with hematological diseases in contaminated areas, there is a higher ratio of total aberrations compared to their background and that the level of stable is lower than unstable aberrations, and 3) by applying electron spin resonance (ESR) it has been shown that the individual distribution of doses approaches a log-normal one, especially for adults, and that a peak shift towards higher doses is noticeable for children.
We mostly deal here with socio-medical aspects of vaccinations. Various initiatives are summed up that are intended to optimize the system of immunization by vaccines and to establish certain innovative, and also internationally remarkable approaches. In spite of the undoubted successes of vaccinations in Austria, there still are some major deficits that should be eliminated. The Austrian system of immunization by vaccines has been mainly concentrating on continuously adapting its vaccination schedules. Such modifications are based on current scientific knowledge and thus dynamic in nature whereas the public health system necessarily relies on commonly established and easily adoptable requirements. This discrepancy has brought about a certain degree of uncertainty in some instances.--(See K. Spork, I. Mutz: "Recommendations for Vaccination in Childhood and for Adults".) By further developing immunization programs into a general concept of immunization by vaccines we should be able to put the potential benefits of preventive medical care better into effect than before because such a concept based on clearly defined public health objectives provides strategic and tactical measures and, what is even more important, also includes evaluation.--(See Vutuc, Kunze: "Epidemiology as Background for Vaccinations".) In this connection it has also been necessary to develop various activities in the field of social marketing, examples of which will be mentioned in this issue. There is mainly one recurring source of dispute that must be discussed here, the question of what is immunization of the public at large and what is immunization to be recommended for certain groups (so called risk groups). It has to be principally noted that the idea of risk group immunization has not been too effective in many areas. A typical example for such a project that has to be reconsidered is the active immunization against Central European Encephalitis (CEE) or Tick Bone Encephalitis (TBE).--(See U. Kunze. G. Böhm: "Epidemiology of TBE and Consequences for Further Control Measures Including Vaccination"). Similar considerations also apply to active immunization against influenza or pneumococcal diseases.--(See Süss et al.: "Project 'Vaccinating Hospital Patients' in Upper Austria--Technical Report". Steger, Maczek, Berger. Grubeck-Loebenstein: "Immunizing Against Tetanus in the Elderly: How Long Does Protection Last?") So far, the basic question has been: "Who shall be vaccinated?". Very detailed recommendations have been worked out for that purpose, and some have led to highly complex definitions of which groups should be protected by a particular vaccine. For the future, we will have to reconsider if this question should not be asked the other way round, that is: "Who should not receive a certain vaccination?", based on the hypothesis that this approach may simplify many decision making processes. This would also guarantee optimal information for different target groups in the public health care system but mostly for the general public. Public health care officials and the general public alike have been much concerned with reactions and aversive reactions and side effects. We have to mention that this subject has been the topic of political debates on health, and that single interest groups, even though we must presume in the best of beliefs, have contributed to quite upsetting the public. Without doubt, the Australian health care system still has deficits in organization and substance which to some extent stem from these highly unobjective discussions. It must not be denied, however, that the system of medical care too has not always responded in an optimal way. As a consequence, public health research has been done on background-morbidity which is absolutely essential for scientific discussion. The name of the study, SERMO, is an abbreviation of the term "self-reported-morbidity"; another source for this name is the latin expression "sermo, sermonis".
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The author considers whether the reason for the variety and multiplicity of theories about the transference might lie in analysts' fears of its dangers. He reviews Freud's development of the concept from its origins, when it was seen as resistance, to its use as a fundamental instrument of the treatment, and lays particular emphasis on its perception as a burden. Classical and later authors' conflicting views of the transference and its management are surveyed in the light of the common ground otherwise existing between schools. Views of the negative transference are also presented. Some clinical vignettes are given, showing the analyst responding to the patient's transference, grappling with his own countertransference feelings and using them to illuminate the clinical situation. The author emphasises the importance of the analyst's training and experience in enabling him to withstand the regressive onslaught of the patient's projections without resorting to theory-related or technical defensive measures. In his view, the transference is not in itself a resistance but may be used as such. The analyst must not interpret merely in order to get rid of the anxiety aroused in himself by the patient's regressive feelings. The paper ends with a consideration of the importance of intuition, the countertransference and sublimated projective counter-identification.
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New computer tools for physicians, nurses, and the medical care team will become common in the 1990s. This paper describes a clinical workstation (CWS) development project that uses new technology that moves the technical support for medical decision making from the computer room to the nursing station. Collection, processing, and display of clinical information including patient identification, laboratory, and radiology results and current medications are carried out in the environment of a multi-windowed computer workstation. Easy access to automated medical literature databases from the workstation is also provided. This pilot project has successfully demonstrated a CWS operating on an acute general neurology and neurosurgical inpatient nursing unit and a critical care unit at The Johns Hopkins Hospital.
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"This review presents a probabilistic formulation of the decision making process, leading to a rigorous treatment of migration behaviour for projection purposes....Aggregate-level models may be applied to migration flows for which the objectively measured characteristics of areas of department and destination act as subjectively measured characteristics and stimuli....Individual-level models use event history methods of analysis to introduce a great variety of characteristics of the subject on the decision to move. They lead to projections using microsimulation models. A further step is taken in integrating macro- and microbehavioural models. The use of aggregate and individual characteristics simultaneously leads to more efficient and sophisticated projection models: the factors affecting behaviour at the micro-level cannot be inferred from aggregate studies and conversely."
"Manpower projection models, adapted to an organizational context, may help in forecasting the consequences of a firm's manpower planning in terms of mobility of personnel, and, in this way, may help in determining the future size and structure of manpower. Various applications may be derived from this projection exercise, including, for instance, determination of the impact of varying the size and structure of a personnel pool on total labour costs." (SUMMARY IN ENG AND SPA)
The Municipal Health Services Act with amendments from 1988 defines environmental health promotion activities directed at physical, chemical, biological and social factors as mandatory for the local Norwegian health authorities. In addition, the municipal health services are responsible for health surveillance and for initiating cross-sectorial preventive measures. In 1991, we undertook a national survey among the Norwegian municipal health services to monitor planning activities, manpower resources, cross-sectorial cooperation, and project-oriented activities within the field of environmental health promotion. Less than one-third of the municipalities employed technically trained hygienic personnel. However, three of four municipalities had carried out some environmental health promotion projects within the last two years. The following factors were all independently related to level of environmental health promotion activity: the availability of technical assistance, the level of cross-sectorial cooperation and the size of the population in the municipality. We conclude that this area of health promotion should be improved by better planning, a higher level of technical hygienic competence within the municipal health services, more inter-sectorial cooperation and greater emphasis on visible projects of limited duration.
"It is widely recognized that population projections are increasingly used in formulating policy in many public and private sectors. However, little information exists on the nature of the projections or their users. This paper reports the results of a survey conducted to rectify this situation. The results confirm that the applications of projections are very broad and that the prime area of increase has been in small-area projections. At this level many users make their own projections rather than use official projections and the paper reviews the methodology used to make these projections. A number of suggestions are made for improving communication between national and subnational producers and local users." The geographical focus is on Australia.
The paper focuses on the role that instruments played in the medical discourse of the 19th century. Towards the end of the century, instruments had imbued the medical sciences to such an extent that the situation soon was compared to the vernacular confusion of the biblical tower of Babel. Whereas the autonomical recordings of laboratory apparatus, vouched for guarantee against biased test results, clinicians and general practitioners were finding it difficult to incorporate the new techniques into their daily routines. A tension between the instrument as invention, moulded to fit a particular series of experiments, and the instrument as a reproducible item, was inevitable. Hence, the unification of the science and practice of medicine, became an important topic at the international medical meetings of the late 19th century. Seen in the light of the industrialization and urbanization of occidental culture and society, the instrumentation of medicine entailed a number of significant issues which hinged on the relationship between the biological destiny of man and the artificial wonders of technology. Grand metaphors like the organic machine and the human motor, did not only signal a scientific preoccupation with the shortcomings of the living organism as opposed to the perfection of the machine, but also indicated closer ties between the human body and technology at large. In a certain sense, medical instruments, along with apparatuses such as the camera, the steam-engine, the telegraph, the phonograph and the cinematograph, offered a new set-up of codes with which the body and its functions could be reinterpreted. In this respect, the late nineteenth-century strive for the standardisation and unification of medical instruments, was not irreconcilable with the notion of the l'homme moyen, as conceived, for example, in the work of the Belgian mathematician Adolphe Quetelet. The paper outlines the span of medical measuring devices, dating from the sphygmometer of Jules Hérisson to the technical obsession of the late 19th century physiologists. During the course of fifty years, the purpose of Hérissons instrument, to achieve a common nomenclator for the evaluation of human blood pressure, had been driven to its extreme. Fascinated with the wonders and possibilities of sheer technology, physiologists cultivated the cult of the instrument to such a degree that the very evidence of organic phenomena, was transfigured into graphical projections, the monotonous of the telephone and other technical manifestations.
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PURPOSE: To describe the implementation and evaluation of an adolescent reproductive health peer education program in West Africa. The program, known as the West African Youth Initiative (WAYI), was developed to improve knowledge of sexuality and reproductive health, and promote safer sex behaviors and contraceptive use among sexually active adolescents in Nigeria and Ghana. METHODS: Between November 1994 and April 1997, two organizations, the Association for Reproductive and Family Health (ARFH), based in Nigeria, and Advocates for Youth, based in Washington D.C., supported community-based youth-serving organizations in the two countries to implement peer education projects. Consultants from the African Regional Health Education Centre (ARHEC) in Nigeria provided technical assistance in designing and conducting a quasi-experimental process and outcome evaluation of the projects. RESULTS: There were significant differences over time and between intervention and control groups concerning reproductive health knowledge, use of contraceptives in the previous 3 months, willingness to buy contraceptives, and self-efficacy in contraceptive use. CONCLUSIONS: Overall, the project provides evidence that peer education is most effective at improving knowledge and promoting attitudinal and behavior change among young people in school settings.
The nursing profession is presently at a crucial stage of its development in terms of the popular image it projects. There has been a tendency for nurses to emphasise their technical skills at the expense of the more psychosocial aspects of their role. Due to the highly technical nature of the working environment, critical care nurses are in particular danger of being viewed primarily in that technical light. This paper focuses on the image of critical care nursing held by undergraduate student nurses. The first stage of a longitudinal research project suggests critical care nursing to be a highly popular future career choice for students at the commencement of their course. Data analysis revealed that attraction to this area centred on the perceived emergency, life-saving and highly technical nature of the environment. There was very little emphasis on the more psychosocial aspects of the critical care nurse's role. The implications of this situation for the image of critical care nursing require serious consideration and intervention.