Recurrent acute hepatic dysfunction in severe anorexia nervosa

Anorexia nervosa (AN) is an eating disorder predominantly affecting young women. Abnormal liver function tests (LFT's) resulting from AN is well‐described but to date few cases of dramatic rises in liver enzymes have been described. We report a 32‐year‐old women with severe anorexia having dramatic rise in LFT's with liver failure during extremely poor nutritional status. Acute rise in liver enzymes observed on several occasions in this patient resulted from ischaemic hepatitis secondary to liver hypoperfusion. Clinicians caring for patients with severe AN should monitor haemodynamic parameters with the knowledge that acute liver failure can be a consequence of sudden liver hypoperfusion. Therapeutic intervention comprising volume support with gradual nutritional support results in normalization of LFT's. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010; 43:770–772     

长期护理保险筹资:德日韩经验与中国实践

通过对德日韩长期护理保险筹资模式、渠道、责任分担和筹资水平的比较发现,三国筹资政策符合本国国情与制度传统,实行多渠道独立筹资,但三国经验亦表明,筹资责任要各方合理分担,现收现付筹资模式也难以应对人口老龄化的挑战。近年来,我国多地相继开展了长期护理保险实践,从筹资渠道、方式、责任分担和筹资水平四个维度对我国13个地区长期护理保险筹资情况进行比较分析发现,我国长期护理保险筹资存在诸多争议,未来我国长期护理保险筹资还需要从多方面加以完善。     

Reduced uncertainty as a diagnostic benefit: an initial assessment of somatostatic receptor scintigraphy's value in detecting distant metastases of carcinoid liver tumours

This paper employs classical concepts of diminishing marginal utility to demonstrate that risk-aversion can increase the perceived value of diagnostic procedures and thus raise optimum diagnostic expenditures. The theory is applied to a model in the spirit of Phelps and Mushlin's initial technology assessments. The specific evaluation is the cost-effectiveness of somatostatin receptor scintigraphy used to detect distant metastases of carcinoid liver tumours in a patient otherwise eligible for surgical resection of the liver. Data for the model are taken from published sources and financial databases, when available, and otherwise from a senior clinician's experience (LKK). The quantitative results indicate that receptor scintigraphy may have two beneficial impacts to risk-neutral individuals. First, it may reduce the combined costs of therapy and treatment because the diagnostic procedure costs less than the expected savings generated by avoiding inappropriate surgeries. Second, it may improve the patient's expected health-status-adjusted life years (HSALY) because the information allows physicians to better match treatment to the cancer's stage. Finally the paper demonstrates that risk aversion, as embodied in classical diminishing marginal utility applied to health status, can increase the value of the diagnostic tests and can lead the patient to choose a less beneficial treatment. An illustrative risk-averse utility function changed the optimum treatment from surgery to chemotherapy and increased scintigraphy's benefit by 500%. © 1998 John Wiley & Sons, Ltd.     

We Can Handle This: Parents' Use of Religion in the First Year Following Their Child's Diagnosis with Cystic Fibrosis

The diagnosis of a child's life-shortening disease leads many American parents to utilize religious beliefs. Models relating religious constructs to health have been proposed. Still lacking are inductive models based on parent experience. The specific aims of this study were: 1. develop a grounded theory of parental use of religion in the year after diagnosis; 2. describe whether parents understand a relationship between their religious beliefs and their follow-through with their child's at-home treatment regimen. Fifteen parent interviews were analyzed using grounded theory method. Parents used religion to make meaning of their child's cystic fibrosis (CF) diagnosis. Parents imagined God as active, benevolent, and interventionist; found hope in their beliefs; felt supported by God; and related religion to their motivation to adhere to their child's treatment plan. Religious beliefs are clinically significant in working with many parents of children recently diagnosed with CF. Interventions that improve adherence to treatment may be enhanced by including religious aspects.     

Women's health theorizing: a call for epistemic action

The women's health community is challenged by global social and economic pressures. In order to ensure the salience of their empirical and theoretical research, women's health researchers are struggling with an analysis of what has successfully typified women's health and a critical awareness of the pressures that will mark its future. For many researchers, this has provoked a quest for new women's health paradigms to inform and spur action regarding the future of women's health. Re-theorizing women's health cannot be successful in the absence of an analysis of the epistemological orientation of women's health research. However, little has been done to examine these epistemological roots. This paper examines the historic epistemological foundation of women's health research in order to facilitate an understanding of the theoretical and conceptual underpinnings of women's health. This review is intended to guide future epistemic action necessary to advance the field of women's health research and highlight current efforts that may support work in this field.     

Lemierre's Syndrome Caused by Klebsiella pneumoniae in a Diabetic Patient: A Case Report and Review of the Literature

Lemierre''s syndrome is characterized by an oropharyngeal infection with internal jugular vein thrombosis followed by metastatic infections in other organs. This infection is usually caused by Fusobacterium spp. In this report, we present a rare case of Klebsiella pneumoniae-associated Lemierre''s syndrome in a patient with poorly-controlled diabetes mellitus. The infection was complicated by septic emboli in many organs, which led to the patient''s death, despite combined antibiotics, anticoagulant therapy, and surgical intervention. Therein, a literature review was performed for reported cases of Lemierre''s syndrome caused by Klebsiella pneumoniae and the results are summarized here.     

ILLUMINATING SOCIAL DETERMINANTS OF WOMEN'S HEALTH USING GROUNDED THEORY

Emphasis in health policy has shifted from curative intervention to prevention and health promotion through personal responsibility for lifestyle choices and, most recently, to the social determination of health. These shifts draw attention to and legitimize women's health research that moves beyond biomedical, epidemiological, and subjective knowledge to question previously unquestioned societal norms and structures that influence women's health. The challenge is to avoid relying solely on population-based studies that support relationships between social determinants and indicators of women's health and to find ways to illuminate the processes by which social determinants interact with the health of specific groups of women. Without such research, our knowledge of how social factors that underpin women's health interact will be faceless and will not address the interplay of health and social policy within women's lives. One research method that may be useful for exploring the interplay between such policies and women's health is grounded theory. Grounded theory is a widely used approach in women's health research. The goal of grounded theory is the discovery of dominant social and structural processes that account for most of the variation in behavior in a particular situation. Despite the usefulness of this method for capturing the interaction between social conditions and women's health experiences, many grounded theory researchers restrict themselves to women's subjective experiences as a source of data for theory development. Consequently, the resultant theory's capacity to illuminate the effects of the social determinants of health is limited. The purpose of this article is to discuss how the grounded theory method can be used in a participatory way to theoretically sample structural conditions at many levels. Using examples from completed and ongoing women's health research where data have and have not been collected primarily from women themselves, we outline the benefits and process for using grounded theory to influence health and public policy in women's health.     

Pseudo-Bartter's syndrome,diuretic abuse,idiopathic edema,and eating disorders

Literature concerning Bartter's syndrome, pseudo-Bartter's syndrome, idiopathic edema, and diuretic abuse is reviewed. The authors suggest that many of the patients who present with the physiological disturbances associated with pseudo-Bartter's syndrome or with diuretic abuse, and a subgroup of those who use diuretics for idiopathic edema, have an underlying eating disorder. The pharmacology and physiology of diuretics are reviewed.     

‘About as comfortable as a stranger putting their finger up your nose’: speculation about the (extra)ordinary in gynaecological examinations

In public health education, gynaecological examinations are presented as a routine and ordinary procedure. Medical research addressing women's reasons for screening reluctance emphasises underlying psychological categories of ‘anxiety’ and ‘poor coping’. Minimal attention is paid to the effects of clinicians' interventions upon women's decision-making. Normalising promotes women's participation as speculum examinations are an essential part of many contemporary diagnostic and treatment procedures. In-depth email interviews were conducted with 26 women with diagnosis of either of the two commonest viral sexually transmitted infections, human papilloma virus and herpes simplex virus, and 12 sexual health clinicians. Data were analysed thematically. Findings indicate that women's screening compliance is influenced by clinicians' (in)attention to power relations, rapport-building, attentiveness to bodily (dis)comfort, technical skill and gender. Women's feedback is a valuable resource in devising interventions that may promote participation in examinations.     

Family Literacy: Exploring Family Practices

For many decades, research has supported the family's influence and their children's acquisition of literacy. Family literacy theories have been generated and challenged, while studies have been conducted on the family's application of literacy interactions, experiences, strategies, materials, influential factors and programs in a variety of context and both inside and outside the home. Most studies suggest that family literacy contributes to young children's literacy development.     

Oncogenic Implications of Chromosomal Instability

The presence of the distinctive formations known as Lewy bodies within brain cells has been linked to senile dementia. A pattern of clinical features helps distinguish Lewy body dementia from Alzheimer's and Parkinson's diseases. Differentiation can be important, because many patients with Lewy body dementia have a hypersensitivity to neuroleptic medications.     

BEING FEMALE: THE PORTRAYAL OF WOMEN'S HEALTH IN PRINT MEDIA

In this article, we examine the portrayal of women's health issues in two of Melbourne's print media: The Age and the Herald Sun . In particular, we aim to examine the patterns of coverage of women's health and the underlying message in articles on women's health issues. We employed an unobtrusive method, and the study was conducted over a three-month period: May to July 1998. We found that many of the articles and public reactions centred on women and reproduction. This implies that women are still seen in relation to their reproductive role in Australian society. In addition, there are many issues regarding women and their health missing from the media's publication during the research period. The message emerging from the analysis implies that if women do not fit into the "ideal women" framework of the society, their health needs are given little attention by the print media and, therefore, their health is likely to suffer. This can be interpreted as one form of women's oppression in Australian society.     

Applications of a job classification system in occupational epidemiology.

An occupational preventive medicine program attempts to control exposure so workers experience no detrimental effect on health. In a chemically complex industry, the definition of exposure is difficult because of the many different chemicals used and produced, the many different jobs and processes with qualitatively different exposures, and the movement of workers from job to job. Jobs have therefore been grouped on the basis of process or product into functionally homogeneous categories called occupational titles (OT''s). Work experience can now be quantified independent of exposure (or by the dominant toxicants in each OT) and compared to health outcomes. Examples are discussed of the application of OT''s to studies of the mortality and morbidity experience in the rubber industry, and the development of dose-response relations.     

‘Mobile men with money’: the socio‐cultural and politico‐economic context of ‘high‐risk’ behaviour among wealthy businessmen and government officials in urban China

China's transition from an injection drug‐driven HIV epidemic to one primarily transmitted through sexual contact has triggered concern over the potential for HIV to move into the non‐drug‐injecting population. Much discussion has focused on the migrant men of China's vast ‘floating population’ who are considered a high‐risk group. As a result, many men who frequently engage in high‐risk behaviour but are not included in this especially vulnerable group are evading HIV prevention messages. This paper highlights the socio‐cultural and politico‐economic factors that motivate many of China's wealthy businessmen and government officials, sometimes referred to as ‘mobile men with money’, to engage in such behaviour. Examination of the activities related to the work of these men reveals a situation where the confluence of a market‐oriented economy operating within a socialist‐style political system under the influence of traditional networking practices has engendered a unique mode of patron‐clientelism that brings them together over shared social rituals including feasting, drinking and female‐centered entertainment that is often coupled with sexual services. As a result, consideration of the socio‐cultural factors influencing these men's sexual practices is important for responding to the newly emerging stage of China's HIV epidemic.     

Changing global essential medicines norms to improve access to AIDS treatment: Lessons from Brazil

Abstract

Brazil's large-scale, successful HIV/AIDS treatment programme is considered by many to be a model for other developing countries aiming to improve access to AIDS treatment. Far less is known about Brazil's important role in changing global norms related to international pharmaceutical policy, particularly international human rights, health and trade policies governing access to essential medicines. Prompted by Brazil's interest in preserving its national AIDS treatment policies during World Trade Organisation trade disputes with the USA, these efforts to change global essential medicines norms have had important implications for other countries, particularly those scaling up AIDS treatment. This paper analyses Brazil's contributions to global essential medicines policy and explains the relevance of Brazil's contributions to global health policy today.     

Lymphatic filariasis: diagnosis and pathogenesis. WHO expert committee on filariasis.

In the past few years, knowledge of many aspects of lymphatic filariasis, s debilitating disease with serious economic and social consequences, has increased. This article presents sections on diagnosis, pathogenesis, immunopathology and protective immunity from the recently published Expert Committee''s report.     

The 6S-model for person-centred palliative care: A theoretical framework

Palliative care is provided at a certain timepoint, both in a person's life and in a societal context. What is considered to be a good death can therefore vary over time depending on prevailing social values and norms, and the person's own view and interpretation of life. This means that there are many interpretations of what a good death can actually mean for an individual. On a more general level, research in palliative care shows that individuals have basic common needs, for example physical, mental, social and spiritual well-being. Therefore, in today's pluralistic Western society, it becomes important that palliative care is person centred to enable individuals to receive, as far as can be achieved, care that promotes as good a life as possible based on the person's own needs and preferences, and in accordance with evidence and current laws. For many years a research group, consisting nurse researchers together with nurses working in palliative care, has developed a model for person-centred palliative care, the 6S-model. The model's central concept is Self-image, where the starting point is the patient as a person and their own experience of the situation. The other concepts: Self-determination, Symptom relief, Social relationships, Synthesis and Strategies are all related to the patient's self-image, and often to each other. The model's development, value base and starting assumptions are reported here, as are examples of how the model is applied in palliative care in Sweden. The model has been, and still is, constantly evolving in a collaboration between researchers and clinically active nurses, and in recent years also with patients and close relatives.     

全球肝癌流行数据解析

肝癌是造成世界癌症负担的主要癌种之一。通过对全球肝癌发病、死亡、生存数据的回顾分析,总结其在地区、年龄、性别和组织学亚型上的分布差异及其发展趋势。提示全球不同国家处在肝癌防治的不同阶段,应积极借鉴和推广肝癌防控成功国家的经验,制定包括降低黄曲霉毒素暴露水平、推广疫苗接种、加强肝炎慢性感染的治疗和实施肝癌早诊早治技术等符合各国国情的综合干预措施。     

The Public Health Service action plan to improve access to immunization services. The Interagency Committee to Improve Access to Immunization Services.

The Public Health Service''s Interagency Committee to Improve Access to Immunization Services (ICI) has responsibility for improving the immunization protection of the nation''s children and other vulnerable populations. ICI''s Action Plan to Improve Access to Immunization Services sets 14 goals with 120 action steps for improving immunization services nationwide by (a) increasing coordination among Federal health, income, housing, education, and nutrition programs; (b) reducing policy and management barriers that limit access to delivery systems, and (c) strengthening the delivery infrastructure. To accomplish the goals of the plan, there is a $72.0 million increase in funding appropriated in fiscal year 1992 specifically for this purpose. The President''s Budget for fiscal year 1993 includes a $24.5 million increase for continued program implementation. The additional resources will be used to address delivery and access problems, which have been determined to be the primary factors limiting immunization for many children.     

Women's lives: Pressure and pleasure,conflict and support

Caring relationships are central to women's lives, producing conflict and support, pressure and pleasure. In this paper I explore how caring relationships in family and work contexts influence women's health in complex ways. Evidence from many studies suggests that women remain healthy despite multiple demands and that caring relationships have positive effects on women's health.