Journal of the Royal Society of Health最新文献

The case is presented of a 65 year old lady with recent onset of neuromuscular manifestations, comprising paraparesis, areflexia and unsteady gait, along with episodes of slurring of speech and diplopia, later confirmed to be due to severe hypercalcaemia--which itself was caused by primary hyperparathyroidism. Restoration of normocalcaemia, by means of rehydration and bisphosphonate therapy, resulted in clinical improvement--whilst subsequent parathyroidectomy was followed by complete resolution of all symptoms. In order to make prompt differentiation between the neurological sequelae of hyperparathyroidism and a primary neurological disorder, a high index of suspicion is required. An urgent serum calcium assay, as part of a bone profile, is mandatory in patients who present with neurological symptoms--especially the elderly, amongst whom hyperparathyroidism is especially common.

The growing influence of non governmental organizations (NGOs) in international health is occurring in the face of major challenges and opportunities. These challenges include the continued increases in global poverty status, the growing influence of private-funded health systems, the need for sustainability of external-funded programs, and the clamour for community participation in the planning and management of external-funded programs. Opportunities include the near universal recognition of the indispensable roles of NGOs by bilateral institutions and governments, the current emphasis on global trade by developed countries, and the need to develop political and economic systems that are equitable and promote social development. This article is an overview of these challenges and how these challenges can become excellent opportunities for NGOs to improve the health and social development of target communities in developing countries.

This study compares numbers of dentists in the countries of the European Union (EU) from 1970 to 1994 with dentist to population ratios and dental caries levels in 12-year-olds, sets the changes which have emerged against other changing dental disease patterns (including those unconnected with caries levels) and goes on to determine the significance of the findings to the problems of dental workforce planning. Data for the numbers of dentists and dentist to population ratios were obtained from published tables. Data for past caries levels in 12-years-olds were obtained from the WHO Global Data Bank. All other data were obtained from Chief Dental Officers in all countries of the EU. In 1994 there were 222,090 practising dentists in the EU and 12,853 other clinical workers of whom 11,493 were dental hygienists. Since 1970, the dentist:population ratios for Spain and Portugal have improved markedly, the improvement for other countries has been less marked and in Austria a small reduction has occurred. Six countries show a considerable reduction in caries levels for 12-year-olds between 1970 and the 1990s, five show smaller reductions and three show a deterioration. As a consequence of the general improvement in caries levels in most of these countries it is probable that workloads in relation to the treatment of caries are falling, particularly for younger age groups. However, because of the overall ageing of populations in many industrialised countries the workload for older age groups is increasing, as older adults increase in number, a greater proportion retain their teeth and are afflicted by a range of problems, which include, but are not exclusive to, dental caries. There are few data for these older age groups than for caries levels in 12-year-olds. It was concluded that those planning the EU dental workforce of the future should take account of reliable epidemiological data for all groups of the population and, as these are not currently available, that suitable periodic oral health surveys covering all population age groups should be carried out regularly in all EU member states.

Are the changes in faecal bile acid concentrations the cause of colorectal cancer or one of its effects? This is an area of controversy mainly due to the lack of a clear explanation as to how the bile acid concentrations are controlled under different circumstances. This review presents an outline of the evidence that bile acids are both a causal factor in colorectal cancer and that their concentrations are affected by it in a synergistic manner. It also offers an explanation of how some dietary fibre protects against colorectal cancer.

The aim of this study was to ascertain the activity of a selection of widely-used antiseptic/disinfectant agents against antibiotic resistant bacteria and strains isolated from patients infected with clinically significant species. Four antiseptic agents (Dettol, Dettol Hospital Concentrate, Savlon and Betadine) were tested against Staphylococcus aureus, Methicillin Resistant S. aureus (MRSA), Enterococcus hirae, Vancomicin Resistant Enterococcus sp (VRE), Escherichia coli and E. coli 0157. The antiseptics were applied at recommended use dilutions and at a half and a quarter of those concentrations in a standard suspension test (EST). Organic material was added to mimic the presence of blood, protein and other such contaminants to be found in the clinical situation. All antiseptics tested were effective against both the antibiotic sensitive and antibiotic resistant strains of S. aureus and E. hirae as well as normal and clinical strains of E. coli at recommended concentrations. All but Betadine were also effective against the antibiotic resistant bacteria at a half and a quarter of normal concentration. The iodine containing antiseptic, however, failed the test against MRSA at a half normal concentration and showed virtually no activity against MRSA at a quarter normal concentration.

The importance of regular monitoring of both serum lithium and creatinine levels, together with thyroid function assessment, in a patient taking lithium carbonate therapy for bipolar affective disorder (hypomanic type) is emphasised. In this case it was the gradual rise of serum creatinine that alerted the physician to the onset of insidiously progressive renal impairment. In the absence of any evidence for another aetiology, it was concluded that a possible cause for the renal problem was the lithium therapy itself. By reducing the dosage it was found that serum lithium levels were maintained within the reference range, thus avoiding the potential psychiatric consequences of high concentrations--which could well have occurred had the former dosage been continued during the period of deteriorating renal function. The situation is currently being carefully monitored in case another cause for renal disease, other than that of a side-effect of therapy, emerges at a later date.