Journal of the Royal Society of Health最新文献

A major threat to the validity and reliability of health and social surveys is that questions asked are regarded as threatening. This leads to the unpredictability of social desirability bias, which can skew responses in a variety of directions. The types of situations in which this may occur are outlined, together with a ten point approach that will assist in overcoming the problems.

Managers come to their task with their frames of reference--certain assumptions--a mind set. They wish to be seen as rational and consistent; to live rent-free in their comfort zones. There is the lure of 'Social Proof'; to act like others placed in a similar situation. Deviance is seen as counter-cultural. This approach is no longer tenable; the antiquity of an error is no reason for its continuance. The entrepreneurial manager must move from the concept of 'fit'--resources to match objectives--to one of 'stretch', which argues for a misfit between strategy and resources; between funding and aspirations. One must do more with less.

A one year cohort of 67 overdose attempts among youth (15-24 years) was examined as part of a case control study. The prevalence rate of 105 per 100,000 population is lower than reported rates in the West but higher than those for the region. The majority of attempters were females and nationals who used paracetamol, and their suicide intent was low. Thirteen percent visited a helping agency in the previous week and 18% in the previous month. The most common difficulties preceding the overdoses were problems with parents, school or work, social isolation and problems with boyfriends, or girlfriends respectively. Adjustment disorder was the most common diagnosis followed by depression. A seasonal variation was noted with 46% of the cases occurring in the summer months. The implications of these findings with respect to future policy making and prevention were discussed.

The effects of smoking habits on thyroid function, echo-texture (nodules and/or cysts) and thyroid gland volume were determined by using ultrasound and measuring serum Thyroxin (T4), Triiodothyronine (T3), Thyrotropin (TSH) and TPO antibodies (ab-TPO) in 189 healthy smokers and non-smokers, randomly selected (111 females and 78 males) among the employees of our hospital and their relatives. When the entire group of subjects was considered the mean ratio of thyroid gland volume/body weight was found to be significantly higher in male (P < 0.05) and female (P < 0.05) smokers compared with non-smokers. In female smokers, mean serum thyroid-stimulating hormone (TSH) was lower (P < 0.05) and the degree of smoking was positively correlated with the ratio of thyroid gland volume/body weight (P < 0.05). However, when the subjects with a family history of goitre in first degree relatives were excluded from our study (14 females and 9 males), no significant differences in mean ratio of thyroid volume/weight or TSH between the remaining smokers and non-smokers were detected. In both sexes, the correlation between the degree of smoking and thyroid volume, although positive, did not reach statistical significance. No difference in prevalence of abnormal echogenicity and echo-texture (nodules and cysts) between smokers and non-smokers was detected. It is concluded that smoking habits present a goitrogenic effect only in subjects with a family history of goitre but have no influence on thyroid gland texture.

The case is presented of a 62 year old doctor with insulin-dependent diabetes mellitus (IDDM) who experienced severe nocturnal hypoglycaemia following a total intake for the day of fruit and yoghurt (providing 230 kcal) for breakfast, four pints of beer (providing 540 kcal-which included the energy from 37.0 g carbohydrate) later in the day and an evening meal containing approximately 123 g of carbohydrate (providing 1050 kcal). He had taken insulin, as was his custom, just before breakfast, half-an-hour prior to the evening meal and again two-and-a-half hours afterwards. He felt entirely well when he retired to bed at 2100 h. He awoke later, having dreamt that he was practically immobile-but then found to his horror that the dream was true. He soon realised that he was severely hypoglycaemic and, as he had no glucose immediately available, had no alternative but in some way to attempt the journey to the kitchen where there was non-diet mandarin drink available in tin cans inside a refrigerator. He was able later to recall and, in consequence, describe the whole terrifying experience in great detail, on account of the remarkable preservation of mental clarity. The clinical features of the episode are viewed in terms of the relationships between alcohol intake, carbohydrate ingested and the insulin administered. Exercise was minimal on this day.