Elsewhere, Bush's record on health matters is equally oblique. In the Department of Defense (DoD), the position of Assistant Secretary for Health Affairs was vacant for some time prior to the turnover of Administrations and no names have even surfaced as far as a nominee for this vital position. Fortunately, the Executive Director of the vast Tricare Management Activity (essentially the whole healthcare system for active duty, retired, and dependents of the military) has been quickly filled with the retirement of its first Director, by the former chief operating officer for Tricare. At least this selection assures continuity of healthcare delivery.In the Department of Veterans Affairs (DVA), the Undersecretary for Health has submitted his resignation but agreed to stay until a replacement is obtained. The whole process of selection has
To television broadcasters good viewing figures are essential in justifying a programme's place in the schedules and, for commercial broadcasters, key to securing the all-important advertising revenue. As a result programme makers are constantly looking for new ways to engage and hold their audience, and allow them to participate in programme formats, particularly as part of live TV shows. One well established way of achieving this is to allow the audience to take part in a televote. Participants are attracted by the sense of direct involvement and influence that televotes provide, and because of this a televote can dramatically increase audience figures. To the operators of a public telephone network, however, these events represent concentrated, abnormal traffic patterns that have the potential to seriously degrade the quality and availability of the network for other applications, consequently specialised network technology needs to be deployed to make these events both manageable and profitable.
vitamin or .by intestinal malabsorption ; this leads to deficiency of 25-hydroxycholecalciferol availability for calcitriol synthesis -and, hence, to an inability to absorb sufficient calcium in the intestine. Renal failure, in which there is deficient loc-hydroxylation, also causes hypocalcaemia. A rare cause of low serum calcium is primary hypoparathyroidism, in which there is deficiency of PTH, thus leading to failure to permit entry of sufficient calcium from the bony skeleton to the blood. In acute pancreatitis there is liberation of free fatty acids (FFAs) into the circulation, formed as digestive products by the action of pancreatic enzymes on local tissues; these FFAs bind calcium, thus removing a significant portion of its functional ionic form. Transfusion of large amounts of citrated blood can also lead to removal of ionic calcium. Certain drugs, such as phenytoin and phenobarbitone, induce the microsomal hydroxylating enzymes in the liver, thereby producing changes in vitamin D metabolism -and hence leading to hypocalcaemia. In neonatal life hypocalcaemia is not infrequently encountered. Furthermore, it is necessary to remember that collection of blood erroneously into EDTA will chelate calciumthereby causing its removal from the blood. In addition, there are other less common causes of hypocalcaemia, including resistance to PTH, resistance to vitamin D, pseudohypoparathyroidism -and hypocalcaemia by way of a number of other mechanisms, too (Cundy and Reid, 1995; Marshall, 1995).References CUNDY T and REID I (1995). Calcium, phosphate and magnesium. In: Clinical Biocbemistry -metabolic and clinical aspects, 87-116 (W J . It receives anonymous data from 438 practices across the UK concerning doctor-diagnosed illnesses, issuing of prescriptions, and out-patient referrals for each person covered by the database. This provides a comprehensive picture of the way patients are managed in practices worldwide.The latest release contains data pertaining to the years 1994-1996, and was drawn from data concerning over two million patients from 288 practices across the UK. It includes information regarding the prevalences of major diseases such as coronary artery disease, stroke, hypertension, diabetes, asthma, and mental illness. Analysis of disease prevalences includes breakdowns by NHS regional office area and by ONS area type, which group areas with similar socio-economic and socio-demographic characteristics. Some of the main findings include:.
health expectancies as a summary measure of the average level of health in a population is considered to have two advantages over other summary measures. Both relate to the ease of communication with non-technical audiences. The first is putting over the concept of an equivalent 'healthy' life expectancy. The second is that health expectancies are measured in units (expected years of life) and this is part of common experience. This does not apply to measures such as mortality rates or incidence rates. Despite the sterling efforts of the network represented by this text, and of the World Health Organization and the Organisation for Economic Co-operation and Development, there remain problems of international standardisation, particularly in unmeasured differences in expectations and norms for health. Progress is being made in improving the comparability of self-report health status data, such as through calibration against established performance tests like Snellen's visual acuity test.The other parts draw extensively on the global perspective, often providing valuable summaries. Part 1 focuses on the main trends in the evolution of the population's health status, including morbidity and disability. Part 2 covers the relevance of health expectancies (social inequalities, sub-national variations, cause-deleted approaches, and mental health). Part 3 considers the pivotal measurement, collection and calculation problems.
9 violence and suicide. Many of these are of course, themselves inherent risk factors for conditions such as heart disease and cancer, which may thus become secondarily affected by the stress response.The individual and diverse expression of distress resulting from the stress response, as exemplified by the organ inferiority hypothesis, must be borne in mind when approaching the management of stress and stress-related illness. The physical, psychological and behavioural realms of the individual must be considered, and a holistic approach to treatment taken where necessary.
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