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Drug interactions may occur when taking multiple medications for several conditions cheap doxycycline 100mg without a prescription. There are two types of treatments for behavioral symptoms: non-drug treatments and prescription medications 100mg doxycycline fast delivery. Non-drug treatments Steps to developing non-drug treatments include: » Identifying the symptom discount doxycycline 100 mg overnight delivery. Often the trigger is a change in the person’s environment, such as: » New caregivers. Because people with Alzheimer’s gradually lose the ability to communicate, it is important to regularly monitor their comfort and anticipate their needs. Prescription medications Medications can be effective in managing some behavioral symptoms, but they must be used carefully and are most effective when combined with non-drug treatments. Medications should target specific symptoms so that response to treatment can be monitored. Use of drugs for behavioral and psychiatric symptoms should be closely supervised. Some medications, called psychotropic medications (antipsychotics, antidepressants, anti-convulsants and others), are associated with an increased risk of serious side effects. These drugs should only be considered when non-pharmacological approaches are unsuccessful in reducing dementia-related behaviors that are causing physical harm to the person with dementia or his or her caregivers. Behavioral: A group of additional symptoms that occur — at least to some degree — in many individuals with Alzheimer’s. Early on, people may experience personality changes such as irritability, anxiety or depression. In later stages, individuals may develop sleep disturbances; agitation (physical or verbal aggression, general emotional distress, restlessness, pacing, shredding paper or tissues, yelling); delusions (firmly held belief in things that are not real); or hallucinations (seeing, hearing or feeling things that are not there). Non-drug: A treatment other than medication that helps relieve symptoms of Alzheimer’s disease. Since 1982, we have awarded over $350 million to more than 2,300 research investigations worldwide. Alois Alzheimer first described the disease in 1906, a person in the United States lived an average of about 50 years. As a result, the disease was considered rare and attracted little scientific interest. That attitude changed as the average life span increased and scientists began to realize how often Alzheimer’s strikes people in their 70s and 80s. The Centers for Disease Control and Prevention recently estimated the average life expectancy to be 78. Today, Alzheimer’s is at the forefront of biomedical research, with 90 percent of what we know discovered in the last 20 years. Some of the most remarkable progress has shed light on how Alzheimer’s affects the brain. Clinical studies drive progress Scientists are constantly working to advance our understanding of Alzheimer’s. But without clinical research and the help of human volunteers, we cannot treat, prevent or cure Alzheimer’s. Clinical trials test new interventions or drugs to prevent, detect or treat disease for safety and effectiveness. Clinical studies are any type of clinical research involving people and those that look at other aspects of care, such as improving quality of life. Every clinical trial or study contributes valuable knowledge, regardless if favorable results are achieved. This protein fragment builds up into the plaques considered to be one hallmark of Alzheimer’s disease. Researchers have developed several ways to clear beta-amyloid from the brain or prevent it from clumping together into plaques. We don’t yet know which of these strategies may work, but scientists say that with the necessary funding, the outlook is good for developing treatments that slow or stop Alzheimer’s. This connection makes sense, because the brain is nourished by one of the body’s richest networks of blood vessels, and the heart is responsible for pumping blood through these blood vessels to the brain. It’s especially important for people to do everything they can to keep weight, blood pressure, cholesterol and blood sugar within recommended ranges to reduce the risk of heart disease, stroke and diabetes. Eating a diet low in saturated fats and rich in fruits and vegetables, exercising regularly, and staying mentally and socially active may all help protect the brain. Our mission is to eliminate Alzheimer’s disease through the advancement of research; to provide and enhance care and support for all afected; and to reduce the risk of dementia through the promotion of brain health. Such distribution does not constitute an endorsement of these parties or their activities by the Alzheimer’s Association. Sever disease is painful irritation and inflammation of the apophysis (growth plate) at the back of the calcaneus (heel bone), where the Achilles tendon inserts. The growth plate is made up of cartilage, which is softer and more vulnerable to injury than mature bone. Sever is most often seen in physically active boys and girls between the ages of 8 and 13 years and is the most common cause of heel pain in this age group.

Protein-bound D-amino acids order 100 mg doxycycline overnight delivery, and to a lesser extent lysinoalanine purchase 100mg doxycycline overnight delivery, decrease true ileal protein digestibility in minipigs as determined with 15N-labeling buy 100mg doxycycline overnight delivery. Milk and nutrient intake of breast-fed infants from 1 to 6 months: Relation to growth and fatness. Total sulfur amino acid requirement in young men determined by indicator amino acid oxidation with L-[1-13C] phenylalanine. Twin preg- nancy: The impact of the Higgins Nutrition Intervention Program on maternal and neonatal outcomes. Ability of the Higgins Nutrition Intervention Program to improve adolescent preg- nancy outcome. The effect of varying protein quality and energy intake on the nitrogen metabolism of parenterally fed very low birthweight (<1600 g) infants. The dietary administration of monosodium glutamate or glutamic acid to C-57 black mice for 2 years. Amino acid excesses for young pigs: Effects of excess methionine, tryptophan, threonine or leucine. Effect of excess levels of methionine, tryptophan, arginine, lysine or threonine on growth and dietary choice in the pig. Protein needs of Chilean pre-school children fed milk and soy protein isolate diets. Protein-Energy Requirement Studies in Developing Countries: Results of Inter- national Research. The amino acid methionine reduces the valproic acid-induced spina bifida rate in the mouse. Effects of ingested steak and infused leucine on forelimb metabolism in man and the fate of the carbon skeletons and amino groups of branched-chain amino acids. The 24-h pattern and rate of leucine oxidation, with par- ticular reference to tracer estimates of leucine requirements in healthy adults. Validation of the tracer-balance concept with reference to leucine: 24-h intravenous tracer studies with L-[1-13C]leucine and [15N-15N]urea. Moderate exercise at energy bal- ance does not affect 24-h leucine oxidation or nitrogen retention in healthy men. Twenty-four-hour oral tracer studies with L-[1-13C]lysine at a low (15 mg⋅kg–1⋅d–1) and intermediate (29 mg⋅kg–1⋅d–1) lysine intake in healthy adults. Changes in total body composition during normal and diabetic pregnancy: Relation to oxygen consumption. Leucine uptake by splanchnic and leg tissues in man: Relative independence of insulin levels. Effects of supplemental methionine on antiserum-induced dysmorphology in rat embryos cultured in vitro. Correlations between brain tryptophan and plasma neutral amino acid levels following food consumption in rats. Short-term neuroendocrine effects of a large oral dose of monosodium glutamate in fasting male subjects. Rat embryo development on human sera is related to numbers of previous spontaneous abortions and nutritional factors. Correlation of aspartate dose, plasma dicarboxylic amino acid concentration, and neuronal necrosis in infant mice. Aspartate-induced neuronal necrosis in infant mice: Protective effect of carbohydrate and insulin. The 24-h whole body leucine and urea kinetics at normal and high protein intakes with exercise in healthy adults. Resting metabolic rate and body composi- tion of healthy Swedish women during pregnancy. Effect of chronic dietary treatment with L-tryptophan on spontaneous salt appetite of rats. Role of insulin and branched-chain amino acids in regulating protein metabolism during fast- ing. Impact of supplemental lysine or tryptophan on pregnancy course and outcome in rats. Adaptation of protein metabolism in relation to limits to high dietary protein intake. Human protein requirements: The effect of variations in energy intake within the maintenance range. Mutagenic activity of glycine upon nitrosation in the presence of chloride and human gastric juice: A possible role in gastric carcinogenesis. Protein-energy requirements of prepubertal school-age boys determined by using the nitrogen-balance response to a mixed-protein diet. Protein-energy requirements of boys 12-14 y old determined by using the nitrogen-balance response to a mixed-protein diet.

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Although order 100mg doxycycline visa, more often than not safe 100 mg doxycycline, this technique will usually come up with the correct diagnosis order 100 mg doxycycline free shipping, the process is time consuming and not cost-effective. A good example of this can be found in the Case Records of the Massachusetts General Hospital feature found in each issue of the New England Journal of Medicine. This strategy is most helpful in diag- nosing very uncommon diseases or very uncommon presentations of common diseases. The hypothetico-deductive strategy, also called diagnosis by probability, involves the formulation of a short list of potential diagnoses from the earliest clues about the patient. Initial hypothesis generation is based on pattern recog- nition to suggest certain diagnoses. This basic differential diagnosis is followed by the performance of clinical maneuvers and diagnostic tests that will increase or decrease the probability of each disease on the list. Further refinement of the differential results in a shortlist of diagnoses and the further testing or the initi- ation of treatment will lead to the final diagnosis. This is the best strategy to use and will lead to a correct diagnosis in most cases. A good example of this can be found in the Clinical Decision Making feature found frequently and irregularly in the New England Journal of Medicine. Heuristics: how we think Heuristics are cognitive shortcuts used in prioritizing diagnoses. The probability that a diagnosis is thought of is based upon how closely its essential features resemble the features of a typical description of the disease. This is analogous to the process of pattern recognition and is accurate if a physician has seen many typical and atypical cases of common diseases. It can lead to erroneous diagnosis if one initially thinks of rare diseases based upon the patient presentation. For example, because a child’s sore throat is described as very severe, a physician might immediately think of gonorrhea, which is particularly painful. The severity of the pain of the sore throat represents gonorrhea in diagnostic thinking. To ignore or minimize the more common causes of sore throat, thinking of a rare disease more often than a common one, is incorrect. Remember that unusual or rare presentations of common diseases such as strep throat, occur more often than common presentations of rare diseases such as pha- ryngeal gonorrhea. The probability of a diagnosis is judged by the ease with which the diagnosis is remembered. The diagnoses of patients that have been most recently cared for are the ones that are brought to the forefront of one’s consciousness. If a physician recently took care of a patient with a sore throat who had gon- orrhea, he or she will be more likely to look for that as the cause of sore throat in the next patient even though this is a very rare cause of sore throat. The availability heuristic is much more problematic and likely to occur if a recently missed diagnosis was of a rare and serious disease. This heuristic refers to the reality that special characteristics of a patient are used to estimate the probability of a given diagnosis. A differential diagnosis is initially formed and additional infor- mation is used to increase or decrease the probability of disease. This tech- nique is the way we think about most diagnoses, and is also called the com- peting hypotheses heuristic. For example, if a patient presents with a sore throat, the physician should think of common causes of sore throat and come up with diagnoses of either a viral pharyngitis or strep throat. After getting more history and doing a physical examina- tion the physician decides that the characteristics of the sore throat are more like a viral pharyngitis than strep throat. This is the adjustment, and as a result, the other diagnoses on the differential diagnosis list are considered extremely unlikely. The adjustment is based on diagnostic information from the history and physical examination and from diagnostic tests. Throughout the patient encounter, new information An overview of decision making in medicine 231 Fig. The problem of premature closure of the differential diagnosis One of the most common problems novices have with diagnosis is that they are unable to recognize atypical patterns. This common error in diagnostic think- ing occurs when the novice jumps to the conclusion that a pattern exists when in reality, it does not. There is a tendency to attribute illness to a common and often less serious problem rather than search for a less likely, but potentially more seri- ous illness. It rep- resents removal from consideration of many diseases from the differential diag- nosis list because the clinician jumped to a too early conclusion on the nature of the patient’s illness. Even experienced clin- icians can make this mistake, thinking that a patient has a common illness when, in fact, it is a more serious but less common one. No one expects the clinician to always immediately come up with the correct diagnosis of a rare presentation or a rare disease. However, the key to good diagnosis is recogniz- ing when a patient’s presentation or response to therapy is not following the pattern that was expected, and revisiting the differential diagnosis when this occurs. Premature closure of the differential diagnosis can be avoided by following two simple rules.

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There are data that suggest that a much lower proportion of patients actually receive treatment for chronic viral hepatitis order 100 mg doxycycline. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www order doxycycline 100 mg with amex. The current literature suggests that public-health programs for the homeless should address issues related to unsafe sex buy discount doxycycline 100 mg on line, drug abuse, homeless- ness, and other lifestyle factors that contribute to adverse health outcomes. Reaching that population is diffcult, and appropriate street-based and shelter-based interventions are potentially effective in doing so. Mobile Health units Community-based mobile services, such as the use of mobile health vans, can mitigate some access issues. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hence, innovative approaches of this type should be considered for hard-to-reach populations. Therefore, the committee offers the following recommendation: Recommendation 5-10. Guidelines for laboratory testing and result reporting of antibody to hepatitis C virus. Testing for hepatitis C virus infection should be routine for persons at increased risk for infection. Lack of ethnic disparities in adult immunization rates among underserved older patients in an urban public health system. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Provision of hepatitis C education in a nationwide sample of drug treatment programs. Preventing and controlling emerging and re- emerging transmissible diseases in the homeless. Establishing a viral hepatitis prevention and control program: Florida’s experience. Integrating multiple programme and policy approaches to hepatitis C prevention and care for injection drug users: A comprehensive approach. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. National hepatitis C prevention strategy: A comprehensive strategy for the prevention and control of hepatitis C virus infection and its consequences. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus in the United States. Screening for chronic hepatitis B among Asian/Pacifc Islander populations— New York City, 2005. Report on the status of state viral hepatitis plans for the Institute of Medicine executive summary of responses (n= ). Eliminating the threat of chronic hepatitis B in the Asian and Pacifc Islander community: A call to action. Low hepatitis B knowledge among pe- rinatal healthcare providers serving county with nation’s highest rate of births to mothers chronically infected with hepatitis B. The estimated direct medical cost of sexually transmitted diseases among American youth, 2000. Chronic hepatitis C in latinos: Natural history, treatment eligibility, acceptance, and outcomes. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Treatment outcomes with pegylated interferon and ribavirin for male prisoners with chronic hepatitis C. Improving diabetes care in mid- west community health centers with the health disparities collaborative. Health care need and utilization: A preliminary comparison of injection drug users, other illicit drug users, and nonusers. Health care access and sociodemographic factors associated with hepatitis B testing in Vietnamese American men. Kaiser and the Health Research and Education Trust survey of employer- sponsored health benefts, - 00. The next plague: Stigmatization and discrimination re- lated to hepatitis C virus infection in Australia. Reliability of the third-generation recombinant immunoblot assay for hepatitis C virus. Racial differences in survival of hepatocellular car- cinoma in the United States: A population-based study.

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In the classroom doxycycline 100mg lowest price, children should not serve themselves food items that are not individually wrapped purchase doxycycline 100mg visa. If you think your child Symptoms has Hepatitis A: Your child may suddenly have a fever and may be tired  Tell your childcare and not want to eat cheap doxycycline 100mg overnight delivery. Childcare and School: If your child is infected, it may take 15 to 50 days for symptoms to start. Call your Healthcare Provider If someone in your home: ♦ has symptoms of hepatitis A. Prevention  Wash hands after using the toilet and changing diapers and before preparing food or eating. Hepatitis A vaccine is recommended for all children 12 to 23 months of age and should be considered for groups at increased risk of hepatitis A. It is rare for children to be infected with hepatitis B with the exception of those children infected by their mothers during pregnancy or childbirth. Children who have chronic hepatitis B infection may be attending childcare or school; however, spread of hepatitis B in these settings is very rare. Jaundice (yellowing of eyes or skin) may be present in adults but it is uncommon in young children. It can be spread person-to-person when blood from an infected person enters an open cut or splashes into the eye or mouth of another person, by sharing any equipment to inject drugs or puncture the skin, such as tattooing or body piercing, or through sexual contact. Although virus can be found in saliva, the amount of virus in the saliva is so low that spread is very unlikely. Some people may have chronic hepatitis B infection and may be infectious for life. Any child, regardless of known Hepatitis B status, who has a condition such as oozing sores that cannot be covered, bleeding problems, or unusually aggressive behavior (e. Hepatitis B virus, as well as other infectious bacteria, may be found in the blood and other bloody body fluids of any person, even when there are no symptoms to suggest infection is present. Wash hands immediately after contact with any body fluids, even if gloves have been worn. It is rare for children to be infected with hepatitis C, the exception may be those children infected by their mothers during childbirth and children who received blood products before July 1992. Most persons infected with hepatitis C develop lifelong infection (chronic infection). While children infected with hepatitis C may be attending childcare or schools, spread of hepatitis C in these settings has not been documented. These symptoms may include fatigue, abdominal pain, and jaundice (yellowing of eyes or skin). Adults may not have symptoms until after 10 to 30 years of chronic (lifelong) infection. It can be spread person to person when blood from an infected person enters an open cut of another person or by sharing equipment to inject drugs or puncture the skin, such as tattooing or body piercing. Any child, regardless of known Hepatitis C status, who has a condition such as oozing sores that cannot be covered, bleeding problems, or unusually aggressive behavior (e. Persons exposed to blood or bloody body fluids from an infected person should call their healthcare provider immediately regarding blood testing. People infected with hepatitis C should be vaccinated against hepatitis A, and all children should be vaccinated against hepatitis B. Hepatitis C virus, as well as other infectious bacteria, may be found in blood and other bloody body fluids of any person, even when there are no symptoms to suggest infection is present. Wash hands immediately after contact with any body fluids, even if gloves have been worn. Fever, sore throat, swollen lymph nodes, or burning or tingling of the skin may be present in the 24 hours before the blisters appear. Saliva of persons may also contain the virus and even people without symptoms can spread it to others. Surfaces and/or objects like mats, floors, locker room surfaces, equipment, and clothing are not likely causes of infection. Follow the athlete’s healthcare provider’s recommendations and specific sports league rules for when the athlete can return to practice and competition. Coaches and Trainers ensure athletes follow these hygiene measures Showering - Shower at school after practice or competition, using liquid soap and water. Equipment and clothing - Change their practice and competition clothing every day. If you think your child Symptoms has Herpes Gladiatorum: A single blister or a cluster of blisters (fluid-filled bumps) may be the only symptom. No Contact Sports: If your child is infected, it may take 2 to 14 days for Until all sores are symptoms to start. Follow your Spread healthcare provider recommendations - By skin to skin contact or touching saliva. Usually and the specific spreads during sports with close physical contact or sports league rules during sports that tend to cause skin abrasions.

The interventions described above targeted at individuals may be less effective if they are imple- mented in populations exposed to widespread tobacco advertising cheap 100 mg doxycycline amex, sponsorship of sporting activities by the tobacco industry discount doxycycline 100 mg without prescription, low-cost tobacco products generic doxycycline 100mg online, and inadequate government tobacco control policies. There is evidence that tobacco consumption decreases markedly as the price of tobacco products increases. Bans on advertising of tobacco products in public places and on sales of tobacco to young people are essential components of any primary prevention programme addressing noncommunicable diseases (140). The cholesterol-raising properties of saturated fats are attributed to lauric acid (12:0), myristic acid (14:0), and palmitic acid (16:0). Stearic acid (18:0) and saturated fatty acids with fewer than 12 carbon atoms are thought not to raise serum cholesterol concentrations (146, 147). The effects of different saturated fatty acids on the distribution of cholesterol over the various lipoproteins are not well known. Trans-fatty acids come from both animal and vegetable sources and are produced by partial hydro- genation of unsaturated oils. Metabolic and epidemiological studies have indicated that trans-fatty acids increase the risk of coronary heart disease (145, 152, 153). It has also been demonstrated that replacing saturated and trans-unsaturated fats with monounsaturated and polyunsaturated fats is more effective in preventing coronary heart disease events than reducing overall fat intake (145, 153, 155). Current guidelines recommend a diet that provides less than 30% of calories from dietary fat, less than 10% of calories from saturated fats, up to 10% from polyunsaturated fats, and about 15% from monounsaturated fats (86, 88, 148). Metabolic studies have shown that dietary cholesterol is a determinant of serum cholesterol concentration (156–158). Reducing dietary cholesterol by 100 mg a day appears to reduce serum cholesterol by about 1% (147). However, there is marked individual variation in the way serum cholesterol responds to dietary cholesterol (159); dietary cholesterol seems to have a relatively small effect on serum lipids, compared with dietary saturated and trans-fatty acids (88, 104, 158). Studies have demonstrated that, in controlled conditions, it is possible to modify behaviour, but in daily life the required intensity of supervision may not be practicable. The effects of advice about reducing or modifying dietary fat intake on total and cardiovascular mortality and cardiovascular morbidity in real-life settings were assessed in a systematic review of 27 studies, comprising 30 902 person–years of observation (160). The interventions included both direct provision of food and, in most trials, dietary advice to reduce intake of total fat or saturated fat or dietary cholesterol, or to shift from saturated to unsaturated fat. The pooled results indicate that reducing or modifying dietary fat reduces the incidence of combined cardiovascular events by 16% (rate ratio 0. The reduction in cardiovascu- lar mortality and morbidity was more pronounced in trials lasting at least 2 years. The protective effect of polyunsaturated fats is similar in high- and low-risk groups for both sources (seafood and plants), and in women and men (104, 155, 161, 162). Epidemiological studies and clinical trials suggest that people at risk of coronary heart disease benefit from consuming omega-3 fatty acids (104, 161, 163, 164). The proposed mechanisms for a cardioprotective role include altered lipid profile, reduced thrombotic tendency, and antihypertensive, anti-inflammatory and antiarrhythmic effects (165–168). A systematic review showed a significant benefit of fish-based dietary supplemental omega-3 fatty acids on cardiovascular morbidity and mortality in patients with coronary heart disease (169, 170). Cohort studies analysing omega-3 fatty acid intake and risk of cardiovascular diseases have shown inconsistent findings, however, and a recent large trial of omega-3 fatty acids did not find any benefits (171). In an attempt to clarify their role, an updated meta-analysis has also been conducted (170, 172). Using data from 48 randomized controlled trials and 41 cohort analyses, an assessment was made of whether dietary or supplemental omega-3 fatty acids altered total mortality, cardiovas- cular events or cancers. Pooled trial results did not show a reduction in the total mortality risk or the risk of combined cardiovascular events in those taking additional omega-3 fats. Population studies have demonstrated that high salt intake is associated with an increased risk of high blood pressure (173). Several observational studies have linked baseline sodium intake, estimated from either 24-hour urinary sodium excretion or dietary intake, to morbidity and mor- tality. In a Finnish study, the hazard ratios for coronary heart disease, cardiovascular disease, and all-cause mortality, associated with a 100 mmol increase in 24-h urinary sodium excretion in men and women, were estimated as 1. A prospective study in a Japanese cohort also showed that high dietary salt intake increased the risk of death from stroke (175). A study in hypertensive patients reported an inverse relation between sodium intake and cardiovascular outcomes (176) and suggested a J-curve relationship. This discordant finding has been attributed to methodologi- cal limitations and further study is needed. The efficacy of reduced sodium intake in lowering blood pressure is well established (176, 177). An average reduction of 77 mmol/day in dietary intake of sodium has been shown to reduce systolic blood pressure by 1. Phase 2 of the Trials of Hypertension Prevention Studies has also documented that a reduced sodium intake can prevent hypertension (178).

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The New Age acolyte is exhorted to eat less fat discount 100 mg doxycycline fast delivery, produce bulky stools buy discount doxycycline 100mg on line, and buy an exercise bicycle buy 100 mg doxycycline visa. While gratuitous violence, terrorism and crime are on the increase, the minders of society talk about tackling the causes of this social unrest. There is nothing wrong with these metaphors, except that it is not clear which river, people and lifesavers. The famous Saint Ber- nard dog, Barry, now stuffed and exhibited in the museum of Natural History in Bern, saved 42 human lives - more than any health promotionist I know. At best they will stare at you; at worst they will try to measure your cholesterol. Too many of our inhabitants worry through life with only fairly good health and while they accomplish their daily duties, these fairly well persons may never know the exuberance and happiness of perfect health. Hence, one goal of the future practitioner of medicine will be the attainment and maintenance of exuberant health, which is the inherent right of every person. This instructive passage, though written nearly 70 years ago, sounds surprisingly modern. Health must be more than the absence of disease, it must be exuberant health, super- health. Is the function of medicine to turn people into economically useful, happy robots? The sort of feeling ordinary people may achieve fleetingly during orgasm, or when high on drugs. Old people drifting into the oblivion of dementia, sour spinsters, jilted lovers, ruined 42 Healthism gamblers, wives of drowned fishermen, victims of violence, or immured lunatics would also spoil the picture. Even Chris- tians, in their boundless optimism, have been more realistic in deferring the promise of complete happiness to the afterlife. In the 1980s health expenditure per head of population fell in about half of the African, two thirds of the Latin American 52 and one third of the Asian countries. Even with training in lesser degrees of exactitude, a layman would shake his head. He also pointed out that pre- ventive medicine is not a substitute for curative medicine, but a luxury for the healthy and an additional expense for 44 Healthism the health service. As with our ability to keep the more chronically ill, handicapped and disabled alive, and to enable more people to survive to old age, the inevitable consequence is an increased demand for hospital beds and medical services to deal with the degenerative diseases of vision, hearing, the cardiovascular system, the respiratory system, the musculo- skeletal system, the urogenital system, and, above all, of the brain. The Asian and African countries, with the exception of Ghana and Sudan, did not attend. The signatories of the Ottawa charter pledged: to acknowledge people as the main health resource; to support and enable them to keep themselves, their families and friends healthy through financial and other means, and to accept the community as the essential voice in matters of its health, living conditions and well-being. The British are traditionally a reticent people, taught to accept adversity with a stiff upper lip, to face the music with chin up and never to grumble. Thus views of visionaries such as Aleck Bourne in his book Health for the Future were seen 58 as eccentric. It should be our aim by coordinated effort to produce the Whole Man of high order. But it was only when public health in Britain fell under the dominating influence of American public health ideology that the health promotion rhetoric from both countries became indistinguishable. This ideology postulates that society needs anticipatory medicine both at individual level and at national level. At the same time, individuals need personal counselling about their lifestyle, and regular medical screen- ing. The agnostic Montaigne put it more strongly: Physicians are not content to deal only with the sick, but they will moreover corrupt health itself, for fear that men 59 should at any time escape their authority. Matters of daily living - habits, attitudes, sexuality, beliefs - they all become legitimate concerns of health promotionists. The American Journal of Health Promotion discussed vari- ous definitions of health promotion. Optimal health is defined as a balance of physical, emotional, social, spiritual and intellectual 62 health. As some of these barriers include racism, intolerance, bigotry, contempt for losers and victim-blaming, the job of health promotion officer would be quite a handful. In the London School of Hygiene and Tropical Medicine, there is now a unit called Health Promotion Sciences. The health promoter is not only a scientist, but also a doctor, psychologist cum psychiatrist, social expert, spiritual advisor and an intellectual! Because it deals with universal happiness it is immune to criticism, which, anyway, could only come from misanthropists or fools.

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