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In his emotional speech to Labour’s centenary conference in September 1999 avana 50 mg line, Tony Blair reaffirmed the government’s commitment to tackling inequalities in British society and pledged to ‘end child poverty within a generation’ buy avana 50mg amex. While this went down well with party traditionalists, Blair was careful to put the distinctive New Labour spin on the concept of equality. Thus he reaffirmed that, for New Labour, ‘true equality’ meant ‘equal worth’, not primarily a question of income, more one of parity of esteem. As Gordon Brown put it, poverty was ‘not just a simple problem of money, to be solved by cash alone’, but a state of wider deprivation, expressed above all in ‘poverty of expectations’. In case there was any 92 THE POLITICS OF HEALTH PROMOTION misunderstanding, Anthony Giddens, chief theoretician of the third way, bluntly explained that there was, ‘no future’ for traditional left- wing egalitarianism and its redistributionist ‘tax and spend’ fiscal and welfare policies (Giddens 1999). Instead ‘modernising social democrats’ needed ‘to find an approach that allows equality to coexist with pluralism and lifestyle diversity’. Giddens’ new egalitarianism meant accepting wide differentials in income, but insisting on ‘equal respect’. New Labour’s message to the poor was: never mind the width of the income gulf—feel the quality of our recognition of your pain. A continuing tension between Old and New Labour approaches to inequality was also apparent in the health inequalities debate. For one group of traditionalists, based in Bristol, ‘poverty really is a problem of the lack of enough money—if you give poor people enough money they stop being poor—it is as simple as that’ (Shaw et al. For Richard Wilkinson at Sussex University, a prominent figure in this debate over two decades, it was not so simple. He maintained that social differentials in health were the result of ‘psychosocial’ rather than material factors, as the ‘chronic stress’ generated by a polarised society takes its toll on the health of those who are relatively worse off (Wilkinson 1996:214–15). Whereas the Bristol group insisted that ‘poverty reduction really is something that can be achieved by “throwing money at the problem”’, Wilkinson argued that the solution lay in strategies to ‘achieve narrower income distribution and better social cohesion’ (Shaw et al. In the harsh world of politics, New Labour’s slavish devotion to Tina, fiscal rectitude and electoral expediency mean that it has no intention, either of raising benefits to the poor, or of doing anything to reduce income differentials. The Bristol group’s repeated demands that such measures ‘should be their top priority’ in face of the unmistakable evidence that government policy is moving in the opposite direction reflect the pathological dependence of Old Labour on New Labour, like that of the battered wife who cannot abandon her abusive partner. Yet, while the government is doing nothing to reduce income differentials, it is very active around issues of health inequalities and social exclusion. Back in 1995 the Kings Fund ‘agenda for action’ against health inequalities indicated four levels of policy intervention: • strengthening individuals; • strengthening communities; 93 THE POLITICS OF HEALTH PROMOTION • improving access to essential facilities and services; • encouraging macroeconomic and cultural change. Level three interventions concerned attempts to promote collaboration in the cause of health among government departments responsible for areas such as employment, housing, education and welfare. Thus, for practical purposes, tackling inequalities in health was a question of individual and community initiatives.

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It is also our modest wish that this book pro- because many childhood diseases (including measles order avana 100mg with amex, mumps cheap 200mg avana with amex, vide valuable information to students and readers regarding whooping cough, and diphtheria) have been effectively con- topics that play an increasingly prominent role in our civic trolled in both developed and developing countries, some par- debates, and an increasingly urgent part of our everyday lives. Lee Lerner & Brenda Wilmoth Lerner, editors suddenly appears, many more children are susceptible. Remy, France A third reason for the rise of infectious diseases is that the June 2002 increasing use of medications that prolong the life of the eld- erly, and of treatments that lower the disease resistance of Editor’s note: World of Microbiology and Immunology is patients, generally weaken the ability of the immune system to not intended to be a guide to personal medical treatment or fight diseases. Readers desiring information related virus (HIV), the virus responsible for AIDS, are a high-risk to personal issues should always consult with their physician. For this reason, tuberculosis (TB) has increased in the desiring current information related to emergency protocols— U. Nearly half the world’s population is especially with regard to issues and incidents related to bioter- infected with the bacterium causing TB, though for most peo- rorism—consult the United States Centers for Disease Control ple the infection is inactive. However, many thousands of new and Prevention (CDC) website at http://www. How to Use the Book Furthermore, the organism causing these new cases of TB is The articles in the book are meant to be understandable resistant to the antibiotics that were once effective in treating by anyone with a curiosity about topics in microbiology or the disease. Cross-references to related articles, definitions, overuse of antibiotics over the last 70 years. Although far from containing a compre- with the pandemic influenza outbreak of 1918 and 1919 would hensive collection of topics related to genetics, World of never recur. However, the emergence of AIDS dramatizes the Microbiology and Immunology carries specifically selected fact that microorganisms can still cause serious, incurable, topical entries that directly impact topics in microbiology and life-threatening diseases. For those readers interested in genetics, the edi- is still much microbiological research to be done, especially in tors recommend Gale’s World of Genetics as an accompanying relation to the fields of immunology and chemotherapy. For those readers interested in additional informa- Recent advances in laboratory equipment and techniques tion regarding the human immune system, the editors recom- have allowed rapid progress in the articulation and under- mend Gale’s World of Anatomy and Physiology. In addition, rapidly developing knowl- Immunology has been designed with ready reference in mind: edge of the human genome offers hope for treatments designed • Entries are arranged alphabetically rather than to effectively fight disease and debilitation both by directly chronologically or by scientific field. In addition to clas- attacking the causative pathogens, and by strengthening the sical topics, World of Microbiology and Immunology body’s own immune response. Canadian Society of Microbiologists • Bold-faced terms direct the reader to related entries. Nova Scotia, Canada • “See also” references at the end of entries alert the Eric v. SUNY Upstate Medical University • A Sources Consulted section lists the most worthwhile Syracuse, New York print material and web sites we encountered in the com- pilation of this volume. Bologna, Italy • The Historical Chronology includes many of the sig- nificant events in the advancement of microbiology and Judyth Sassoon, Ph. The most current entries date from just Department of Biology & Biochemistry days before World of Microbiology and Immunology University of Bath went to press. Bath, England • A comprehensive General Index guides the reader to Constance K.

Immediate transfer is ideal cheap avana 50mg otc, as management in an acute specialised unit is associated with reduced mortality order avana 200mg mastercard, increased neurological recovery, shorter length of stay and reduced cost of care, compared to treatment in a non- Box 5. The objects of management are to prevent • To prevent further spinal cord damage by reduction and further spinal cord damage by appropriate reduction and stabilisation of spine stabilisation of the spine, to prevent secondary neuronal injury, • To prevent secondary neuronal injury and to prevent medical complications. Unfortunately, some patients will not be fit enough for immediate transfer because of Box 5. In such cases it is advisable to consult, and perhaps arrange a visit by, a Patient unfit to transfer—multiple injuries —need for emergency surgery spinal injuries consultant. Transfer to a spinal injuries centre is —severe respiratory impairment most easily accomplished by means of a Stryker frame, which —cardiorespiratory instability can be fitted with a constant tension device for skull traction. Consider visit by spinal injuries consultant The RAF pattern turning frame is similarly equipped and was specifically developed for use by the Royal Air Force. In civilian practice, studies have shown that patients can be safely transferred from emergency departments using the standard 23 ABC of Spinal Cord Injury techniques for cervical immobilisation described earlier. Tetraplegic patients should be accompanied by a suitably experienced doctor with anaesthetic skills, who can quickly intubate the patient if respiratory difficulty ensues. Transfer by helicopter is often the ideal and is advisable if the patient has to travel a long distance. Spine 1993; 18:955–70 • Tator CH, Duncan EG, Edmonds VE, Lapczak LI, Andrews DF. Neurological recovery, mortality and length of stay after acute spinal cord injury associated with changes in management. Amsterdam: Elsevier Science Publishers, 1992 24 6 Medical management in the spinal injuries unit David Grundy, Anthony Tromans, John Carvell, Firas Jamil Management of spinal cord injury in an acute specialised unit is associated with reduced mortality, increased neurological recovery, shorter length of stay and reduced cost of care, compared to treatment in a non-specialised centre. The cervical spine In injuries of the cervical spine skull traction is normally Box 6. The spine may be positioned in • Skull traction for at least six weeks neutral or extension depending on the nature of the injury. Thus • Halo traction—allows early mobilisation by conversion into halo flexion injuries with suspected or obvious damage to the posterior brace in selected patients ligamentous complex are treated by placing the neck in a degree • Spinal fusion —acute central disc prolapse (urgent decompression of extension. The standard site of insertion of skull calipers need required) not be changed to achieve this; extension is achieved by correctly —severe ligamentous damage positioning a pillow or support under the shoulders. Most injuries —correction of major spinal deformity are managed with the neck in the neutral position. An appropriately sized neck roll can also be inserted to maintain normal cervical lordosis and for the comfort of the patient. The application of a halo brace is a useful alternative to skull traction in many patients, once the neck is reduced. Its use is often necessary for up to 12 weeks, when it can be replaced by a • Widening of gap between adjacent spinous processes cervical collar if the neck is stable. Radiographs are taken vertebral body regularly for position and at six weeks for evidence of bony • Increased angulation between adjacent vertebrae union, immobilisation being continued for a further two to Figure 6. Note forward slip of C4 on C5 and widened interspinous gap, indicating posterior ligament damage.

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As people often teach the way they were taught discount avana 100 mg on-line, medical Three cases studies educators should model these educational principles with their The boxes (right) describe three “real world” case studies students and junior doctors discount avana 100mg mastercard. This will help the next generation of representing situations encountered in medical education teachers and learners to become more effective and should lead to better care for patients settings. The educational theories described above, and the principles which emerge from them, can guide us in solving the problems posed in these three cases. Case 1 solution Case 1: Teaching basic science You could present an interactive lecture on the autonomic You have been asked to give a lecture on the nervous system. This autonomic nervous system to a first year medical would contain key points, space for written notes, and two key class of 120 students. This has traditionally been multiple choice or “short answer” questions requiring higher a difficult subject for the class, particularly as it level thinking (principle 1, see box above). You could stop twice has not been explicitly covered by faculty in the during the lecture and ask the students to discuss their response problem based anatomy course. You wonder how to each question with their neighbours (principles 1, 3, and 5). A you can make this topic understandable to the show of hands would determine the class responses to the class in a 50-minute lecture. Finally, you could assign a learning issue for the students to research in their own time (principle 4). Case 2: Ethics education Case 2 solution You could assign the students to small groups of four to six, and You are a member of a course committee in the ask each group to submit two case studies describing clinical department of internal medicine, which is ethics issues in their local hospitals (principles 1 and 2). The charged with the task of integrating the topic of ethics theory and approach needed to analyse these cases could ethics into the third year medicine rotation. Your be prepared by experts and presented on a website in advance committee has been given six blocks of two hours over a 12 week period. The first of the six blocks of two make the material engaging, understandable, and hours could be used to discuss the material on the website and useful to the students. You could then show the students how to work though a case, with participation by the class (principle 7). The other five blocks could then be used for each small group to work through some of the cases prepared earlier, followed by a debriefing session with the whole class (principles 5 and 6). Case 3: General practice training Case 3 solution You are the trainer for a first year registrar in her You could first invite the registrar to observe you with patients, first year of a general practice training and do a quick debrief at the end of the day (principles 2, 6, and programme. With help from you, she could then develop her own have very little time to spend with her. You learning goals, based on the certification requirements and wonder how you can contribute to providing a perceived areas of weakness (principles 1, 3, and 4). Finally, the registrar could begin to see patients alone and keep a journal (written or electronic) in which she records the results of “reflection on practice” (principle 6).

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