ABSTRACT
Lesbian, gay, and bisexual youth have often been forgotten in the provision of care to families. Not only are 10%-12% of all youth lesbian, gay, or bisexual, they all have families of origin and many also have "families of choice" that are dramatically increasing the numbers of persons who are directly affected. These youth can suffer disqualification ranging from internalized poor esteem and suicidality to physical danger, often at the hands of those very persons who are expected to care for them--families, educators, and health care providers. This article examines both how homophobia and heterosexism are both manifest and recovered from using case examples and offering therapeutic suggestions to clinicians.
Subject(s)
Family Therapy , Family/psychology , Homosexuality, Female/psychology , Homosexuality, Male/psychology , Adolescent , Female , Humans , MaleABSTRACT
This paper presents an unusual form of sexual (masturbatory) activity and brings this unusual cause of death to wider medical attention and understanding. All 19 cases of autoerotic asphyxial death that occurred between 1978 and 1989 in the province of Alberta, Canada were reviewed. The fatal victim of autoerotic asphyxia is typically a single male aged 15 to 29 years. Autoerotic sexual activity is typically performed in isolation; often there is evidence of repetitive practice. The accidental death usually results when the "safety" mechanism designed to alleviate neck compression fails. Often the first sign of the activity (usually a surprise to family and friends) is death itself. Physicians who are alert to the practice may suggest counselling when patients present with sexual concerns, unusual marks around the neck or evidence of abrasions to limbs suggesting bondage or other masochistic practices.
Subject(s)
Asphyxia/mortality , Cause of Death , Masturbation , Accidents/mortality , Accidents/psychology , Adolescent , Adult , Alberta/epidemiology , Asphyxia/psychology , Cross-Sectional Studies , Humans , Incidence , Male , Masturbation/psychology , Middle Aged , Social IsolationABSTRACT
1. The attitudes and knowledge of doctors in the Northern Region to reporting of adverse drug reactions were assessed using a postal questionnaire to all doctors in two, previously identified, high reporting and two low reporting health districts. Comparisons were made of the attitudes and knowledge within professional groups (GPs, Consultants and Junior Hospital Doctors), and between the amalgamated doctor groups. 2. 1181 of 1600 doctors (74%) responded. Despite being selected on the basis of previous adverse drug reaction reporting patterns, GPs and consultants from high and low reporting districts perceived they had sent a similar number of ADR reports, and there were few differences in opinion and attitude within these two groups. 3. Most differences within doctor groups were found for junior doctors, with those from low reporting districts indicating they had sent significantly less yellow cards than those in high reporting districts. There were also significant differences in the estimates junior doctors made with a frequency of adverse drug reactions, the existing documentation on adverse drug reactions, and the purposes of the adverse reaction scheme. 4. General Practitioners in low reporting areas stated they wrote more prescriptions (P < 0.02), consultants spent more time in clinical contact (P < 0.01) and junior doctors did both (P < 0.01), all of which suggest different workloads may effect reporting of adverse drug reactions. 5. When given clinical examples, or asked about the CSMs black triangle scheme, all doctor groups performed poorly. 6. The number of reports stated as being sent increased with time from qualification for 10 years, then seemed to plateau.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Adverse Drug Reaction Reporting Systems , Attitude of Health Personnel , Adult , Age Factors , Aged , Consultants , Drug Prescriptions , Family Practice , Female , Humans , Male , Middle Aged , Physicians, Family , Surveys and Questionnaires , United KingdomABSTRACT
Healthcare managers are seeking new ways to increase productivity in the workplace. New technologies, such as word processing, electronic mail, electronic conferencing, calendar management, data base management systems, artificial intelligence, decision support systems, and local area networks, are being developed to help the healthcare manager make the workplace more productive. The challenge therefore is to implement these systems smoothly and address the organizational issues associated with implementation.
Subject(s)
Efficiency , Electronic Data Processing , Hospital Administration , Office Management , Decision Making , Telecommunications , United StatesABSTRACT
Canada's divorce rate increased by 50% between 1968 and 1982. This has resulted in new family forms. One of these, the family which has been `blended' through remarriage of a parent, has some unique developmental hardships and differences from traditional nuclear families. Blended families are subject to a number of myths that may adversely affect their formation. In addition, members of these families need more time and patience to form a stable and functioning family group than do traditional families. Family physicians can aid the blended family with frank discussion, preparation and specific information.
ABSTRACT
A patient who developed chronic hypothermia following tuberculous meningitis is described. A central defect of thermoregulation was discovered, probably due to a discrete vascular lesion in the anterior hypothalmus.
Subject(s)
Hypothermia/etiology , Tuberculosis, Meningeal/complications , Adult , Body Temperature Regulation , Chronic Disease , Circadian Rhythm , Epilepsy, Tonic-Clonic/etiology , Female , Humans , Memory, Short-Term , Tuberculosis, Meningeal/psychologyABSTRACT
1 beta-Adrenoceptor blockade, plasma labetalol concentrations and anti-hypertensive actions were investigated at 2 hourly intervals during the interdose period of chronic oral therapy in six hypertensive patients. 2 beta-adrenoceptor blockade varied during the inter-dose period and was maximal 2 and 4 h after the oral dose (P < 0.05). 3 Systolic pressure rose during the interdose period (P < 0.05). A significant correlation was found between the degree of beta-adrenoceptor blockade and the change in systolic pressure at 2 h after the oral dose. 4 Efficacy of labetalol as a beta-adrenoceptor antagonist and anti-hypertensive drug was assessed 2 h after an oral dose during chronic eight hourly dosage in sixteen hypertensive patients. Pharmacokinetics of labetalol were studied in the same patients. 5 Peak plasma labetalol concentration occurred 2 h after the oral dose and subsequently the plasma concentration declined monoexponentially. 6 The steady state concentration (CSS) of labetalol was correlated significantly with the daily oral dose in mg kg-1, the mid point labetalol concentration (Cmax+Cmin) divided by 2 and the isoprenaline dose ratio-1 at 2 h after the oral dose. 7 No correlation was found between the antihypertensive effect and the CSS ng ml-1 labetalol or between the isoprenaline dose ratio-1 and the CSS labetalol ng ml-1.
Subject(s)
Blood Pressure/drug effects , Ethanolamines/metabolism , Hypertension/drug therapy , Labetalol/metabolism , Receptors, Adrenergic, beta/drug effects , Receptors, Adrenergic/drug effects , Administration, Oral , Adult , Humans , Kinetics , Labetalol/therapeutic use , Male , Middle Aged , Time FactorsABSTRACT
1 The pharmacological and therapeutic effects of labetalol were investigated during an 8 h interdose period of chronic oral therapy in six patients with essential hypertension. 2 Peak plasma labetalol concentrations were observed 2 h after the morning oral dose, and subsequent decline was mono exponential. 3 Beta-adrenoceptor blockade paralleled the changes in labetalol concentration and was maximal 2 and 4 h after the oral dose. 4 Resting supine systolic BP rose significantly during the interdose period, but no change occurred in diastolic BP. 5 Ambulatory intra-arterial BP studies in a further six patients with essential hypertension controlled with labetalol did not confirm the increase in BP during an 8 h interdose period.
Subject(s)
Blood Pressure/drug effects , Ethanolamines/therapeutic use , Hypertension/drug therapy , Labetalol/therapeutic use , Adrenergic beta-Antagonists , Adult , Drug Administration Schedule , Heart Rate/drug effects , Humans , Isoproterenol/blood , Isoproterenol/therapeutic use , Labetalol/blood , Labetalol/pharmacology , Male , Time FactorsABSTRACT
1 Mean steady-state plasma concentrations of labetalol (labetalol Css) in 17 hypertensive patients undergoing chronic treatment with this drug, have been examined in relation to dose, fall in BP, and beta-blockade. 2 A significant relationship (rs = 0.81, P less than 0.001) was observed between labetalol Css and daily dose. 3 No correlation was found between labetalol Css and antihypertensive response. 4 In thirteen patients, there seemed to be significant relationship between labetalol Css and beta-blockade (rs = 0.72, P less than 0.005). In three patients, the degree of beta-blockade was disproportionate to the drug concentration.
Subject(s)
Ethanolamines/blood , Hypertension/drug therapy , Labetalol/blood , Adult , Dose-Response Relationship, Drug , Female , Humans , Hypertension/physiopathology , Kinetics , Labetalol/therapeutic use , Male , Placebos , Time FactorsABSTRACT
1 Twenty patients with essential hypertension completed a double-blind, dose-tritrated, cross-over comparison of methyldopa and labetalol. 2 Average lying BPs (systolic/diastolic) were reduced by 28/15 mmHg with methyldopa and by 23/15 mmHg with labetalol. 3 Average standing BPs (systolic/diastolic) were reduced by 29/14 mmHg with methyldopa and by 29/15 mmHg with labetalol. 4 Both lying and standing heart rates were reduced with labetalol. 5 It is concluded that the antihypertensive properties of labetalol and methyldopa are similar but that larger patient populations are needed to study the relative incidence of subjective adverse effects.
Subject(s)
Ethanolamines/therapeutic use , Hypertension/drug therapy , Labetalol/therapeutic use , Methyldopa/therapeutic use , Blood Cell Count , Blood Pressure/drug effects , Clinical Trials as Topic , Double-Blind Method , Female , Heart Rate/drug effects , Humans , Male , Middle Aged , Patient Compliance , Time FactorsABSTRACT
1 The pharmacological and therapeutic effects of labetalol were investigated during an 8 h interdose period of chronic oral therapy in six patients with essential hypertension. 2 Peak plasma labetalol concentrations were observed 2 h after the morning oral dose, and subsequent decline was mono exponential. 3 Beta-adrenoceptor blockade paralleled the changes in labetalol concentration and was maximal 2 and 4 h after the oral dose. 4 Resting supine systolic BP rose significantly during the interdose period, but no change occurred in diastolic BP. 5 Ambulatory intra-arterial BP studies in a further six patients with essential hypertension controlled with labetalol did not confirm the increase in BP during an 8 h interdose period.
ABSTRACT
1 Twenty patients with essential hypertension completed a double-blind, dose-tritrated, cross-over comparison of methyldopa and labetalol. 2 Average lying BPs (systolic/diastolic) were reduced by 28/15 mmHg with methyldopa and by 23/15 mmHg with labetalol. 3 Average standing BPs (systolic/diastolic) were reduced by 29/14 mmHg with methyldopa and by 29/15 mmHg with labetalol. 4 Both lying and standing heart rates were reduced with labetalol. 5 It is concluded that the antihypertensive properties of labetalol and methyldopa are similar but that larger patient populations are needed to study the relative incidence of subjective adverse effects.
ABSTRACT
1 Mean steady-state plasma concentrations of labetalol (labetalol Css) in 17 hypertensive patients undergoing chronic treatment with this drug, have been examined in relation to dose, fall in BP, and beta- blockade. 2 A significant relationship (rs = 0.81, P less than 0.001) was observed between labetalol Css and daily dose. 3 No correlation was found between labetalol Css and antihypertensive response. 4 In thirteen patients, there seemed to be significant relationship between labetalol Css and beta-blockade (rs = 0.72, P less than 0.005). In three patients, the degree of beta-blockade was disproportionate to the drug concentration.
ABSTRACT
1 In a multicentre open trial, labetalol was given to 128 patients in ten centres. Forty-three patients had not previously received antihypertensive therapy; the remainder (85 patients) had been on antihypertensive therapy with either unsatisfactory BP control or troublesome side-effects. 2 Thirty-two patients were withdrawn from the trial in the first 6 months of therapy, 24 (19% of the total) because of side-effects. 3 Control of BP was generally satisfactory or considerably improved. Other drugs (usually a diuretic) had to be added in 23 patients. 4 There was an abnormality of liver function in one patient; otherwise there were no biochemical or haematological problems.
ABSTRACT
20 patients (12 female) with moderately severe essential hypertension [blood pressure during placebo treatment 181 +/- 6 (systolic), 107 +/- 3 (diastolic)] completed a double-blind, cross-over dose-titrated comparison of labetalol and methyldopa. Both drugs reduced lying and standing arterial blood pressure to a similar extent, although only labetalol reduced heart rate. Compliance was high (greater than 95%) with both drugs, and the incidence of subjective adverse effects was similar.
