Demarcation and transformation within homoeopathic knowledge. A strategy of professionalization.

Both the medically and non-medically qualified homoeopaths in Britain have engaged in a number of changes to the way that their knowledge is constructed and communicated. In this paper we describe these changes and link them to claims for legitimacy, status and authority in the health care market. The public presentation of homoeopathic knowledge claims are thus linked to a 'professional project'.

Involvement of the primary health care team in coronary heart disease prevention.

BACKGROUND: Recent years have seen a vast increase in the amount of health promotion activity undertaken in general practice. AIM: This study set out to identify the level of general practitioner and nurse involvement in activities aimed at coronary heart disease prevention and to examine variations in involvement. METHOD: A questionnaire survey was undertaken of a sample of general practitioners across England and the nurses who worked in their practices. RESULTS: Of 1696 randomly selected general practitioners 64% completed a questionnaire, of 928 practice nurses 71% responded and of 682 health visitors and 679 district nurses 52% and 40% responded, respectively. Of the general practitioners 94% reported that they were involved in assessing lifestyle risk factors in the routine consultation and regular assessments most commonly involved blood pressure testing and inquiry about smoking status. Eighty six per cent of practices were reported by the practice nurse as having well person clinics; these clinics were usually run by the practice nurse. Clinics for the management of specific lifestyle risk factors were also usually run by practice nurses, although many doctors were involved in hypertension clinics and cholesterol clinics. Health visitors and district nurses had a low level of involvement in this practice based clinic activity. Involvement of general practitioners and practice nurses in coronary heart disease prevention was associated with training in health promotion and positive attitudes towards prevention and health promotion. The level of involvement of practice nurses in health promotion was associated with the support received from primary health care facilitators, family health services authorities and district health authorities. CONCLUSION: Members of the primary health care team appeared to have their own distinct area of preventive activity. However, this division did not appear to be a result of organized teamwork and deployment of skills and expertise according to a clearly defined management protocol. Instead it seemed to be a product of general practitioner contract and management arrangements which tended to encourage an approach to general practice health promotion which revolved around the practice nurse and which hindered the development of a broader team based approach to planning and delivery of health promotion in relation to the needs of the practice population.

Infertility: causes and treatment.

Issues related to infertility appear with increasing regularity in the media. Many people who suffer from this problem are surprised and shocked to find themselves attending an infertility clinic. The author describes the most common types of infertility and explores the treatments available. In particular, she examines male infertility and the impact this has on the couple.

Timing of ovulation for artificial insemination.

Two studies involving eighty women having treatment with artificial insemination by donor (AID) have demonstrated that the use of a urinary semi-quantitative assay for luteinising hormone (LH) gives pregnancy rates comparable to those obtained using plasma LH for the timing of insemination. The advantage of self test assay is evident in a scattered region such as Grampian.

Assessment of occupational exposure to arsenic, copper, and lead in a western copper smelter.

A comprehensive industrial hygiene survey was conducted at a western copper smelter and arsenic trioxide production facility. The major contaminants reported are arsenic, copper, and lead. The greatest concern noted was for the arsenic measurements found, 69% of which exceeded the 10 micrograms/M3 permissible exposure limit. The company must use a combination of feasible engineering and administrative controls as well as a sophisticated respiratory protection program, however, the efficacy of that program will require continued study and evaluation.