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By V. Sivert. Coleman College.

In addition purchase fluticasone 100 mcg overnight delivery, they tended to be driven by examples rather than by theories or models which made them difficult to turn into lectures (from my perspective) or to use for essays or revision (from my students perspective) purchase 250 mcg fluticasone. I also wanted to emphasize theory and to write the book in a way that would be useful (‘easily plagiarized’ I often think! Aims of this new third edition This third edition started as a quick update but has ended up as a fairly major revision best 500mcg fluticasone. Health psychologists sometimes refer to the indirect and direct pathways between psychology and health. The indirect pathway refers to the role of factors such as health related behaviours (smoking, drinking, eating, etc. To date this book has mostly reflected this indirect pathway with its emphasis on beliefs and a range of health behaviours. These chapters have always been the strongest and have presented the theories and research in greatest depth, probably reflecting my own research interests. In contrast, the direct pathway refers to the role of factors such as stress and pain and draws upon the more biologically minded literatures. The first chapter (Chapter 10) examines models of stress, stress and changes in physi- ology and how stress is measured. It includes a review of the literature on whether stress does result in illness and describes research which has explored how this association might come about. This chapter also describes the role of coping, social support, control and personality in moderating the stress illness link. I have included more work on how psychological factors may exacerbate pain perception and have detailed the recent reviews of pain management and the interesting work on pain acceptance. The structure of the third edition Health psychology is an expanding area in terms of teaching, research and practice. Health psychology teaching occurs at both the undergraduate and postgraduate level and is experienced by both mainstream psychology students and those studying other health- related subjects. Undergraduates are often expected to produce research projects as part of their assessment, and academic staff and research teams carry out research to develop and test theories and to explore new areas. Such research often feeds directly into practice, with intervention programmes aiming to change the factors identified by research. This book aims to provide a com- prehensive introduction to the main topics of health psychology. In addition, how these theories can be turned into practice will also be described. This book is now supported by a comprehen- sive website which includes teaching supports such as lectures and assessments. Health psychology focuses on the indirect pathway between psychology and health which emphasizes the role that beliefs and behaviours play in health and illness. The contents of the first half of this book reflect this emphasis and illustrate how different sets of beliefs relate to behaviours and how both these factors are associated with illness. Chapter 2 examines changes in the causes of death over the twentieth century and why this shift suggests an increasing role for beliefs and behaviours. The chapter then assesses theories of health beliefs and the models that have been developed to describe beliefs and predict behaviour. Chapter 3 examines beliefs individuals have about illness and Chapter 4 examines health professionals’ health beliefs in the context of doctor– patient communication. Chapters 5– 9 examine health-related behaviours and illustrate many of the theories and constructs which have been applied to specific behaviours. Chapter 5 describes theories of addictive behaviours and the factors that predict smoking and alcohol con- sumption. Chapter 6 examines theories of eating behaviour drawing upon develop- mental models, cognitive theories and the role of weight concern. Chapter 9 examines screening as a health behaviour and assesses the psychological factors that relate to whether or not someone attends for a health check and the psychological consequences of screening programmes. Health psychology also focuses on the direct pathway between psychology and health and this is the focus for the second half of the book. Chapter 10 examines research on stress in terms of its definition and measurement and Chapter 11 assesses the links between stress and illness via changes in both physiology and behaviour and the role of moderating variables. Chapter 12 focuses on pain and evaluates the psycho- logical factors in exacerbating pain perception and explores how psychological interven- tions can be used to reduce pain and encourage pain acceptance. Chapter 13 specifically examines the interrelationships between beliefs, behaviour and health using the example of placebo effects. Chapter 16 explores the problems with measuring health status and the issues surrounding the measurement of quality of life. Finally, Chapter 17 examines some of the assumptions within health psychology that are described throughout the book. My thanks again go to my psychology and medical students and to my colleagues over the years for their comments and feedback. For this edition I am particularly grateful to Derek Johnston and Amanda Williams for pointing me in the right direction, to David Armstrong for conversation and cooking, to Cecilia Clementi for help with all the new references and for Harry and Ellie for being wonderful and for going to bed on time. Take advantage of the study tools offered to reinforce the material you have read in the text, and to develop your knowledge of Health Psychology in a fun and effective way. Study Skills Open University Press publishes guides to study, research and exam skills, to help under- graduate and postgraduate students through their university studies. Get a £2 discount off these titles by entering the promotional code app when ordering online at www. The chapter highlights differences between health psychology and the biomedical model and examines the kinds of questions asked by health psychologists. Then the possible future of health psychology in terms of both clinical health psychology and becoming a professional health psychologist is discussed. Finally, this chapter outlines the aims of the textbook and describes how the book is structured. This chapter covers: ➧ The background to health psychology ➧ What is the biomedical model? Darwin’s thesis, The Origin of Species, was published in 1856 and described the theory of evolution. This revolutionary theory identified a place for Man within Nature and suggested that we were part of nature, that we developed from nature and that we were biological beings. This was in accord with the biomedical model of medicine, which studied Man in the same way that other members of the natural world had been studied in earlier years. This model described human beings as having a biological identity in common with all other biological beings. The biomedical model of medicine can be understood in terms of its answers to the following questions: s What causes illness? According to the biomedical model of medicine, diseases either come from outside the body, invade the body and cause physical changes within the body, or originate as internal involuntary physical changes. Such diseases may be caused by several factors such as chemical imbalances, bacteria, viruses and genetic predisposition.

Lung abscesses from septic emboli are another possibility in an intravenous drug user with a deep vein thrombosis cheap fluticasone 250mcg without prescription, and a chest X-ray should be taken although the lack of respiratory symptoms makes this less likely discount fluticasone line. In this case the intravenous line has been left in place longer than usual because of the difficulties of intravenous access and it has become infected discount fluticasone online american express. Lines should be inspected every day, changed regularly and removed as soon as possible. On recovery and discharge there were problems with the question of anticoagulation. Warfarin treatment raised difficulties because of the unreliability of dosing, attendance at anticoagulant clinics and blood sampling. It was decided to continue treatment as an out- patient with subcutaneous heparin for 6 weeks. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the Publisher. The content and opinions expressed in this book are the sole work of the authors and editors, who have war- ranted due diligence in the creation and issuance of their work. The publisher, editors, and authors are not responsible for errors or omissions or for any consequences arising from the information or opinions presented in this book and make no warranty, express or implied, with respect to its contents. Cleary For additional copies, pricing for bulk purchases, and/or information about other Humana titles, contact Humana at the above address or at any of the following numbers: Tel: 973-256-1699; Fax: 973-256-8341; E-mail: orders@humanapr. The fee code for users of the Transactional Reporting Service is: [1-58829-368-8/05 $30. In fact, the origin of the forensic phy- sician (police surgeon) as we know him or her today, dates from the passing by Parliament of The Metropolitan Act, which received Royal Assent in June of 1829. Since then, there are records of doctors being “appointed” to the police to provide medical care to detainees and examine police officers while on duty. Only through an aware- ness of the complex issues regarding the medical care of detainees in custody and the management of complainants of assault can justice be achieved. The field of clinical forensic medicine has developed in recent years into a specialty in its own right. The importance of properly trained doctors working with the police in this area cannot be overemphasized. It is essential for the protection of detainees in police custody and for the benefit of the criminal justice system as a whole. Police officers are often extremely concerned about potential exposure to infections, and this area is now comprehensively covered. The results of the use of restraint by police is discussed in more detail, including areas such as injuries that may occur with handcuffs and truncheons (Chapters 7, 8, and 11), as well as the use of crowd-control agents (Chapter 6). The chapter on general injuries (Chapter 4) has been expanded to include the management of bites, head injuries, and self-inflicted wounds. Substance misuse continues to be a significant and increasing part of the workload of a forensic physician, and the assessment of substance misuse problems in custody, with particular emphasis on mental health problems (“dual diagnosis”), has been expanded. Traffic medicine is another area where concerns are increasing over the apparent alcohol/drugs and driving problem. There has been relevant research conducted in this area, which is outlined Chapter 12. Forensic sampling has undergone enormous technological change, which is reflected in the chapter on sexual assault examination (Chapter 3). The chapter on the history and development of clinical forensic medicine worldwide has been updated (Chapter 1). Chapters on fundamental principles (Chapter 2), nonaccidental injury in children (Chapter 5), and care of detainees (Chapter 8) are all fully revised, as are the appendices (now containing a list of useful websites). I was very pleased with the response to the first book, and there appears to be a genuine need for this second edition. I hope the good practice outlined in this book will assist forensic physicians in this “Cinderella speciality. Stark ix Preface to the First Edition “Clinical forensic medicine”—a term now commonly used to refer to that branch of medicine involving an interaction among the law, the judiciary, and the police, and usually concerning living persons—is emerging as a specialty in its own right. There have been enormous developments in the subject in the last decade, with an increasing amount of published research that needs to be brought together in a handbook, such as A Physician’s Guide to Clinical Forensic Medicine. The role of the health care professional in this field must be indepen- dent, professional, courteous, and nonjudgemental, as well as well-trained and informed. This is essential for the care of victims and suspects, for the criminal justice system, and for society as a whole. As we enter the 21st century it is important that health care professionals are “forensically aware. A death in police custody resulting from failure to identify a vulnerable individual is an avoidable tragedy. Although training in clinical forensic medicine at the undergraduate level is variable, once qualified, every doctor will have contact with legal matters to a varying degree. A Physician’s Guide to Clinical Forensic Medicine concentrates on the clinical aspects of forensic medicine, as opposed to the pathological, by endeavoring to look at issues from fundamental principles, including recent research developments where appropriate. This volume is written primarily for physicians and nurses working in the field of clinical forensic medicine—forensic medical examiners, police surgeons, accident and emergency room physicians, pediatricians, gynecologists, and forensic and psychiatric nurses—but such other health care professionals as social workers and the police will also find the contents of use. The history and development of clinical forensic medicine worldwide is outlined, with special focus being accorded the variable standards of care for detainees and victims. Because there are currently no international standards of training or practice, we have discussed fundamental principles of consent, confidentiality, note-keeping, and attendance at court. The primary clinical forensic assessment of complainants and those suspected of sexual assault should only be conducted by those doctors and nurses xi xii Preface who have acquired specialist knowledge, skills, and attitudes during both theoretical and practical training. All doctors should be able to accurately describe and record injuries, although the correct interpretation requires considerable skill and expertise, especially in the field of nonaccidental injury in children, where a multidisciplinary approach is required. Avoidance of a death in police custody is a priority, as is the assessment of fitness-to-be-detained, which must include information on a detainee’s general medical problems, as well as the identification of high-risk individuals, i. Deaths in custody include rapid unexplained death occurring during restraint and/or during excited delirium. The recent introduction of chemical crowd-control agents means that health professionals also need to be aware of the effects of the common agents, as well as the appropriate treatments. However, in recent years there have been a number of well-publicized miscarriages of justice in which the conviction depended on admissions made during interviews that were subsequently shown to be untrue. Recently, a working medical definition of fitness-to-be-interviewed has been developed, and it is now essential that detainees be assessed to determine whether they are at risk to provide unreliable information. The increase in substance abuse means that detainees in police custody are often now seen exhibiting the complications of drug intoxication and withdrawal, medical conditions that need to be managed appropriately in the custodial environment. Furthermore, in the chapter on traffic medicine, not only are medical aspects of fitness-to-drive covered, but also provided is detailed information on the effects of alcohol and drugs on driving, as well as an assessment of impairment to drive. Once the eBook is installed on your com- puter, you cannot download, install, or e-mail it to another computer; it resides solely with the computer to which it is installed.

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General observations and details of any current medical problems are ascertained cheap fluticasone 250mcg line, and the first measurement of the pulse is taken buy 250 mcg fluticasone overnight delivery. If no signs of drug influence are found fluticasone 250mcg with visa, the procedure is termi- nated; if any medical problems are found, a medical assessment is obtained, and if drugs are still suspected, a full assessment is carried out. If at any time during the assessment a serious medical condition is suspected, a medical opinion will be obtained. Eye examination: the driver is assessed for horizontal gaze nystagmus, vertical gaze nystagmus, and convergence. Divided attention tests: once at a police station, the Romberg balance test, walk and turn test, one-leg stand test, and the finger-to-nose test are carried out. These are all examples of divided attention tests whereby balance and movement tests are performed in addition to remembering instructions. Vital signs examination: blood pressure, temperature, and a second recording of the pulse are carried out. Darkroom examination: pupil size is measured in room light and then in near total darkness, using both indirect artificial light and direct light. Muscle tone: limb tone is assessed as some drugs cause rigidity, whereas others, for example, alcohol, cause flaccidity. Injection sites examination: the purpose is to seek evidence of intravenous or injection drug abuse. Toxicology testing: at the same time, samples are obtained for toxicological examination, either a blood or urine sample being taken for analysis of common drugs. The mere detection of a drug does not prove impairment unless, of course, the jurisdiction has per se laws whereby the detection of drugs at some predeter- mined level is ruled, by law, to be proof of impairment. Whether the examination is carried out by a forensic physician in London or an emergency room physician in San Francisco, the aim of the examination is to exclude any medical condition other than alcohol or drugs as the cause of the driver’s behavior. The differential diagnosis is wide and includes head injury, neurological problems (e. The procedure should include introductory details, full medical history, and clinical examination. Similar forms are not available in the United States, but there is nothing to prevent any emergency department in the United States from drafting and providing a similar document. Even if no special form is provided, most of the relevant material will have been (or at least should be) recorded in the emergency department record. Introductory Details These should include the name, address, and date of birth of the driver and the name and number of the police officer, as well as the place and date Traffic Medicine 379 the examination took place, and various times, including time doctor con- tacted, time of arrival at police station/hospital, and time the examination com- menced and ended. The doctor will need to know brief details of the circumstances leading to arrest and the results of any field impairment tests that may have been car- ried out by the police officer. Full Medical History Details of any current medical problems and details of recent events, par- ticularly whether there was a road traffic accident that led to the event, should be recorded. Past medical history (with specific reference to diabetes, epilepsy, asthma, and visual and hearing problems), past psychiatric history, and alcohol and drug consumption (prescribed, over the counter, and illicit) should be noted. Clinical Examination This should include general observations on demeanor and behavior, a note of any injuries, speech, condition of the mouth, hiccoughs, and any smell on the breath. The cardiovascular system should be examined and pulse, blood pressure, and temperature recorded. Examination of the eyes should include state of the sclera, state of the pupils (including size, reaction to light, convergence, and the pres- ence of both horizontal or vertical nystagmus). A series of divided attention tests should be performed including the Rom- berg test, finger–nose test, one-leg-stand test, and walk and turn test. A survey of forensic physicians’ opinions within Strathclyde police demonstrated concerns regarding the introduction of standardized field sobriety tests with the walk and turn test and the one-leg-stand test, causing the highest levels of concern (90). The mental state should be assessed and consideration given to obtaining a sample of handwriting. Fitness for detention is of paramount importance, and any per- son who is not fit to be detained because of illness or injury should be transferred to hospital and not subjected to a Section 4 assessment. If the person refuses to consent to an examination, it is prudent to make observations on his or her man- ner, possible unsteadiness, etc. At the end of the examination, the doctor should decide whether there is a condition present that may result from some drug. In the case of short-acting drugs, the observations of the police officer or other witnesses can be of cru- cial importance. In a recent case, a person was found guilty of driving while unfit resulting from drug use on the basis of the officer’s observations and the results and opinion of the toxicologist; the forensic physician was not called to give evidence (91). Similarly, if the police officer reports that the person 380 Wall and Karch was swerving all over the road but the doctor later finds only minimal physi- cal signs, this may be sufficient to indicate that a condition may be present because of some drug (e. The doctor should inform the police officer whether there is a condition present that may be the result of a drug, and if so, the police officer will then continue with the blood/urine option. On this occasion, 10 mL of blood should be taken and di- vided equally into two septum-capped vials because the laboratory requires a greater volume of blood for analysis because of the large number of drugs potentially affecting driving performance and their limited concentration in body fluids; indeed, if the driver declines the offer of a specimen, both samples should be sent. If they fail, they will be considered as a suspect drug driver and examined by a forensic physician and a forensic sample obtained and ana- lyzed if appropriate. The drug incidence in the two groups will then be compared, as will the police officers’ and doctors’ assessments using standardized proformas. In Victoria, Australia (93), forensic physicians with relevant qualifica- tions and experience act as experts for the court by reviewing all the evidence of impaired driving, the police Preliminary Impairment Test, the forensic physician’s assessment, and toxicological results and provide an opinion. However, there were several inconsistencies in the physical examination with the drugs eventually found on toxicological examination, cases where the individual were barely conscious, where a formal assessment should not even have been considered, and missed medical and psychiatric conditions. For Medical Practitioners: At a Glance Guide to the Current Medical Standards of Fitness to Drive. Austroads Assessing Fitness to Drive: Austroads Guidelines for Health Profession- als and Their Legal Obligations. Occupational profile and cardiac risk: possible mechanisms and implications for professional drivers. Modification of patient driving behavior after implantation of a cardioverter defibril- lator. In: T86: Proceed- ings of the 10th International Conference on Alcohol, Drugs, and Traffic Safety, Amsterdam, September 9–12, 1986. Crash Risk of Alcohol Impaired Driving in T2002 Proceedings of the 16th Inter- national Conference on Alcohol, Drugs and Traffic Safety. Proceedings of the 12th International Conference on Alcohol, Drugs, and Traffic Safety, Cologne, Ger- many, 1992. The specific deterrence of administrative per se laws in reducing drunk driving recidivism. Comparative study of ethanol levels in blood versus bone marrow, vitreous humor, bile and urine. Study into the ability of patients with impaired lung function to use breath alcohol testing devices. Study into the ability of healthy people of small stature to satisfy the sampling requirements of breath alcohol testing instruments. Comparative studies of postmortem ethyl alcohol in vitreous humor, blood, and muscle. Effects of alcohol, zolpidem and some other sedatives and hypnotics on human performance and memory.

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Wash your hands after using the toilet and before touching food fluticasone 500mcg cheap, and practise safe sex to avoid spreading the parasites purchase fluticasone with amex. The disease causes degenerative changes in an area of the brain called the substantia nigra buy fluticasone us. Nerve cells in this area are responsible for producing the neurotrans- mitter dopamine. As these nerve cells become damaged and die, there is insufficient dopamine to relay messages between nerve and muscle cells, and it becomes pro- gressively more difficult for the body to move smoothly. This causes characteristic tremors and shaking, which interfere with normal activities such as walking, sitting, and standing. In Canada, there are approximately 100,000 people or one out of every 100 adults P with Parkinson’s disease. Parkinson’s most often affects older adults and as Canada’s population continues to age, the incidence of Parkinson’s disease is expected to rise. Ev- eryone loses some dopamine-producing neurons with age, but those with Parkinson’s lose around 60 percent or more of the neurons in the substantia nigra. Scientists be- lieve that a combination of genetic and environmental factors is involved. Over the years there have been great advances in science that have improved quality of life for those with Parkinson’s. Soon after, the first effective treatment for the disease was introduced, a drug called levodopa. As the disease progresses, it may cause: • Dementia: Some people with Parkinson’s develop impaired mental function, which affects the ability to think, reason, and remember. Parkinson’s is usually diagnosed after age 60, but some people have developed it in their twenties. It is thought that genetic or environ- mental factors over time lead to neural damage. Farmers P and those handling these chemicals and those who drink well water are at higher risk. Examples include: haloperidol (Haldol) and chlorproma- zine (Thorazine), which are used to treat psychiatric disorders, drugs used to treat nausea, such as metoclopramide (Reglan), and the epilepsy drug valproate (Depak- ene). However, with chronic use, the benefits often diminish and it may be nec- essary to adjust the dosage, switch medications, or take multiple medications. Along with medication, physical therapy, exercise, and proper nutrition are recommended. When lifestyle changes are no longer enough, your doctor will likely recommend certain medications, either alone or in combination. Some of the most common medi- cations used include: Amantadine: An antiviral that reduces the side effects that are sometimes caused by taking levodopa for a long time. Amantadine is sometimes used alone or, in the early stages of the disease, along with levodopa. They help control tremor in the early stages of the disease, but are only mildly benefi- cial and cause side effects such as dry mouth, nausea, confusion, hallucinations, and urine retention. They are often used for young adults or those in early stages, along with Sinemet. Examples include: bromocriptine (Parlodel), pramipexole (Mirapex), and ropinirole (Requip). Side effects include involuntary movements, hallucinations, drowsiness, and the risk of inflammatory reactions in the heart and lungs. It is often used early in the disease and later combined with Sinemet to enhance its effects. Levodopa is a natural substance found in plants and animals that is converted into dopamine by nerve cells in the brain. Carbidopa enhances the amount of levodopa that gets into the brain and helps reduce the side effects of therapy. Side effects include involuntary movements, hal- lucinations, and low blood pressure when standing. There are a variety of experimental procedures under development such as stem cell transplants and tissue grafts. Fruits and vegetables also provide antioxidants that help to neutralize damaging free radicals. Foods to avoid: • Avoid processed and fast foods and artificial sweeteners, which contain chemicals that may have a negative effect on brain function. This is because certain dietary proteins can interfere with the stomach’s absorption of levodopa and the body’s ability to get it to the brain cells. It is important to consult with a dietitian for proper advice on planning your meals. Lifestyle Suggestions P • Exercise can help improve mobility, range of motion, and muscle tone and strength. Weight-bearing activities (walking, dancing) can help strengthen the bones, which helps in the prevention of osteoporosis. Wear proper footwear and consult with a physical therapist or personal trainer to get advice on exercises that can improve balance, coordination, and strength. This is a specialty supplement that is available through natural health care practitioners. People with Parkinson’s tend to have low Q10 levels and several studies have shown that supple- ments can slow the progression of the disease. The 1,200 mg dose of coenzyme Q10 significantly slowed the progression of the disease (Archives of Neurology, 2002: 59; 1541–1550). Preliminary studies with methio- nine and L-carnitine have shown benefits for reducing symptoms. L-tyrosine should not be taken with L-dopa as it may interfere with the transport of L-dopa to the brain. Many studies have shown that it can improve memory and cognitive function in the elderly. Dosage: 120–240 mg daily, standardized to 6 percent terpene lactones and 24 percent flavone glycosides. P Vitamin B6: May improve Parkinson’s symptoms and enhance the effectiveness of Sinemet. Do not take if you are taking levodopa alone as this can increase the conversion of levodopa to dopamine outside the brain. Vitamins C and E: Antioxidants that protect against free radical damage in the brain, includ- ing key dopamine-producing brain cells. Boost intake of fibre (whole grains, fruits, and vegetables) along with healthy fats and yogurt. Minimize or avoid saturated fat, alcohol, processed and fast foods, and artificial sweeteners.