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Query: UMLS:C0020538 (hypertension)
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A total of 114 patients who had not attended their general practitioner in the previous three years were identified by searching a sample of 1488 records (12.8% of the practice list). An invitation for a health check was sent, in keeping with the requirements of the new general practitioner contract. Seventeen out of 94 patients invited (18%) attended. Surgery staff spent 28 hours and the practice doctors spent 15 hours on arranging and carrying out the investigation. The group responding to the invitation were in general healthy; the only new finding of remediable disease was mild hypertension in one man. The smoking rate and alcohol consumption rate were low. Of 13 patients who needed tetanus immunization, five refused it and five failed to return. All three women who were overdue for a cervical smear failed to return to have it done. It is concluded that screening infrequent attenders is not an efficient use of medical time.
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PMID:Inviting infrequent attenders to attend for a health check: costs and benefits. 210 33

The present study describes the results achieved 6 months after the establishment of a health examination, with different features depending on age and sex groups, which was progressively applied to the population of the C.A.P. "Virgen de la Fuensanta" (Valencia). The preventive activities included: vaccination (rubella, tetanus and influenza), tuberculin skin testing, determination of body weight and mass (BMI), measurement of blood pressure and heart rate, cervical cytology, breast examination and search for occult blood in feces. Among the 388 evaluated individuals (69.4% females and 30.6% males), 10 cases of hypertension, 2 of diabetes, 65 of obesity, 20 of hypercholesterolemia, 23 women with benign breast abnormalities and 8 instances of occult blood in feces were detected. In the age group of 15-26 years, 7 positive tuberculin reactions were detected. In 175 cytological studies no case of malignant disease was discovered. The degree of acceptance of the program by the users was satisfactory, as assessed by the compliance with both the appointments (85%) and the individual interventions (88-100%).
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PMID:[Results of health examination by age and sex groups]. 251 28

Ethiopia is a country of 45 million people in northeast Africa. With a stagnant, agriculture-based economy and a per capita gross national product of $110 in 1984, it is one of the world's poorest nations. 70% of the children are mildly to severely malnourished, and 25.7% of children born alive die before the age of 5. Life expectancy is 41 years. The population is growing at the rate of 2.9%/year, but only 2% of the people use birth control. After the 1974 revolution, the socialist government nationalized land and created 20,000 peasant associations and kebeles (urban dwellers' associations), which are the units of local government. The government has set ambitious goals for development in all sectors, including health, but famine, near famine, forced resettlement programs, and civil war have prevented any real progress from being made. The government's approach to health care is based on an emphasis on primary health care and expansion of rural health services, but the Ministry of Health is allocated only 3.5% of the national budget. Ethiopia has 3 medical schools -- at Addis Ababa, Gondar, and the Jimma Institute of Health Sciences. Physicians are government employees but also engage in private practice. A major problem is that a large proportion of medical graduates emigrate. Ethiopia has 87 hospitals with 11,296 beds, which comes to 1 bed per 3734 people. There are 1949 health stations and 141 health centers, but many have no physician, and attrition among health workers is high due to lack of ministerial support. Health care is often dispensed legally or illegally by pharmacists. Overall, there is 1 physician for 57,876 people, but in the southwest and west central Ethiopia 1 physician serves between 200,000 and 300,000 people. In rural areas, where 90% of the population lives, 85% live at least 3 days by foot from a rural health unit. Immunization of 1-year olds against tuberculosis, diphtheria-pertussis-tetanus, poliomyelitis, and measles is 11, 6, 6, and 12% respectively. Infectious diseases dominate the medical scene in Ethiopia. In 1984, tuberculosis accounted for 11.2% of hospital admissions and 12.2% of deaths. The leading cause of childhood mortality in 1984 was diarrhea (45%). Malaria, trypanosomiasis, schistosomiasis, leishmaniasis, and meningococcal meningitis are endemic. Intestinal parasitism is rampant, and the nationwide prevalence of leprosy is 3/1000. Venereal diseases were the 9th most common cause of hospital outpatient visits in 1984, but AIDS is rare. The leading noninfectious diseases are rheumatic and syphilitic heart disease, hypertension, diabetes mellitus, hepatoma, and elephantiasis. Ethiopia has the highest number of cases of nonfilarial elephantiasis -- an estimated 350,000 cases -- in the world. Aside from a large influx of money, the most necessary changes to improve the health system are lowering the salaries of doctors and nurses, reorienting physician training toward primary health care, increasing the quality of existing health services, more efficient management, and better coordination between the Ministry of Health and the voluntary organizations.
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PMID:Health and medical care in Ethiopia. 271 Jan 85

A total of 150 patients were treated for tetanus in the tetanus ward of the J. J. Hospital, Bombay, between October 1983 and January 1986. The complications of tetanus and the mode of management in the presence of restricted resources are outlined. Intensive care, proper nutrition, early tracheostomy and ventilator support in severe tetanus were chiefly responsible for an overall reduction in mortality from 30 to 12%. The mortality in severe tetanus was reduced from 70 to 23%. Sudden death due to unexpected cardiac arrest was an important complication in severe tetanus. We observed that an abrupt marked rise in rectal temperature (greater than 107 degrees F, 41.7 degrees C), if undetected, could lead to sudden circulatory collapse and death. Well-marked hypoxaemia was observed in all patients with severe tetanus, and was related to ventilation perfusion inequalities and to an increase in the true venous admixture (increased Qs/Qt) in the lungs. Bronchopulmonary infections and the adult respiratory distress syndrome added significantly to morbidity and mortality. Autonomic cardiovascular disturbances included bradycardia alternating with tachycardia, and hypertension which was either labile, paroxysmal or sustained. Persistent hypotension was of ominous significance. Amongst numerous complications involving other systems, sepsis and septic shock were associated with a high mortality.
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PMID:Tetanus and its complications: intensive care and management experience in 150 Indian patients. 342 73

South Africa is unique in many ways, including the state of health of its children. Discussion focuses on vital statistics -- perinatal and infant mortality rates, disease profiles, nutritional status; and demographic and socioeconomic data -- African communities, Indian communities, coloured communities, and social expenditure. The perinatal mortality rate for africans in Natal and Kwa Zulu varies from 19.7-51.9/1000 in the smaller hospitals. At the main teaching hospital in Durban, the King Edward viii, it was 75.8/1000 in 1980. The most common causes of death in the rural babies weighing more than 1500 gm were septicemia, asphyxia, meconium aspiration, and tetanus neonatorum. In those under 1500 mg the most common causes were respiratory distress, intracranial hemorrhage, and hypothermia. The main causes of the high perinatal mortality among Africans at King Edward viii Hospital were amniotic fluid infection syndrome, abruptio placenta, hypoxia, hypertension, and congenital syphilis. Accurate data for infant mortality rates for Africans are unavailable. Available data show considerable variation. The official infant mortality rates given by the State Health Department for 1975 for the country as a whole were 20.1/1000 for whites, 100.2/1000 for Africans, 104.0/1000 for coloureds, and 34.7/1000 for Asians. Black children under age 5 make up 16% of the total population but account for 55% of total deaths, whereas white children of this age make up 11% of the population and account for only 7% of total deaths. Of the 7688 admissions of African children to King Edward viii Hospital in 1980, more than 80% were due to infections, and the overall mortality in these patients was 20%. The percentage of children below the 3rd centile for weight was 6-12% for infants under 1 year old, 20-55% in children aged 1-6 years, and 30-70% in school age children. The percentage stunted (below 3rd centile for height) varied from 22-66% in preschool children. At King Edward viii Hospital, approximately 40% of children admitted are malnourished. In the main the majority of blacks are poor, illiterate, and living in overcrowded conditions. Many are unemployed or employed away from home, which causes serious disruption of family life with such consequences as teenage pregnancies and malnutrition. The mortality rates, disease profiles, and socioeconomic status of the whites in Sourh Africa are similar, and often superior, to those in Western countries. The reason for this discrepancy in the state of health and socioeconomic development of population groups is the government's policy of separate but unequal development; the policy of apartheid that reserves 87% of the land for 16% of the people, the white minority.
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PMID:The health of children in South Africa: some food for thought. 614 93

Both beta- and alpha-adrenergic mechanisms are important in the control of blood pressure; alpha-mediated vasoconstriction is responsible for the regulation of vascular tone, and beta-mediated responses stimulate the heart directly and indirectly by liberating renin and affecting vascular smooth muscle tone. beta-Adrenergic blocking drugs have long been established in the treatment of hypertension. The development of drugs which combine this action with an alpha-blocking effect represents an additional mode of action to lower the blood pressure. Numerous studies have demonstrated that labetalol intravenously or orally gives a rapid fall of blood pressure in essential and renal hypertension. It has also been used intravenously in phaeochromocytoma, tetanus, clonidine withdrawal, and as an adjunct to halothane to produce hypotensive anaesthesia. Intravenously, labetalol is probably best given as a graded infusion or as repeated small bolus injections to assure a smooth fall of blood pressure. Many long term studies have shown it to be effective orally in prolonged treatment of hypertension with studies of over 5 years, showing that tolerance does not develop. Labetalol can be used in combination with diuretics and other drugs when necessary. It can be employed to control the blood pressure in all grades of hypertension. A dosage of 100mg twice daily will often be adequate to control mild hypertension and the use of even lower doses has been reported. However, the dosage can be markedly increased in severe hypertension and while such doses are relatively exceptional, several trials have employed over 2 g per day for the more resistant cases. Studies have demonstrated that blood pressure control with labetalol is equivalent to that with beta-adrenoceptor blocking drugs plus vasodilators, or methyldopa. Labetalol has been used in patients with severe renal impairment and a number of studies suggest that it may now be the drug of choice in raised blood pressure of pregnancy. Side effects can be divided into those related to beta-blockade, those related to alpha-blockade and those not clearly related to either effect. It has been suggested that the side effects attributable to the beta-blocking component are less obtrusive than those seen with pure beta-blocking drugs without alpha-activity because the alpha-blockade modifies the consequences of beta-blockade. Heart failure has been reported, but for haemodynamic reasons would be expected to be less common; careful patient selection should avoid any risk. Similarly labetalol may worsen asthma even if the risks are probably less than with non-selective beta-blockade alone.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Combined alpha- and beta-receptor inhibition in the treatment of hypertension. 615 91

The hyperadrenergic syndrome that occurs in tetanus is characterised by hypertension, tachycardia, and increased systemic arteriolar resistance. A 74 year old man with tetanus was found to have very high catecholamine concentrations--as high as those in phaeochromocytoma--and the fluctuations in blood pressure and heart rate were measured to see whether they paralleled changes in the catecholamine values. A labetalol infusion of 0.25-1 mg/min gradually stabilised the cardiovascular disturbances and the patient recovered.
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PMID:Hyperadrenergic syndrome in severe tetanus: extreme rise in catecholamines responsive to labetalol. 642 11

A descriptive study was conducted in 1967, 1968, and 1969 on some of the basic health characteristics of the approximately 1,100 veterinarians in Illinois. A total of 87% had consulted a physician concerning their health within the past 30 months. Within the past 18 months 47% had been vaccinated against tetanus. Over one-third of the veterinarians had received their last tetanus inoculation because of an injury. Thirty-one percent had been tested serologically for zoonotic infections other than at a meeting of the state veterinary association, 69% wore glasses, 12% were allergic to an antimicrobial, and 24% had a history of an appendectomy. Nearly one-half smoked and another 22% were former smokers. Thirteen percent had hernias with 67% of these repaired surgically. The males of the subpopulation of veterinarians had a mean height of 5 feet 6 1/2 inches and a mean weight of 179 pounds. Gastrointestinal ulcers had been diagnosed in 10%, arthritis in 11%, heart disease in 8%, hypertension in 7%, diabetes in 2% and cancer in 1%. Sixty-eight percent had not lost a single workday in the past year. The total group had a mean loss of 0.85 days due to accident and 4.09 due to illness.
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PMID:The health characteristics of veterinarians in Illinois. 733 86

Between 1975 and 1983 health care expenditures in Ghana dropped to a low point as a consequence of the structural readjustment program instituted by the World Bank. During 1975-76 only 15% of available funds were spent on primary health care (PHC), which was officially introduced in the late 1970s. PHC made up 20-25% of the health care expenditures by 1991 with about 25% of health personnel engaged in PHC. 2/3 of health care delivery covered urban areas when 60% of the population lived in the countryside. The district of Ejisu-Juaben in the Ashanti region had high morbidity. Tetanus, polio, whooping-cough, and diphtheria had been brought under control, but measles, diarrhea, and malnutrition were still widespread among children under 5 years old. Malaria, bilharzia, intestinal parasites, respiratory infections, hepatitis, anemia, hypertension, and vitamin A deficiency were also grave problems. AIDS was on the rise. Child mortality amounted to 130/1000 live births and maternal mortality to 1400/100,000 cases. The medical structure of the district comprises 10 health posts (6 governmental and 4 mission). Only 72 villages and 120,000 people are cared for. Each post has a mobile team. In 1993 a new community-based health care program began funded by Save the Children Netherlands. In 60 villages a village health committee existed but they were substandard. They were either reactivated or new committees were set up. Training activities were also started in prenatal care, delivery, care of malnutrition and diarrhea, hygiene, and sanitation. Two years later safe motherhood indicators had improved; postnatal care increased from 16% to 49%; medical deliveries increased from 27% to 37%; the share of families with contraceptive acceptance increased from 7% to 21%; and tetanus vaccination among mothers was estimated to have increased from 27% to 86%.
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PMID:[Primary health care in Ghana: no pay no cure?]. 750 Oct 68

Giving a definition of analgesia in ICU needs to answer several questions: Why sedation? Which drugs can we use? How can we deal with sedation? (monitoring, continuous administration, weaning...)? Two different types of sedation must be considered: treatment-sedation (status epilepticus, tetanus, intracranial hypertension...) and comfort-sedation in anxious and/or restless and/or painful patients and in those necessitating mechanical ventilation. Analgesic consumptions vary widely with diseases and their outcome, background diseases and ICU environment. Several studies have shown that pain and analgesia are frequently neglected in ICU. The authors review the different drugs in use, with their advantages and drawbacks. A particular place is reserved to regional techniques, often underused in ICU. Indications are then fully discussed, according to several specific pathological conditions. Monitoring and weaning of sedation are also discussed at the end of the review.
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PMID:[Role of analgesia for sedation in intensive care medicine]. 776 33


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