Many snakes are non-venomous (e.g. pythons, garter snakes, king snakes, boa constrictors) but may still in?ict painful bites and cause local swelling. Most venomous snakes belong to the viper and cobra families and are common in Asia, Africa, Australia and South America. Victims of bites may experience various e?ects including swelling, PARALYSIS of the bitten area, blood-clotting defects, PALPITATION, respiratory di?culty, CONVULSIONS and other neurotoxic and cardiac e?ects. Victims should be treated as for SHOCK – that is, kept at rest, kept warm, and given oxygen if required but nothing by mouth. The bite site should be immobilised but a TOURNIQUET must not be used. All victims require prompt transfer to a medical facility. When appropriate and available, antivenoms should be administered as soon as possible.
Similar management is appropriate for bites and stings by spiders, scorpions, sea-snakes, venomous ?sh and other marine animals and insects.
Bites and stings in the UK The adder (Vipera berus) is the only venomous snake native to Britain; it is a timid animal that bites only when provoked. Fatal cases are rare, with only 14 deaths recorded in the UK since 1876, the last of these in 1975. Adder bites may result in marked swelling, weakness, collapse, shock, and in severe cases HYPOTENSION, non-speci?c changes in the electrocardiogram and peripheral leucocytosis. Victims of adder bites should be transferred to hospital even if asymptomatic, with the a?ected limb being immobilised and the bite site left alone. Local incisions, suction, tourniquets, ice packs or permanganate must not be used. Hospital management may include use of a speci?c antivenom, Zagreb®.
The weever ?sh is found in the coastal waters of the British Isles, Europe, the eastern Atlantic, and the Mediterranean Sea. It possesses venomous spines in its dorsal ?n. Stings and envenomation commonly occur when an individual treads on the ?sh. The victim may experience a localised but increasing pain over two hours. As the venom is heat-labile, immersion of the a?ected area in water at approximately 40 °C or as hot as can be tolerated for 30 minutes should ease the pain. Cold applications will worsen the discomfort. Simple ANALGESICS and ANTIHISTAMINE DRUGS may be given.
Bees, wasps and hornets are insects of the order Hymenoptera and the females possess stinging apparatus at the end of the abdomen. Stings may cause local pain and swelling but rarely cause severe toxicity. Anaphylactic (see ANAPHYLAXIS) reactions can occur in sensitive individuals; these may be fatal. Deaths caused by upper-airway blockage as a result of stings in the mouth or neck regions are reported. In victims of stings, the stinger should be removed as quickly as possible by ?icking, scraping or pulling. The site should be cleaned. Antihistamines and cold applications may bring relief. For anaphylactic reactions ADRENALINE, by intramuscular injection, may be required.... Medical Dictionary
Dictionary of Tropical Medicine
Dialysis is available as either haemodialysis or peritoneal dialysis.
Haemodialysis Blood is removed from the circulation either through an arti?cial arteriovenous ?stula (junction) or a temporary or permanent internal catheter in the jugular vein (see CATHETERS). It then passes through an arti?cial kidney (‘dialyser’) to remove toxins (e.g. potassium and urea) by di?usion and excess salt and water by ultra?ltration from the blood into dialysis ?uid prepared in a ‘proportionator’ (often referred to as a ‘kidney machine’). Dialysers vary in design and performance but all work on the principle of a semi-permeable membrane separating blood from dialysis ?uid. Haemodialysis is undertaken two to three times a week for 4–6 hours a session.
Peritoneal dialysis uses the peritoneal lining (see PERITONEUM) as a semi-permeable membrane. Approximately 2 litres of sterile ?uid is run into the peritoneum through the permanent indwelling catheter; the ?uid is left for 3–4 hours; and the cycle is repeated 3–4 times per day. Most patients undertake continuous ambulatory peritoneal dialysis (CAPD), although a few use a machine overnight (continuous cycling peritoneal dialysis, CCPD) which allows greater clearance of toxins.
Disadvantages of haemodialysis include cardiovascular instability, HYPERTENSION, bone disease, ANAEMIA and development of periarticular AMYLOIDOSIS. Disadvantages of peritoneal dialysis include peritonitis, poor drainage of ?uid, and gradual loss of overall e?ciency as endogenous renal function declines. Haemodialysis is usually done in outpatient dialysis clinics by skilled nurses, but some patients can carry out the procedure at home. Both haemodialysis and peritoneal dialysis carry a relatively high morbidity and the ideal treatment for patients with end-stage renal failure is successful renal TRANSPLANTATION.... Medical Dictionary
Major diet-related health problems in prosperous communities tend to be the result of dietary excesses, whereas in underdeveloped, poor communities, problems associated with dietary de?ciencies predominate. Excessive intakes of dietary energy, saturated fats, sugar, salt and alcohol, together with an inadequate intake of dietary ?bre, have been linked to the high prevalence of OBESITY, cardiovascular disease, dental caries, HYPERTENSION, gall-stones (see GALL-BLADDER, DISEASES OF), non-insulindependent DIABETES MELLITUS and certain cancers (e.g. of the breast, endometrium, intestine and stomach) seen in developed nations. Health-promotion strategies in these countries generally advocate a reduction in the intake of fat, particularly saturated fat, and salt, the avoidance of excessive intakes of alcohol and simple sugars, an increased consumption of starch and ?bre and the avoidance of obesity by taking appropriate physical exercise. A maximum level of dietary cholesterol is sometimes speci?ed.
Undernutrition, including protein-energy malnutrition and speci?c vitamin and mineral de?ciencies, is an important cause of poor health in underdeveloped countries. Priorities here centre on ensuring that the diet provides enough nutrients to maintain health.
In healthy people, dietary requirements depend on age, sex and level of physical activity. Pregnancy and lactation further alter requirements. The presence of infections, fever, burns, fractures and surgery all increase dietary energy and protein requirements and can precipitate undernutrition in previously well-nourished people.
In addition to disease prevention, diet has a role in the treatment of certain clinical disorders, for example, obesity, diabetes mellitus, HYPERLIPIDAEMIA, inborn errors of metabolism, food intolerances and hepatic and renal diseases. Therapeutic diets increase or restrict the amount and/or change the type of fat, carbohydrate, protein, ?bre, vitamins, minerals and/or water in the diet according to clinical indications. Additionally, the consistency of the food eaten may need to be altered. A commercially available or ‘homemade’ liquid diet can be used to provide all or some of a patient’s nutritional needs if necessary. Although the enteral (by mouth) route is the preferred route for feeding and can be used for most patients, parenteral or intravenous feeding is occasionally required in a minority of patients whose gastrointestinal tract is unavailable or unreliable over a period of time.
A wide variety of weight-reducing diets are well publicised. People should adopt them with caution and, if in doubt, seek expert advice.... Medical Dictionary
Health has driven much of environmental policy since the work of Edwin Chadwick in the early 1840s. The ?rst British public-health act was introduced in 1848 to improve housing and sanitation with subsequent provision of puri?ed water, clean milk, food hygiene regulations, vaccinations and antibiotics. In the 21st century there are now many additional environmental factors that must be monitored, researched and controlled if risks to human health are to be well managed and the impact on human morbidity and mortality reduced.
Environmental impacts on health include:
noise
air pollution
water pollution
dust •odours
contaminated ground
loss of amenities
vermin
vibration
animal diseases
Environmental risk factors Many of the major determinants of health, disease and death are environmental risk factors. Some are natural hazards; others are generated by human activities. They may be directly harmful, as in the examples of exposure to toxic chemicals at work, pesticides, or air pollution from road transport, or to radon gas penetrating domestic properties. Environmental factors may also alter people’s susceptibility to disease: for example, the availability of su?cient food. In addition, they may operate by making unhealthy choices more likely, such as the availability and a?ord-ability of junk foods, alcohol, illegal drugs or tobacco.
Populations at risk Children are among the populations most sensitive to environmental health hazards. Their routine exposure to toxic chemicals in homes and communities can put their health at risk. Central to the ability to protect communities and families is the right of people to know about toxic substances. For many, the only source of environmental information is media reporting, which often leaves the public confused and frustrated. To bene?t from public access to information, increasingly via the Internet, people need basic environmental and health information, resources for interpreting, understanding and evaluating health risks, and familiarity with strategies for prevention or reduction of risk.
Risk assessment Environmental health experts rely on the principles of environmental toxicology and risk assessment to evaluate the environment and the potential e?ects on individual and community health. Key actions include:
identifying sources and routes of environmental exposure and recommending methods of reducing environmental health risks, such as exposure to heavy metals, solvents, pesticides, dioxins, etc.
assessing the risks of exposure-related health hazards.
alerting health professionals, the public, and the media to the levels of risk for particular potential hazards and the reasons for interventions.
ensuring that doctors and scientists explain the results of environmental monitoring studies – for example, the results of water ?uoridation in the UK to improve dental health.
National policies In the United Kingdom in 1996, an important step in linking environment and health was taken by a government-initiated joint consultation by the Departments of Health and Environment about adding ‘environment’ as a key area within the Health of the Nation strategy. The ?rst UK Minister of State for Public Health was appointed in 1997 with responsibilities for health promotion and public-health issues, both generally and within the NHS. These responsibilities include the implementation of the Health of the Nation strategy and its successor, Our Healthy Nation. The aim is to raise the priority given to human health throughout government departments, and to make health and environmental impact assessment a routine part of the making, implementing and assessing the impact of policies.
Global environmental risks The scope of many environmental threats to human health are international and cannot be regulated e?ectively on a local, regional or even national basis. One example is the Chernobyl nuclear reactor accident, which led to a major release of radiation, the e?ects of which were felt in many countries. Some international action has already been taken to tackle global environmental problems, but governments should routinely measure the overall impacts of development on people and their environments and link with industry to reduce damage to the environment. For instance, the e?ects of global warming and pollution on health should be assessed within an ecological framework if communities are to respond e?ectively to potential new global threats to the environment.... Medical Dictionary
Ben: Kalmegh
Mal: Nilaveppu, Kiriyattu Tam: Nilavempu Kan: KreataImportance: Kalmegh, the Great or Green Chiretta is a branched annual herb. It is useful in hyperdipsia, burning sensation, wounds, ulcers, chronic fever, malarial and intermittent fevers, inflammations, cough, bronchitis, skin diseases, leprosy, pruritis, intestinal worms, dyspepsia, flatulence, colic, diarrhoea, dysentery, haemorrhoids and vitiated conditions of pitta (Warrier et al, 1993). It is used to overcome sannipata type of fever, difficulty in breathing, hemopathy due to the morbidity of kapha and pitta, burning sensation, cough, oedema, thirst, skin diseases, fever, ulcer and worms. It is also useful in acidity and liver complaints (Aiyer and Kolammal, 1962). The important preparations using the drug are Tiktakagheta, Gorocandi gulika, Candanasava, Panchatiktam kasaya, etc. (Sivarajan et al, 1994). A preparation called “Alui” is prepared by mixing powdered cumin (Cuminium cyminum) and large cardamom (Amomum subulatum) in the juice of this plant and administered for the treatment of malaria (Thakur et al, 1989). It is also a rich source of minerals.Distribution: The plant is distributed throughout the tropics. It is found in the plains of India from U.P to Assam, M.P., A.P, Tamil Nadu and Kerala, also cultivated in gardens.Botany: Andrographis paniculata (Burm.f.) Wall ex.Nees belongs to the family Acanthaceae. It is an erect branched annual herb, 0.3-0.9m in height with quadrangular branches. Leaves are simple, lanceolate, acute at both ends, glabrous, with 4-6 pairs of main nerves. Flowers are small, pale but blotched and spotted with brown and purple distant in lax spreading axillary and terminal racemes or panicles. Calyx-lobes are glandular pubescent with anthers bearded at the base. Fruits are linear capsules and acute at both ends. Seeds are numerous, yellowish brown and sub-quadrate (Warrier et al,1993).Another species of Andrographis is A. echioides (Linn.) Nees. It is found in the warmer parts of India. The plant is a febrifuge and diuretic. It contains flavone-echiodinin and its glucoside-echioidin (Husain et al, 1992).Agrotechnology: The best season of planting Andrographis is May-June. The field is to be ploughed well, mixed with compost or dried cowdung and seedbeds of length 3m, breadth 1/2m and 15cm height are to be taken at a distance of 3m. The plant is seed propagated. Seeds are to be soaked in water for 6 hours before sowing. Sowing is to be done at a spacing of 20cm. Seeds may germinate within 15-20 days. Two weedings, first at one month after planting and the second at 2 month after planting are to be carried out. Irrigation during summer months is beneficial. The plant is not attacked by any serious pests or diseases. Flowering commences from third month onwards. At this stage, plant are to be collected, tied into small bundles and sun-dried for 4-5 days. Whole plant is the economic part and the yield is about 1.25t dried plants/ha (Prasad et al, 1997).Properties and activity: Leaves contain two bitter substances lactone “andrographolid” and “kalmeghin”. The ash contains sodium chloride and potassium salts. Plant is very rich in chlorophyte. Kalmeghin is the active principle that contains 0.6% alkaloid of the crude plant. The plant contains diterpenoids, andrographolide, 14-deoxy-11-oxo-andrographolide, 14-deoxy-11,12-dihydroandrographolide, 14-deoxy andrographolide and neoandrographolide (Allison et al, 1968). The roots give flavones-apigenin-7,4-dio-O-methyl ether, 5-hydroxy-7,8,2’,3’- tetramethoxyflavone, andrographin and panicolin and -sitosterol (Ali et al, 1972; Govindachari et al, 1969). Leaves contain homoandrographolide, andrographosterol and andrographone.The plant is vulnerary, antipyretic, antiperiodic, anti-inflammatory, expectorant, depurative, sudorific, anthelmintic, digestive, stomachic, tonic, febrifuge and cholagogue. The plant is antifungal, antityphoid, hepatoprotective, antidiabetic and cholinergic. Shoot is antibacterial and leaf is hypotensive(Garcia et al, 1980). This is used for the inflammation of the respiratory tract. In China, researchers have isolated the andrographolide from which soluble derivative such as 14-deoxy-11, 12-dehydro-andrographolide which forms the subject of current pharmacological and clinical studies. Apigenin 7,4’-O-dimethyl ether isolated from A. paniculata exhibits dose dependent, antiulcer activity in shay rat, histamine induced ulcer in guinea pigs and aspirin induced ulcers in rats. A crude substance isolated from methanolic extract of leaves has shown hypotensive activity. Pre-treatment of rats with leaf (500mg/kg) or andrographolide (5mg/kg) orally prevented the carbon tetrachloride induced increase of blood serum levels of glutamate-oxaloacetate transaminase in liver and prevented hepatocellular membrane.... Tropical Medicinal PlantsBen: Kalmegh
Mal: Nilaveppu, Kiriyattu Tam: Nilavempu Kan: KreataImportance: Kalmegh, the Great or Green Chiretta is a branched annual herb. It is useful in hyperdipsia, burning sensation, wounds, ulcers, chronic fever, malarial and intermittent fevers, inflammations, cough, bronchitis, skin diseases, leprosy, pruritis, intestinal worms, dyspepsia, flatulence, colic, diarrhoea, dysentery, haemorrhoids and vitiated conditions of pitta (Warrier et al, 1993). It is used to overcome sannipata type of fever, difficulty in breathing, hemopathy due to the morbidity of kapha and pitta, burning sensation, cough, oedema, thirst, skin diseases, fever, ulcer and worms. It is also useful in acidity and liver complaints (Aiyer and Kolammal, 1962). The important preparations using the drug are Tiktakagheta, Gorocandi gulika, Candanasava, Panchatiktam kasaya, etc. (Sivarajan et al, 1994). A preparation called “Alui” is prepared by mixing powdered cumin (Cuminium cyminum) and large cardamom (Amomum subulatum) in the juice of this plant and administered for the treatment of malaria (Thakur et al, 1989). It is also a rich source of minerals.Distribution: The plant is distributed throughout the tropics. It is found in the plains of India from U.P to Assam, M.P., A.P, Tamil Nadu and Kerala, also cultivated in gardens.Botany: Andrographis paniculata (Burm.f.) Wall ex.Nees belongs to the familyAcanthaceae. It is an erect branched annual herb, 0.3-0.9m in height with quadrangular branches. Leaves are simple, lanceolate, acute at both ends, glabrous, with 4-6 pairs of main nerves. Flowers are small, pale but blotched and spotted with brown and purple distant in lax spreading axillary and terminal racemes or panicles. Calyx-lobes are glandular pubescent with anthers bearded at the base. Fruits are linear capsules and acute at both ends. Seeds are numerous, yellowish brown and sub-quadrate (Warrier et al,1993).Another species of Andrographis is A. echioides (Linn.) Nees. It is found in the warmer parts of India. The plant is a febrifuge and diuretic. It contains flavone-echiodinin and its glucoside-echioidin (Husain et al, 1992).Agrotechnology: The best season of planting Andrographis is May-June. The field is to be ploughed well, mixed with compost or dried cowdung and seedbeds of length 3m, breadth 1/2m and 15cm height are to be taken at a distance of 3m. The plant is seed propagated. Seeds are to be soaked in water for 6 hours before sowing. Sowing is to be done at a spacing of 20cm. Seeds ma y germinate within 15-20 days. Two weedings, first at one month after planting and the second at 2 month after planting are to be carried out. Irrigation during summer months is beneficial. The plant is not attacked by any serious pests or diseases. Flowering commences from third month onwards. At this stage, plant are to be collected, tied into small bundles and sun-dried for 4-5 days. Whole plant is the economic part and the yield is about 1.25t dried plants/ha (Prasad et al, 1997).Properties and Activity: Leaves contain two bitter substances lactone “andrographolid” and “kalmeghin”. The ash contains sodium chloride and potassium salts. Plant is very rich in chlorophyte. Kalmeghin is the active principle that contains 0.6% alkaloid of the crude plant. The plant contains diterpenoids, andrographolide, 14-deoxy-11-oxo-andrographolide, 14-deoxy-11,12-dihydroandrographolide, 14-deoxy andrographolide and neoandrographolide (Allison et al, 1968). The roots give flavones-apigenin-7,4-dio-O-methyl ether, 5-hydroxy-7,8,2’,3’- tetramethoxyflavone, andrographin and panicolin and -sitosterol (Ali et al, 1972;Govindachari et al, 1969). Leaves contain homoandrographolide, andrographosterol and andrographone.The plant is vulnerary, antipyretic, antiperiodic, anti-inflammatory, expectorant, depurative, sudorific, anthelmintic, digestive, stomachic, tonic, febrifuge and cholagogue. The plant is antifungal, antityphoid, hepatoprotective, antidiabetic and cholinergic. Shoot is antibacterial and leaf is hypotensive(Garcia et al, 1980). This is used for the inflammation of the respiratory tract. In China, researchers have isolated the andrographolide from which soluble derivative such as 14-deoxy-11, 12-dehydro-andrographolide which forms the subject of current pharmacological and clinical studies. Apigenin 7,4’-O-dimethyl ether isolated from A. paniculata exhibits dose dependent, antiulcer activity in shay rat, histamine induced ulcer in guinea pigs and aspirin induced ulcers in rats. A crude substance isolated from methanolic extract of leaves has shown hypotensive activity. Pre-treatment of rats with leaf (500mg/kg) or andrographolide (5mg/kg) orally prevented the carbon tetrachloride induced increase of blood serum levels of glutamate-oxaloacetate transaminase in liver and prevented hepatocellular membrane.... Tropical Medicinal PlantsGrade of obesity
BMI (W/H2) III >40 II 30–40 I 25–29·9 not obese <25
Causes Whatever the causes of obesity, the fact remains that energy intake (in the form of food and drink) must exceed energy output (in the form of activity and exercise) over a suf?ciently long period of time.
Obesity tends to aggregate in families. This has led to the suggestion that some people inherit a ‘thrifty’ gene which predisposes them to obesity in later life by lowering their energy output. Indeed, patients often attribute their obesity to such a metabolic defect. Total energy output is made up of the resting metabolic rate (RMR), which represents about 70 per cent of the total; the energy cost of physical activity; and thermogenesis, i.e. the increase in energy output in response to food intake, cold exposure, some drugs and psychological in?uences. In general, obese people are consistently found to have a higher RMR and total energy output, per person – and also when expressed against fat-free mass – than do their lean counterparts. Most obese people do not appear to have a reduced capacity for thermogenesis. Although a genetic component to obesity remains a possibility, it is unlikely to be great or to prevent weight loss from being possible in most patients by reducing energy intake. Environmental in?uences are believed to be more important in explaining the familial association in obesity.
An inactive lifestyle plays a minor role in the development of obesity, but it is unclear whether people are obese because they are inactive or are inactive because they are obese. For the majority of obese people, the explanation must lie in an excessive energy intake. Unfortunately, it is di?cult to demonstrate this directly since the methods used to assess how much people eat are unreliable. For most obese people it seems likely that the defect lies in their failure to regulate energy intake in response to a variety of cognitive factors (e.g. ease of ?tting of clothes) in the long term.
Unfortunately, it can be possible to identify by the time of their ?rst birthday, many of the children destined to be obese.
Rarely, obesity has an endocrine basis and is caused by hypothyroidism (see under THYROID GLAND, DISEASES OF), HYPOPITUITARISM, HYPOGONADISM or CUSHING’S SYNDROME.
Symptoms Obesity has adverse e?ects on MORBIDITY and mortality (see DEATH RATE) which are greatest in young adults and increase with the severity of obesity. It is associated with an increased mortality and/or morbidity from cardiovascular disease, non-insulin-dependent diabetes mellitus, diseases of the gall-bladder, osteoarthritis, hernia, gout and possibly certain cancers (i.e. colon, rectum and prostate in men, and breast, ovary, endometrium and cervix in women). Menstrual irregularities and ovulatory failure are often experienced by obese women. Obese people are also at greater risk when they undergo surgery. With the exception of gallstone formation, weight loss will reduce these health risks.
Treatment Creation of an energy de?cit is essential for weight loss to occur, so the initial line of treatment is a slimming diet. An average de?cit of 1,000 kcal/day (see CALORIE) will produce a loss of 1 kg of fat/week and should be aimed for. Theoretically, this can be achieved by increasing energy expenditure or reducing energy intake. In practice, a low-energy diet is the usual form of treatment since attempts to increase energy expenditure, either by physical exercise or a thermogenic drug, are relatively ine?ective.
Anorectic drugs, gastric stapling and jaw-wiring are sometimes used to treat severe obesity. They are said to aid compliance with a low-energy diet by either reducing hunger (anorectic drugs) or limiting the amount of food the patient can eat. Unfortunately, the long-term e?ectiveness of gastric stapling is not known, and it is debatable whether the modest reduction in weight achieved by use of anorectic drugs is worthwhile – although a new drug, ORLISTAT, is becoming available that reduces the amount of fat absorbed from food in the gastrointestinal tract. For some grossly obese patients, jaw-wiring can be helpful, but a regain of weight once the wires are removed must be prevented. These procedures carry a risk, so should be done only if an individual’s health is in danger.... Medicinal Plants Glossary
Pemphigus vulgaris is a serious form a?ecting skin and MUCOUS MEMBRANE. It a?ects young and middle-aged people with widespread blistering, erosion and crusting of the skin. Extensive involvement of the lips, mouth and throat interfere with nutrition. Untreated, it is eventually fatal, but the disease can now be controlled by large doses of oral CORTICOSTEROIDS and other immunosuppressive drugs. MORBIDITY from the adverse e?ects of steroids is a serious problem, but some patients are eventually cured.
Pemphigus foliaceus is seen in the elderly; the blistering is more super?cial in the epidermis. It may be very widespread, but is not life-threatening because mucous membranes are not a?ected. Topical corticosteroids will sometimes control the eruption, but in severe cases treatment is as for pemphigus vulgaris.
Pemphigoid is a variant where the blistering occurs because of separation of the epidermis and dermis. Mucosae are rarely a?ected and the disease a?ects mainly the arms and legs in the elderly. Treatment is as for pemphigus but smaller doses of corticosteroids usually su?ce.... Herbal Medical
The concept of the dose-response is important for understanding the risk of exposure to a particular substance. This is embodied in a statement by Paracelsus (c.1493–1541): ‘All substances are poisons; there is none which is not a poison. The right dose di?erentiates a poison and a remedy.’
Poisoning may occur in a variety of ways: deliberate – SUICIDE, substance abuse or murder; accidental – including accidental overdose of medicines; occupational; and environmental
– including exposure during ?re.
Ingestion is the most common route of exposure, but poisoning may also occur through inhalation, absorption through the skin, by injection and through bites and stings of venomous animals. Poisoning may be described as acute, where a single exposure produces clinical e?ects with a relatively rapid onset; or chronic, where prolonged or repeated exposures may produce clinical e?ects which may be insidious in onset, cumulative and in some cases permanent.
Diagnosis of poisoning is usually by circumstantial evidence or elimination of other causes of the clinical condition of the patient. Some substances (e.g. opioids) produce a characteristic clinical picture in overdose that can help with diagnosis. In some patients laboratory analysis of body ?uids or the substance taken may be useful to determine or con?rm the o?ending agent. Routine assays are not necessary. For a very small number of poisons, such as paracetamol, aspirin, iron and lead, the management of the patient may depend on measuring the amount of poison in the bloodstream.
Accurate statistics on the incidence of poisoning in the UK are lacking. Mortality ?gures are more reliable than morbidity statistics; annually, well over 100,000 cases of poisoning are admitted to hospital. The annual number of deaths from poisoning is relatively small – about 300 – and in most cases patients die before reaching hospital. Currently, CARBON MONOXIDE (CO) is by far the most common cause of death due to poisoning. The most common agents involved in intentional or accidental poisoning are drugs, particularly ANALGESICS, ANTIDEPRESSANT DRUGS and SEDATIVES. Alcohol is also commonly taken by adults, usually in combination with drugs. Children frequently swallow household cleaners, white spirit, plant material – such as belladonna (deadly nightshade) and certain mushrooms; for example, death cap and ?y agaric – aftershave and perfume as well as drugs. If possible, the suspect container, drug or plant should be taken with the victim to the hospital or doctor. The use of child-resistant containers has reduced the number of admissions of children to hospital for treatment. Bixtrex® is an intensely bitter-tasting agent which is often added to products to discourage ingestion; however, not everybody is able to taste it, nor has any bene?cial e?ect been proven.
Treatment of poisoning usually begins with decontamination procedures. For ingested substances this may involve making the patient sick or washing the stomach out (GASTRIC LAVAGE): this is usually only worthwhile if performed soon after ingestion. It should be emphasised that salt (sodium chloride) water must never be given to induce vomiting, since this procedure is dangerous and has caused death. For substances spilt on the skin, the a?ected area should immediately be thoroughly washed and all contaminated clothing removed. Following eye exposure, the a?ected eye/s should be thoroughly irrigated with saline or water.
Treatment thereafter is generally symptomatic and supportive, with maintenance of the victim’s respiratory, neurological and cardiovascular systems and, where appropriate, monitoring of their ?uid and electrolyte balance and hepatic and renal function. There are speci?c antidotes for a few substances: the most important of these are PARACETAMOL, iron, cyanide (see CYANIDE POISONING), opioids (see OPIOID), DIGOXIN, insecticides and some heavy metals. Heavy-metal poisoning is treated with CHELATING AGENTS – chemical compounds that form complexes by binding metal ions: desferrioxamine and pencillinamine are two such agents. The number of people presenting with paracetamol overdose – a common drug used for attempted suicide – has fallen sharply since restrictions were placed on its over-thecounter sales.
When a patient presents with an illness thought to be caused by exposure to substances at work, further exposure should be limited or prevented and investigations undertaken to determine the source and extent of the problem. Acutely poisoned workers will usually go to hospital, but those su?ering from chronic exposure may attend their GP with non-speci?c symptoms (see OCCUPATIONAL HEALTH, MEDICINE AND DISEASES).
In recent years, legislation has been enacted in the UK to improve safety in the workplace and to ensure that data on the hazardous constituents and e?ects of chemicals are more readily available. These o?cial controls include the Control of Substances Hazardous to Health (COSHH) and the Chemicals (Hazard Information and Packaging) Regulations (CHIP) and are UK legislation in response to European Union directives.
The National Poisons Information Service is a 24-hour emergency telephone service available to the medical profession and provides information on the likely e?ects of numerous agents and advice on the management of the poisoned patient. The telephone numbers are available in the medical literature. In the UK this is not a public-access service. People who believe they, or their relatives, have been poisoned should seek medical advice from their GPs or attend their local hospital.
Toxbase The National Poisons Information Service provides a primary clinical toxicology database on the Internet: www.spib.axl.co.uk. This website provides information about routine diagnosis, treatment and management of people exposed to drugs, household products and industrial and agricultural products.
(See also APPENDIX 1: BASIC FIRST AID.)... Medical Dictionary
Central to an understanding of public health is recognition that public-health practitioners are concerned not just with individuals, but also with whole populations – and that improving health care plays only a part of public-health improvement. The health of populations (public health) is also dependent on many factors such as the social, economic and physical environment in which the people live and the nutrition and health care available to them.
For thousands of years, a fundamental feature of civilisations has been to seek to improve the health of the population and protect it from disease. This has led to the development of legal frameworks which di?er widely from country to country, depending on their social and political development. All are concerned to stop the spread of infectious diseases, and to maintain the safety of urban food and water supplies and waste disposal. Most are also associated with housing standards, some form of poverty relief, and basic health care. Some trading standards are often covered, at least in relation to the sale and distribution of poisons and drugs, and to controls on industrial and transport safety – for example, in relation to drinking and driving and car design. Although these varied functions protect the public health and were often originally developed to improve it, most are managerially and professionally separated from today’s public-health departments. So public-health professionals in the NHS, armed with evidence of the cause of a disease problem, must frequently act as advocates for health across many agencies where they play no formal management part. They must also seek to build alliances and add a health perspective to the policies of other services wherever possible.
Epidemiology is the principal diagnostic method of public health. It is de?ned as the study of the distribution and determinants of health-related states in speci?ed populations, and the application of this study to the control of health problems. Public-health practitioners also draw on many other skills, such as those of statisticians, sociologists, anthropologists, economists and policy analysts in identifying and trying to resolve the health problems of the societies they serve. Treatments proposed are likely to extend well beyond the clinic or hospital and may include recommendations for measures to resolve poverty, improve sanitation or housing, control pollution, change lifestyles such as smoking, improve nutrition, or change health services. At times of acute EPIDEMIC, public-health doctors have considerable legal powers granted to enable them to prevent infection from spreading. At other times their work may be more concerned with monitoring, reporting, planning and managing services, and advocating policy changes to politicians so that health is promoted.
The term ‘the public health’ can relate to the state of health of the population, and be represented by measures such as MORTALITY indices
(e.g. perinatal or infant mortality and standardised mortality rates), life expectancy, or measures of MORBIDITY (illness). These can be compared across areas and even countries. Sometimes people refer to a pubic health-care system; this is a publicly funded service, the primary aim of which is to improve health by the use of population-based measures. They may include or be separate from private health-care services for which individuals pay. The structure of these systems varies from country to country, re?ecting di?erent social composition and political priorities. There are, however, some general elements that can be identi?ed:
Surveillance The collection, collation and analysis of data to provide useful information about the distribution and causes of health and disease and related factors in populations. These activities form the basis of epidemiology, which is the diagnostic backbone of public-health practice.
Intervention The design, advocacy and implementation of policies to improve health. This may be through the provison of PREVENTIVE MEDICINE, environmental measures, in?uencing the behaviour of individuals, or the provision of appropriate services to limit disability and handicap. It will lead to advocacy for health, promoting change in many areas of policy including, for example, taxation and improved housing and employment opportunities.
Evaluation Assessment of the ?rst two steps to assess their impact in terms of e?ectiveness, e?ciency, acceptability, accessibility, value for money or other indicators of quality. This enables the programme to be reviewed and changed as necessary.
The practice of public health The situation in the United Kingdom will be described as, even though systems vary, it will give a general impression of the type of work covered. HISTORY Initially, public-health practice related to food, the urban environment and the control of infectious diseases. Early examples include rules in the Bible about avoiding certain foods. These were probably based on practical experience, had gradually been adopted as sensible behaviour, become part of culture and ?nally been incorporated into religious laws. Other examples are the regulations about quarantine for PLAGUE and LEPROSY in the Middle Ages, vaccination against SMALLPOX introduced by William Jenner, and Lind’s use of citrus fruits to prevent SCURVY at sea in the 18th century.
It was during the 19th century, in response to the health problems arising from the rapid growth of urban life, that the foundations of a public-health system were created. The ‘sanitary’ concept was fundamental to these developments. This suggested that overcrowding in insanitary conditions was the cause of most disease epidemics and that improved sanitation measures such as sewerage and clean water supplies would prevent them. Action to introduce such measures were often initiated only after epidemics spread out of the slums and into wealthier and more powerful families. Other problems such as the stench of the River Thames outside the Houses of Parliament also led to a demand for e?ective sanitary control measures. Successive public-health laws were passed by Parliament, initially about sanitation and housing, and then, as scienti?c knowledge grew, about bacterial infections.
In the middle of the 19th century the ?rst medical o?cers of health were appointed with responsibility to report regularly and advise local government about the measures needed to control disease and improve health. Their scope and responsibility widened as society changed and took on a wider welfare role. After more than a century they changed as part of the reforms of the NHS and local government in the 1960s and became more narrowly focused within the health-care system and its management. Increased recognition of the multifactorial causes, costs and limitations of treatment of conditions such as cancer and heart disease, and the emergence of new problems such as AIDS/HIV and BOVINE SPONGIFORM ENCEPHALOPATHY (BSE) have again showed the importance of prevention and a broader approach to health. With it has come recognition that, while disease may be the justi?cation for action, a narrow diseasetreatment-based approach is not always the most e?ective or economic solution. The role of the director of public health (the successor to the medical o?cer of health) is again being expanded, and in 1997 – for the ?rst time in the UK – a government Minister for Public Health was appointed. This re?ects not only a greater priority for public health, but also a concern that the health e?ects of policy should be considered across all parts of government.
(See also ENVIRONMENT AND HEALTH.)... Community Health
Dictionary of Tropical Medicine
