By N. Gnar. University of North Carolina at Pembroke.
For the millions with arthritis keppra 500 mg fast delivery, for example, “total joint replacement emerges as a medical mira- cle of the late twentieth century,” yielding substantial pain relief and im- proving function in over 90 percent of people with osteoarthritis and other hip problems. Despite costs per surgery of $25,000, representing $12 bil- Final Thoughts / 263 lion per year in the United States, joint replacement surgery saves money, considering the costs of assisting people disabled by arthritis with their daily activities (Katz 2001, 203). People—at least those with health insurance—generally can choose whether to have expensive interventions like joint replacements. Public and private health insurers cover these costs, asking relatively few ques- tions. Although rates of these procedures have grown, many people, like Mike Campbell, delay surgery as long as possible. Even among those with serious arthritis, less than 15 percent of people are willing to undergo joint replacement (Hawker et al. Multiple factors probably contribute, including differences in access to care and personal preferences. In general, however, access to such major surgeries is certainly better in the United States than in some other countries. Second, research in rehabilitation and physical and occupational therapy is progressing, yielding better understanding of how the brain and body in- teract to produce voluntary movement. Although more research is needed, especially on the beneﬁts of conventional rehabilitation approaches, new discoveries could improve people’s physical functional abilities even after severely debilitating conditions, like strokes. People themselves, like Jimmy Howard with his exercycle, have independently discovered the beneﬁts of exercise. Across the general population, however, the fraction of people achieving recommended levels of physical activity remained unchanged from 1990 to 1998, at around 25 percent (Centers for Disease Control 2001a).
Adolescents and 231 232 Pearlman teenagers often need to feel like they are part of the decision-making process discount keppra 500 mg on-line. This can include dosage formulations, routes of administration, or types of medication. For the purposes of this chapter, I will limit my discussion to the abortive therapy of migraine rather than prevention. Nonpharmacological Therapies and Lifestyle Modiﬁcation Nonpharmacologic therapies may be well received in younger patients, including adolescents. Resting in a dark room, using an ice pack, and playing quiet music can be beneﬁcial. Basic lifestyle modiﬁcations may be reinforced in adolescents such as implementing regular sleeping patterns. Regular meals, consistent sleep patterns, and routine exercise may be simple life-style changes that can improve adolescent and childhood headaches. Stress is often a factor in children and adoles- cents with migraine; however, stress factors differ in children vs. School stress can include anxiety about workload, grades, and relationships with peers. Many children are overextended with extracurricular activities, and they may not have time to complete their schoolwork or time to relax and enjoy a little social or leisure activ- ity. For some children, reducing the number and frequency of after-school activities allows them to focus on schoolwork, perform well, sleep regularly, and participate in leisure activities. Pharmacological Treatment Medications used in the acute treatment of migraine attacks can be divided into two major categories: migraine speciﬁc and migraine nonspeciﬁc therapies. Studies are available supporting use of several of these medications for treatment of migraine. However, further study is warranted for all medications, with speciﬁc attention needed for dosing strategies. Common nonspeciﬁc acute medications are listed in Table 1 and available migraine-speciﬁc therapies with their formulations and avail- able doses are detailed in Table 2.
The only significant problems encountered by the government in this area resulted from external factors—its retreat on tobacco sponsorship of motor racing and a legal challenge to its attempt to ban cigarette advertising best 250mg keppra. Saving Lives did focus on one subject that had been conspicuously avoided by the previous government—that of health inequalities. The White Paper emphasised that the government was ‘addressing inequality with a range of initiatives on education, welfare-to-work, housing, neighbourhoods, transport and environment, which will help health’ (DoH 1999:x) Critics pointed out that this wide range of government initiatives against inequality did not include the provision of higher levels of welfare benefits. The White Paper later asserted that ‘the strong association between low income and health is clear’ and immeditely added that ‘for many people the best route out of poverty is through employment’ (DoH 1999:45). For the many people for whom that route was not practicable, the White Paper offered no alternative. Given the continuing controversy around health inequalities, it is worth briefly tracing its evolution during the 1990s. The concerns of the 1980s that increasing differentials in income were resulting in a growing gap between the health of the rich and that of the poor, became an increasingly prominent focus of medical research and discussion in the 1990s. Encouraged by Donald Acheson, the Kings Fund sponsored a series of investigations and seminars which culminated in the publication of Tackling Inequalities in Health in 1995, subtitled ‘an agenda for action’ (Benzeval et al. The BMA produced a report in the same year recommending a wide range of economic and social policies in 90 THE POLITICS OF HEALTH PROMOTION response to this problem (BMA 1995). Both before and after its 1997 election victory, New Labour adopted the issue of health inequalities as one of its major themes, a preoccupation that is reflected in its public health policy documents. At first inspection, the extent of medical and political concern with health inequalities appears puzzling. Though, as we have seen, class differentials have persisted, in real terms the health of even the poorest sections of society is better than at any time in history: indeed the health of the poorest today is comparable with that of the richest only twenty years ago (see Chapter One). Furthermore, it appears that the preoccupation with social class in the sphere of health (as indicated by the scale of academic publications) has grown in inverse proportion to the salience of class in society in general.