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Because vaccinating all but 1% against measles would be dicult to achieve buy 100mg trazodone otc, a two-dose program for measles is an attractive alternative in some countries [50 order trazodone 100mg on-line, 98, 99]. In the prevaccine era, every child had measles, so the incidences were approximately equal to the sizes of the birth cohorts. After the measles vaccine was licensed in 1963 in the United States, the reported measles incidence dropped in a few years to around 50,000 cases per year. In 1978 the United States adopted a goal of eliminating measles, and vaccination coverage increased, so that there were fewer than 5,000 reported cases per year between 1981 and 1988. Pediatric epidemiologists at meetings at the Centers for Disease Control in Atlanta in November 1985 and February 1988 decided to continue the one-dose program for measles vaccinations instead of changing to a more expensive two-dose program. Each year some of the reported cases are imported cases and these imported cases can trigger small outbreaks. The proportion of cases not associated with importation has declined from 85% in 1995, 72% in 1996, 41% in 1997, to 29% in 1998. Analysis of the epidemiologic data for 1998 suggests that measles is no longer an indigenous disease in the United States [47]. Measles vaccination coverage in 19 to 35-month-old children was only 92% in 1998, but over 99% of children had at least one dose of measles-containing vaccine by age 6 years. Because measles is so easily transmitted and the worldwide measles vaccination coverage was only 72% in 1998 [48, 168], this author does not believe that it is feasible to eradicate measles worldwide using the currently available measles vaccines. In recent rubella outbreaks in the United States, most cases occurred among unvaccinated persons aged at least 20 years and among persons who were foreign born, primarily Hispanics (63% of re- ported cases in 1997) [46]. Worldwide eradication of rubella is not feasible, because over two-thirds of the population in the world is not yet routinely vaccinated for rubella. Indeed, the policies in China and India of not vaccinating against rubella may be the best policies for those countries, because most women of childbearing age in these countries already have disease-acquired im- munity. Chickenpox is usually a mild disease in children that lasts about four to seven days with a body rash of several hundred lesions. Shingles is a painful vesicular rash along one or more sensory root nerves that usually occurs when the immune system is less eective due to illness or aging [23]. But the vaccine-immunity wanes, so that vaccinated children can get chickenpox as adults. Two possible dangers of this new varicella vaccination program are more chickenpox cases in adults, when the complication rates are higher, and an increase in cases of shingles. An age-structured epidemiologic-demographic model has been used with parameters estimated from epidemiological data to evaluate the eects of varicella vaccination programs [179]. Although the age distribution of varicella cases does shift in the computer simulations, this shift does not seem to be a problem since many of the adult cases occur after vaccine-induced immunity wanes, so they are mild varicella cases with fewer complications. Thus the simulations validate the second danger that the new vaccination program could lead to more cases of shingles in the rst several decades [179]. Type A inuenza has three subtypes in humans (H1N1, H2N2, and H3N2) that are associated with widespread epidemics and pandemics (i. Inuenza subtypes are classied by antigenic properties of the H and N surface gly- coproteins, whose mutations lead to new variants every few years [23]. For example, the A/Sydney/5/97(H3N2) variant entered the United States in 1998 1999 and was the dominant variant in the 1999 2000 u season [51]. An infection or vaccination for one variant may give only partial immunity to another variant of the same subtype, so that u vaccines must be reformulated almost every year. If an inuenza virus sub- type did not change, then it should be easy to eradicate, because the contact number for u has been estimated above to be only about 1. But the frequent drift of the A subtypes to new variants implies that u vaccination programs cannot eradicate them because the target is constantly moving. Completely new A subtypes (antigenic shift) emerge occasionally from unpredictable recombinations of human with swine or avian inuenza antigens. A new H1N1 subtype led to the 1918 1919 pandemic that killed over half a million people in the United States and over 20 million people worldwide. Pandemics also occurred in 1957 from the Asian Flu (an H2N2 subtype) and in 1968 from the Hong Kong u (an H3N2 subtype) [134]. When 18 conrmed human cases with 6 deaths from an H5N1 chicken u occurred in Hong Kong in 1997, there was great concern that this might lead to another antigenic shift and pandemic. Fortunately, the H5N1 virus did not evolve into a form that is readily transmitted from person to person [185, 198]. The two classic in- fectious disease models in section 2 assume that the total population size remains constant. However, constant population size models are not suitable when the nat- ural births and deaths are not balanced or when the disease-related deaths are sig- nicant. Infectious diseases have often had a big impact on population sizes and historical events [158, 168, 202]. For example, the black plague caused 25% population decreases and led to social, economic, and religious changes in Europe in the 14th century.

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SignStage presents plays in which actors simultaneously use spoken words and sign language order trazodone 100 mg on line, allowing both hearing and deaf audiences to seamlessly understand what is happening on stage without the use of a third party such as an interpreter cheap trazodone 100mg with amex. This forum allowed the Care Alliance to integrate health literacy messaging in the discussions. Through this program, local artists create participatory activities for children that bring literary works to life while also helping to build connections between arts and culture partners and local neighborhoods. The two organizations presented a flm called A Lot LikeYou, which tells the story of a woman who traces her cultural roots in Tanzania and uncovers stories of rape and abuse. A rape survivor herself, the woman uses her journey to become a storyteller, to ignite dialogue and inspire deep introspection about rape and abuse because truth that is never spoken can never lead to change. In the fall of 2013, the Sculpture Center presented an unusual exhibition in partnership with the East Cleveland Township Cemetery and the Alfred and Norma Lerner Tower of University Hospitals Case Medical Center. Called Made in Mourning: Contemporary Memorial and Reliquary, it used art installations to initiate thoughts and conversations dealing with death. An accompanying lecture series called The Dirt on Death was intended to generate broader community discussions on death and mourning in contemporary society. Cleveland s arts and culture sector is a vital resource for drawing attention to pressing community health concerns, providing opportunities for breaking stereotypes and strengthening community ties. Community Partnership for Arts and Culture 48 Creative Minds in Medicine case study cleveland museum of natural history Melissa Duy, Health Education Coordinator Photo courtesy of the Cleveland Museum of Natural History Community Partnership for Arts and Culture 49 Creative Minds in Medicine banishing boredom At the Cleveland Museum of Natural History, dull health classes are not allowed. Young children learn about their fve senses from puppet plays and dental health from brushing the teeth of Mr. Others play along with Disease Detectives, a mystery-story video that contains clues for them to discover the ways illnesses start and spread. And vivid imagery acts like mental refrigeration, keeping lessons fresh in all the students heads. As the museum s distance-learning coordinator and science instructor, she uses her theater and biology backgrounds to turn learning into memorable fun for young people in Northeast Ohio and beyond. For that reason, getting students to take home information in their heads as well as in their hands has become a process that s as creative for the children as for their health instructors at the museum. Says Health Education Coordinator Melissa Duy, art as part of the learning experience is something that just makes it unique and different. And they absorb a lesson about effective washing better when they get to cover their hands frst Because health is ever-evolving, the content of classes and the methods used to present it have to change, too. Gambol uses herself as an example:Though she likes teaching, she was a somewhat unenthusiastic student because sitting and listening is not my bag. She ended up working at the Great Lakes Science Center for four years, then joining the touring Mr. Wizard things, blowing stuff up to HealthSpace Cleveland, a health museum and educational organization that was the frst in the area to undertake video- conferencing and distance-learning. When HealthSpace merged with the natural-history museum in 2007, Gambol came along, bringing her arts-based teaching techniques with her. Because health is ever-evolving, she adds, the content of classes and the methods used to present it have to change, too. So whether a new prop is needed or recent studies demand new instructions for elementary-school hygiene students, creativity and effective re-design stay important to the museum s education department. Part of that artistic process of learning is, Don t push that button, I want to push it myself. Or by silence, as children examine an animal skull and then draw pictures of its teeth, reinforcing their memories by turning them to art. Or by hilarity, when Gambol plays stand-up comic and challenges a class of teenagers to consider how darned odd she feels, talking about private parts to roomful of perfect strangers. Its namesake, Abraham Flexner, was a former teacher and educational expert hired by the Carnegie Foundation to identify key ways of improving the structure of medical training. During this period, the Carnegie Foundation was focusing its resources on improving the nation s healthcare feld and conjectured that the poor state of medical training was a key weakness. To test this hypothesis, Flexner traveled the country to carry out a survey Key Benefts on the quality of U. Johns Hopkins School of practitioners: Medicine in Baltimore had already implemented such a German-style model218 and served as the gold standard by which Flexner measured other Develop higher levels of empathy, trust and 219 medical schools. Without of patients enforceable medical curriculum standards, any group Deliver patient-centered care of physicians could establish a for-proft medical Alleviate personal stress school and grant degrees [that] were scarcely worth the paper they were written on. In this environment, the concept of a full- time system in medical schools also took hold, Community Partnership for Arts and Culture 54 Creative Minds in Medicine Medical Training and Medical Humanities establishing the idea that the advancement of knowledge was to trump all other involvements in the academic physician s life. This chapter will explore the development of medical humanities programs and the ways art and culture are enriching medical students education. Medical Humanities In the United States, the oldest medical humanities programs emerged in the 1960s and 1970s as a reaction to perceived shortcomings in the teaching, practice and evaluation of medicine. Arts and Culture in the Medical Field In many ways, arts and culture serve to enrich the practices of community healthcare professionals by strengthening their practical skills; raising their awareness of cultural issues; and introducing doctors to artists working in healthcare settings. When working with real patients, attention to the most minute of details can yield more accurate diagnosis. Medical students learn patient-centered care by shadowing artists working with hospital patients, which enhances the students understanding of the benefts that arts and artists can bring to healthcare settings, while also engaging doctors in the creation of arts and culture activities for their patients.

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Arnold Gehlen discount trazodone 100 mg otc, Die Stele im technischen Zeitalter buy trazodone 100mg, Sozialpsychologische Probleme in der industriellen Gesellschaft (Hamburg: Rowohlt, 1957). Ackerknecht, "Natural Diseases and Rational Treatment in Primitive Medicine," Bulletin of the History of Medicine 19 (May 1946): 467-97, is a dated but still excellent review of the literature on the functions of medical cultures. Ackerknecht provides convergent evidence that medicine plays a social role and has a holistic and Unitarian character in primitive cultures that modern medicine cannot provide. Fred Binder, Die Brotnahrung: Auswahl-Bib-liographie zu ihrer Geschichte und Bedeutung, Donau Schriftreihe no. Lucia, Wine and the Digestive System: A Select and Annotated Bibliography (San Francisco: Fortune House, 1970). Michler, "Das Problem der westgriechischen Heilkunde," Sudhoffs A rchiv 46 (1962): 141 ff. Heyer- Grote, Atemschulung als Element der Psychotherapie (Darmstadt: Wissen- schaftliche Buchgesellschaft, 1970). Kilton Steward, "Dream Theory in Malaya," Complex: The Magazine of Psychoanalysis and Related Matters 6 (1951): 21-33. Writing towards the end of the 15th century Ibn Khaldun observed the conflict between the craft of medicine required by sedentary culture and its luxury and Bedouin medicine, which was based mainly upon tradition and individual experience. Carlyle suggests that both ideas first took recognizable form in the toast of the victorious Alexander to the homo-ousia (like-naturedness) of men. Combined with the idea of progress, the Utopia of healthy mankind came to prevail over the ideal of concrete and specific patterns of functioning characteristic for each tribe or polis. Sidney Pollard, The Idea of Progress: History and Society (New York: Basic Books, 1968), deals with the ideology of human progress in relation to concrete history and the politico-economic aspects complementing philosophy. Ashburn, The Ranks of Death: A Medical History of the Conquest of America (New York: Coward-McCann, 1947). No comprehensive study of the imperialism of European medical ideology in Latin America is available. For a first orientation, see Gonzalo Aguirre Beltran, Medicina y magia: El proceso de aculturacin en la estructura colonial (Mexico: Institute Nacional Indigenista, 1963). Wilhelm Scherer, Der Ausdruck des Schmerzes and der Freude in der mittelhochdeutschen Dichtung der Bltezeit (Strassburg, 1908). Ernst Hannes Brauer, Studien zur Darstellung des Schmerzes in der antiken bildenden Kunst Griechenlands and Italiens, inaugural dissertation, Univ. People differ in the intensity with which they modulate experience; some reduce and others increase what is perceived, including pain. Jarvik, "Relationship Between Superficial and Deep Somatic Threshold of Pain, with a Note on Handedness," American Journal of Psychology 77 (1964): 589-99. Contains much information on the impact of culture on the level of fear and the relationship between fear and the pain experience. Beecher, Measurement of Subjective Responses: Quantitative Effects of Drugs (New York: Oxford Univ. Opiates exert their principal action, not on the pain impulse, which is transmitted through the nervous system, but on the psychological overlay of pain. Severe postsurgical pain can be relieved in about 35% of patients by giving them a sugar or saline tablet instead of an analgesic. Since only 75% are relieved under such circumstances with large doses of morphine, the placebo effect might account for 50% of drug effectiveness. Scott, "The Effect of Early Experience on the Response to Pain," Journal of Comparative and Physiological Psychology 50 (April 1957): 155-61. On the importance and practical utility of religion and superstition in early modern England in the relief of suffering. Jahrhundert in ihren Vorraussetzungen und Folgen," Medizinhistorisches Journal 6 (1971): 707-61. Ferdinand Sauerbruch and Hans Wenke, Wesen und Bedeutung des Schmerzes (Berlin: Junker & Dnnhaupt, 1936). An invaluable guide to the history of physiology since the 16th century, which comes as close as possible to a history of the medical perception of pain. Rothschuh, Vm Boerhaave bis Berger: Die Entwicklung der kontinentalen Psychologie im 18. Jahrhundert mil besonderer Beruecksichtigung der Neurophysiologie (Stuttgart: Fischer, 1964). Frenzen, Klagebilder und Klagegebrden in der deutschen Dichtung des hfischen Mittelalters, dissertation, Univ. Hartman, The Structure of Value: Foundation of Scientific Axiology (Carbondale: Southern Illinois Univ. The pain about which a history ought to be written is the personalized experience of intrinsic pain: the inclusion in the experience of pain of the social situation in which pain occurs. Holmstedt, "Historical Survey," in Ethnopharmacologic Search for Psycho- active Drugs (Washington, D. Carstairs, "Daru and Bhang, Cultural Factors in the Choice of Intoxicant," Quarterly Journal of Studies on Alcohol 15 (June 1954): 220-37. Bergman, "Navajo Peyote Use: Its Apparent Safety," American Journal of Psychiatry 128 (December 1971): 695-9.

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