British medical bulletin
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The socio-economic impact of stroke is considerable world-wide. Stroke is assuming an increasing impact in terms of media attention, patient and career knowledge, service developments and research. It is estimated that there are 4.5 million deaths a year from stroke in the world and over 9 million stroke survivors. ⋯ It is estimated that by 2023 there will be an absolute increase in the number of patients experiencing a first ever stroke of about 30% compared with 1983. There is a total prevalence rate of around 5 per thousand population. One year after a stroke, 65% of survivors are functionally independent, stroke comprising the major cause of adult disability.
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In 1900, the population was beset with poverty, and infectious and deficiency diseases were common. The first half of the century was blighted by world wars, economic depression and post-war austerity. ⋯ The impact on food processing was manifold: nascent technologies such as freezing and chilling were increasingly exploited, and the consumer became the major focus of a food industry that became more sophisticated, embracing automation, computerisation and new developments in, for example, drying, heat processing, controlled and modified atmosphere packaging, ingredients and quality assurance. By 1999, this had led to an industry which provided foods that were not only safe, nutritious and palatable, but which were also increasingly convenient and healthy.
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Acute stroke treatment using aspirin and/or heparin was studied in the International Stroke Trial (IST) and Chinese Acute Stroke Trial (CAST) which randomised over 40,000 patients altogether. Combining the results demonstrated that aspirin (150-300 mg) given within 48 h of the onset of stroke produced a small but significant improvement in outcome (death or dependency) 4 weeks to 6 months after stroke of about 1 patient per 100 treated. There was a significant reduction in recurrent ischaemic stroke of similar degree, which was not associated with significant increase in cerebral haemorrhage. ⋯ Low molecular weight heparins and heparinoids have not proved any more beneficial. Therefore, heparin does not appear to be a useful routine therapy in acute stroke. The use of heparin should, therefore, be limited to patients at high risk of deep vein thrombosis or early recurrence.
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British medical bulletin · Jan 2000
ReviewUnderstanding life-style and food use: contributions from the social sciences.
The contribution of social sciences to the study of life-style and food use in Britain is illustrated by drawing on recent evidence of purchasing patterns, reports of the organisation of meals, snacks, eating out and images of the origins of food. Work discussed underlines a considerable degree of empirical complexity, demonstrates that the supply side as well as demand should be taken into account, and illustrates the manner in which even supposedly highly voluntaristic spheres of consumption activity may none the less be circumscribed. The article is prefaced by briefly contrasting the approach to 'life-style' adopted by market researchers, public health professionals and social theorists. It concludes with the proposal that in order to understand the complexity surrounding human food use, we may be advised to consider ensuring that the descriptive and conceptual tools being used can capture that complexity.
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Sedation is a process of soothing. The concept of the ideal level of sedation is controversial and has changed over the last decade. ⋯ This change in attitude has been brought about by sophisticated modes of ventilation allowing the ventilator to synchronize with the patient's own breathing pattern. In addition, the increasingly recognised adverse effects of over-sedation have contributed to the reduction in the depth of sedation.