Primary care medicine is the new frontier in medicine. Every nation in the world has recognized the necessity to deliver personal and primary care to its people. This includes first-contact care, care based in a positive and caring personal rela tionship, care by a single healthcare provider for the majority of the patient's prob lems, coordination of all care by the patient's personal provider, advocacy for the patient by the provider, the provision of preventive care and psychosocial care, as well as care for episodes of acute and chronic illness. These facets of care work most effectively when they are embedded in a coherent integrated approach. The support for primary care derives from several significant trends. First, technologically based care costs have rocketed beyond reason or availability, occurring in the face of exploding populations and diminishing real resources in many parts of the world, even in the wealthier nations. Simultaneously, the primary care disciplines-general internal medicine and pediatrics and family medicine-have matured significantly. They have become viable alternatives to the specialty approach to care with its potential dehumanization, coordination problems, and increased cost."

The author has organized basic, core information on the diagnosis, treatment and prevention of chemical dependence into a readily understandable format. His approach teaches the physician what steps to take from a practical point of view: how to prevent addiction in the first place, how to diagnose the condition, how to aid the family get the addict into treatment, and how to increase the chances of long-term recovery. The book is divided into three sections. The first section covers basic definitions and concepts. The second section describes the pharmacology of the various psychoactive substances: depressants, opioids, stimulants, cannabinoids, hallucinogens, phencyclidines, and inhalants. The third section discusses chemical dependence in special groups: women, adolescents, the elderly, ethnic minorities, dual diagnosis patients, HIV- positive patients, and impaired physicians.

Preventing Disease, the offspring of an extraordinary collaboration between the U.S. and Canadian Preventive Services Task Forces, presents a meticulous and objective review of the published evidence on preventive measures. Examining such diverse and relevant topics as screening for endometrial cancer, exercise counselling for healthy adults, and the evidence for a causal relation between dietary lipids and coronary heart disease, this volume reflects the editors' shared conviction that recommendations for preventive action should rarely exceed what is well justified by the evidence. In the current period, characterized as the Second Public Health Revolution, the authors' hard-nosed approach leads them to ask the tough questions. Are preventive measures cost-saving? Does preventive screening actually lead to treatment in clinical practice? Does the treatment do more good than harm? To what extent does our desire to eliminate causes of serious disability, ill health and premature death cloud our objectivity? All concerned about preventive medicine, community health, and primary care will find valuable stimulation for thought and action in this book: the contributions have gone beyond the rhetoric.

An ever greater number of our contemporaries will reach a very much greater age than their ancestors. Longevity is one of the most fertile fields for paradoxes: it is clear that the same causes do not produce the same effects at the age of ten and at the age of one hundred! On the subject of longevity, the "recipe book" is far from having been written. Nevertheless, the Fondation IPSEN has chosen a few of these paradoxes to discuss and try and explain them.

Pelvic pain in the female patient is common in gynaecological practice, but the specialties of general surgery, urology and orthopaedics provide a significant number of patients and problems. These patients may suffer a multitude of symptoms, and only careful analysis and investigation of each individual problem by the doctor concerned will lead to correct diagnosis and management. The subject matter of this book lies in the practice of many specialties, and all are combined here in a coherent whole. This emphasises the close collaboration necessary between family practitioners, junior hospital staff and consultants. The authors are consultants who work together in a busy district general hospital, and their experience and collaboration is evident in the approach to the diagnosis and management of pelvic pain in the female. Emphasis is laid on the careful evaluation of history and examination and the correct interpretation of diagnostic investigations. Full details of radiology, ultrasound scanning, endoscopy, peritoneoscopy and bacteriological investigation are given. Full consultation between members of staff who have special experience in these investigative procedures is of paramount importance. Details of treatment for relief of pain are important to all doctors concerned with this aspect of clinical management. and this section will be of particular value. The blending of these specialties allows full consideration of the problems affecting the patients. Careful management leads to better treatment for the patient and better satisfaction for the doctor.

Cells have evolved multiple strategies to adapt the composition and quality of their protein equipment to needs imposed by changes in intra- and extracellular conditions. The appearance of pro teins transmit ting novel functional properties to cells can be controlled at a transcrip tional, posttranscriptional, translational or posttranslational level. Extensive research over the past 15 years has shown that transcriptional regulation is used as the predominant strategy to control the production of new proteins in response to extracellular stimuli. At the level of gene transcription, the initiation ofmRNA synthesis is used most frequently to govern gene expression. The key elements controlling transcription initiation in eukaryotes are activator proteins (transactivators) that bind in a sequence-specific manner to short DNA sequences in the of genes. The activator binding sites are elements of larger proximity control units, ca lied promoters and enhancers, which bind many distinct proteins. These may synergize or negatively cooperate with the activators. The do novo binding of an activator to DNA or, if already bound to DNA, its functional activation is what ultimately turns on a high-level expression of genes. The activity of transactivators is controlled by signalling pathways and, in some cases, transactivators actively partici pate in signal transduction by moving from the cytoplasm into the nuc1eus. In this first volume of Inducible Gene Expression, leading scientists in the field review six eukaryotic transactivators that allow cells to respond to various extracellular stimuli by the expression of new proteins."

The Fourth International Congress of Peritoneal Dialysis was held in Venice, Italy, June 29 to July 2, 1987. By this time peritoneal dialysis had emerged as a treatment for a substantial fraction of patients with end-stage renal disease and countless numbers of patients with acute renal failure. This treatment is now practiced worldwide and is the life-sustaining treatment for about 40,000 patients with chronic renal failure, representing 15 to 20% of dialysis therapy in about 1000 centers. It is not surprising, therefore, that the number of health professionals engaged in the investigation and the application of the treatment has also grown exponen tially. The First International Symposium on Peritoneal Dialysis, organized by Dr. A. Treviiio-Be cerra in Chapala, Mexico, in 1978, brought together a group of pioneers when continuous ambulatory peritoneal dialysis was in its infancy. In 1981, Dr. G. M. Gahl chaired the Second Symposium, in West Berlin, when the technique and professional interest were growing con siderably. By 1984, when Dr. 1. F. Winchester and I organized the Third Symposium, the pre sented papers exceeded 100 and there were about 1000 attendees. At that time, it was deemed appropriate to form a more organized group and the International Society for Peritoneal Dialy sis was founded. One of the first actions of the Society was to choose from among several applicants Dr."

Headache pain is widespread: 70% of Americans report suffering from headaches; 12% of those experience migraine pain. Aiming to supply clinicians with the information they need to care for headache patients, this second edition covers the most current information on headache classification, diagnostic procedures, and the treatment and management of chronic headache pain, including botulinum toxin for headache and zolmitriptan. The author discusses all common headache conditions: migraine, chronic migraine, status migraine, cluster and related headaches, tension headaches, sinus headaches, cervicogenic headaches, secondary headaches, and neuralgias. Part of the Oxford American Pain Library, this concise handbook aims to provide clinicians with practical information about the diagnosis and management of headache patients. Treating migraine and headache care holistically, the author includes a thorough review of both pharmacological medicines, such as anticonvulsants, antidepressants, and triptans as well as non-pharmacological alternatives, such as botanical remedies, acupuncture, and behavioral therapy. The book concludes with a collection of representative cases to help the physician integrate factual knowledge with evidence from real-life clinical situations. Compact and affordable, this volume is accessible, fact-filled, readable, and clinically pertinent.

Following an introduction to the philosophical and theoreti- cal background of traditional Chinese medicine, the dia- gnostic system is presented: the Chinese system of channels and functional organs, the significance of pointsand point categories, methods of needling and moxibustion. There is a chapter on treatment based on western diagnosis.

The recent interest in the pharmacology of the skin and the treatment of its diseases has come about for two reasons. The first is a realisation that many aspects of pharmacology can be studied as easily in human skin, where they may be more relevant to human physiology and diseases, as in animal models. Examples of this are the action of various vasoactive agents and the isolation of mediators of inflammation after UV irradiation and antigen-induced dermatitis. The second reason is the fortuitous realisation that a pharmacological approach to the treatment of skin disease need not always await the full elucidation of etiology and mechanism. For example, whilst the argument continued unresolved as to whether the pilo-sebaceous infection which constitutes acne was due to a blocked duct or to a simple increase in sebum production, 13-cis-retinoic acid was found quite by chance totally to ablate the disease; again, whilst cyclosporin, fresh from its triumphs in organ transplantation, has been found able to suppress the rash of psoriasis, it has resuscitated the debate on etiology. We are therefore entering a new era in which the pharmacology and clinical pharmacology of skin are being studied as a fascinating new way of exploring questions of human physiology and pharmacology as well as an important step in the development and study of new drugs, use of which will improve disease control and at the same time help to define pathological mechanisms.

Comprehensive Management of Menopause is a balanced, authoritative, and state-of-the-art approach to the treatment of all medical issues of the menopausal patient, strongly emphasizing clinical and practical applications for comprehensive care. The book is edited by leaders in the field and contains an impressive array of internationally recognized contributors. Divided into five easily referenced sections: Physiology, Diagnosis and Epidemiology; Medical Aspects of the Menopause; Gynecologic Aspects of the Menopause; Management and Therapeutic Guidelines; and The Future; this outstanding volume contains the most up-to-date information on diagnosis, treatment, and management of: - osteoporosis and musculo-skeletal pain; - cardiovascular disease and lipid and metabolism disorders; - all gynecologic aspects of menopause, including the newest technology and advances in hormone therapies; - breast problems and skin care. It also includes preventive medicine and general health care guidelines. Comprehensive Management of Menopause is the definitive text comprising all aspects of menopause and is indispensable to every physician providing medical care to women.

Since the apoE4 allele is a risk factor or susceptibility gene in late-onset familial and sporadic AD, the mechanism of disease expression may involve metabolic effects that are isoform specific. Isoform-specific interactions of apoE therefore become critical in the mechanism of AD pathogenesis. Detailed characterization of the binding of the apoE isoforms with proteins and peptides relevant to the pathology of the disease may be critical in understanding disease pathogenesis. These critical isoform-specific interactions of apoE may involve interactions with proteins and pep tides in the defining neuropathologic lesions of the disease, the neurofibrillary tangle and senile plaque. Other possible critical isoform-specific interactions include the mechanism of internalization, intracellular trafficking, and subsequent metabolism. In addition, differential post-translational modifications of apoE isoforms may determine differences in metabolism contributing to the pathogenesis of the disease. Oxidation of apoE may confer several isoform-specific, biochemically distinct properties. Since {3A peptide binds apoE in the lipoprotein binding domain of the protein and not in the receptor-binding domain, apoE could target bound {3A4 peptide to neurons via the LRP receptor. Internalization of the apoEI {3A peptide complex into the cell, by the same route as the apoE-containing lipoproteins, would result in incorporation into primary lysosomes and pH dependent dissociation. The demonstration of apoE in the cytoplasm of neurons, with isoform-specific interactions of apoE with the microtubule-binding protein tau demonstrated in vitro, suggest additional, testable hypotheses of disease pathogenesis.

Although dyspepsia has been investigated for a long period of time, there is no international agreement on what constitutes this condition nor any standardized guidelines. National guidelines followed by practitioners in different countries vary in diagnostic and therapeutic approach, underlining the necessity for a unique definition worldwide. Dyspepsia in Clinical Practice summarizes the current guidelines while offering a unified, practical definition of dyspepsia, and a diagnostic algorithm with an emphasis on the upper gastrointestinal endoscopy and rational first-line therapeutic approach based on epidemiology, pathophysiology, clinical presentation, diagnostic workup and response to previous therapy. Up-to-date scientific information about dyspepsia is presented from a practical, clinician's point of view. Written by experts in the field, this volume addresses dyspepsia in childhood and in the elderly, a very important issue often insufficiently emphasized in the literature. Guidelines are provided that can be easily followed in clinical practice, leading to a reduction in costs and increased patient safety. Dyspepsia in Clinical Practice will be of great value to gastroenterologists, internists, primary care physicians, pediatricians, infectious disease specialists, residents and fellows in training.

Based on the Commonwealth Harvard Alcohol Research and Teaching Program, this clinically oriented work is designed to give internists and primary care practitioners the knowledge and skills necessary to recognize and care for patients with alcoholism.

The purpose of this particular NATO Advanced Study Institute is to contribute to the dissemination of advanced knowledge and the formation of contacts between scientists from different countries. The Institute is meant to have a substantial teaching component while also providing a forum for discussion at the highest level. The NATO Advanced Study Institute on Progress in Biomechanics was held July 10-21, 1978 in Ankara, Turkey and the Proceedings are presented in this volume. Sixty-four engineers, mechanicians, medical and biological scientists from fourteen countries attended. Prof. R.M. Kenedi of the University of Strathclyde, Glasgow, Scotland and Prof. W. Goldsmith of the University of California, Berkeley, USA were the other members of the Organizing Committee. As Director of the Institute, I wish to thank them for their assistance without which the Institute would not have taken place. Time will show whether the Institute has served its purpose; namely, exciting interdisciplinary communications and developing a lasting and productive link from which significant academic and technological advances might emerge.

This essential handbook for sports medicine clinicians combines resources from various United States and International Olympic Committee sporting guidelines; national and international youth, scholastic, collegiate, and professional associations; and real-world experience to provide the most up to date and relevant information needed to fulfill coverage duties for sporting events. Easy to read, concise, and complete, this guide is a one-stop reference for sideline medical coverage of nearly fifty sports. Geared for live event coverage, chapters deliver quick hit specifics designed for in-the-moment use on the field.The book opens with a review of general coverage concepts applicable to most sports along with chapters dedicated to overriding medical concerns including emergency management, nutrition and hydration, adaptive sports considerations, and doping in sports, among other key topics. The core of the book focuses on coverage details for individual sports, organized by contact level and presented in a templated format for quick identification. Each sport-focused chapter describes its history, governing organizations, participants, rules and regulations, equipment, medical coverage logistics, medical emergencies, and common injuries. A dedicated "Medical Bag" for every sport outlines the necessary items providers should have at hand for managing emergencies and common injuries. This essential handbook belongs in every sports bag and will serve as a ready resource for clinicians and sideline personnel covering sporting events at any level. Key Features: Handy reference for on-field, sideline, or event sports coverage - with digital access for mobile use on most devices Current guidelines for almost 50 sports, including information specific to the disabled athlete when applicable Every chapter contains sport-specific information on emergencies and common injuries What's in your bag? Highlights medical bag essentials by sport, so you're always prepared Includes general chapters on clinician role, traveling with a team, pre-participation exams, medicolegal and ethical concerns, and approach to signature medical emergencies in sports

A fine team of state-of-the-art researcher/clinicians who know their fields, have contributed to the advancement of knowledge, and are in a position to judge what is truly important have here pooled their thoughts in a series of chapters on the cutting edges of gastroenterology. Four attributes render this volume superior to other update-oriented publications. The first striking feature, which is immediately evident upon scanning the table of contents, is the imaginative choice of subjects, ranging from trav eler's diarrhea and sexually transmitted GI infections through TPN and interventional endoscopy to geriatrics and iatrogenic disease. A second outstanding feature of this volume is its success in balanc ing basic pathophysiology with practical considerations of clinical man agement. This is achieved in the discussions of such diverse topics as acid-peptic diseases, infectious and other diarrheal syndromes, and hep atitis immunization. Throughout the book we are led smoothly from basic science principles to specific recommendations for diagnosis and therapy. This practical emphasis appears repeatedly and sometimes pro duces a delightful surprise, such as a chapter on radiology that is not tech nology-based but instead problem-oriented."

My conviction is that the matters addressed in this volume are of transcendental importance if we are to face up to the challenges of the 1990s and beyond. How, for instance, are we to cope with a truly ecological approach to public health and all its concomitant changes of risk groups worldwide unless there is a full appre ciation of the popUlation perspective throughout the health establishment? The global village has achieved a measure of interdependence requiring recognition by all concerned with the health of both individuals and communities that there is an urgent need to share our knowledge and deploy our resources in the best interests of people everywhere. The history of public health initiatives, the origins of epidemiology, and the tragic separation-virtually a divorce--of public health from medicine recounted in the chapters that follow argue strongly for an early rapprochement. Health professionals who complement each other's knowledge and skills can be reunited through their common reliance on epidemiology as a major fundamental science for the entire health enterprise. Henceforth, epidemiology should be ranked in importance with cellular and molecular biology, immunology, and the social and systems sciences; all are essential if we are to cope with the vast array of diseases and disorders that face us in both the developed and developing worlds. We need more first-rate laboratory scientists, clinicians, nurses, aides, village health work ers, and managers committed to serving the public."

Cell Immobilisation Biotechnology Biotechnology is divided into two volumes. The first volume is dedicated to fundamental aspects of cell immobilisation while the second volume deals with the diverse applications of this technology.
The first volume, Fundamentals of Cell Immobilisation Biotechnology, comprises 26 chapters arranged into four parts:

• Materials for cell immobilisation/encapsulation,
• Methods and technologies for cell immobilisation/encapsulation,
• Carrier characterisation and bioreactor design, and
• Physiology of immobilised cells: techniques and mathematical modelling.

More than half a million people worldwide are now sustained by renal replacement therapy, mainly hemodialysis at a cost exceeding USD 30 billion per year. Each case of ESRD that is delayed or prevented saves funds that may be applied to other aspects of health care. Edited by an internationally renowned nephrologist, Prognosis for Kidney Disorders provides a timely summary of exciting work in progress directed toward renoprotection and of ultimate interdiction of ESRD.
Suitable for researchers and clinicians, Dr. Morrell Michael Avram has collected and commented on promising initiatives likely to enter everyday practice in the immediate future. Suitable for renal trainees, experienced kidney doctors, nurses, nutritionists and cardiologists.

Non-Parametric Statistical Diagnosis

Physicians in most developed countries are at a great disadvantage when confronted with geographic and tropical diseases. They may be faced with prevention for patients who are outward bound or with diagnosis and treatment on their return. The practitioners' difficulties relate to inade quate teaching in medical schools and to the infrequency with which they are confronted with these exotic diseases. It is quite surprising to realize the extent of travel by Americans to areas where the tropical diseases abound: in 1979 there were 3 million trips by U. S. residents to Central and South America and almost 1 million to Africa and Asia. I Further, the influx from the tropics to the United States in 1978 involved 4. 5 million visitors and more than half a million immigrants. I The single most danger ous ofthese infections is malaria, which is now averaging about 500 cases yearly in the United States; it is important to realize that infection with one species of this organism (Plasmodium falciparum) can be lethal within a few days of the onset of fever. Highly contagious infections such as the newly discovered and extremely lethal Lassa and Ebola fevers may be imported to our shores, plus cholera, antibiotic-resistant bacillary dys entery, and amebic dysentery and liver abscess. Chronic worm infections such as schistosomiasis, although rarely lethal, may have severe conse 2 quences such as paraplegia or hematemesis."

During September 10-14, 1984, we held a Research Workshop at the Lake Arrowhead Conference Center, California, bringing togeth er leaders in the field of electronic spatial sensors for the blind from the psychology, engineering, and rehabilitation areas. Our goal was to engage these groups in discussion with one another about prospects for the future of electronic spatial sensing, in the light of emerging technologies and the increasing sophistica tion of behavioral research related to this field. The papers in this book give an update on several of the key research traditions in thi s fi e 1 d. Broader overvi ews are provi ded in the paper by Brabyn, and in our Historical Overview, Final Commentary and the Introductions to each section. In a field as complex as this, some overlap of discussion is desirable and the reader with a serious interest in this field is advised to sample several opinions. This volume, and the conference on which it is based, received assistance from many people and organizations. The Scientific Affai rs Divi sion of the North Atl antic Treaty Organization sup ported the conference as part of their program of Advanced Research Workshops, and the Science and Technology to Aid the Handicapped Program of the National Science Foundation provided additional major financial support. The Center for Social and Behavioral Sciences Research of the University of California, Riverside provided financial as well as major logistical support."

Prevention of disease and injury, including early identification of risks and disease and optimal control of potentially debilitating or fatal complications of chronic conditions, is the area of clinical medicine that holds the greatest promise for improving human health. Each year a long list of major, but potentially preventable health problems exacts a terrible human and financial toll. These problems urgently need our attention, especially as major advances in curative medicine become more complex and costly. Prevention of disease and injury may well be the central health issue of our time, an issue of vital concern to every quarter of our society. Now is a very good time to promote prevention. Citizens and some social groups are increasingly aware of and interested in health and fitness issues. There is great enthusiasm about-even obsession with-health, and we are seeing an astonishing proliferation of health publications and media presentations for laymen, fitness and weight control cen ters, exercise programs, health food stores, disease support groups, health education programs, and do-it-yourself diagnostic kits. All of this betokens an increased health consciousness on the part of public and perhaps signals greater individual accountability for health."

This timely and important work looks at the collaborative health care model for the delivery of mental health care in a primary care setting. This has become the ideal model for the treatment of comorbid medical and psychiatric or psychological disorders. There is also an increased awareness that pharmacological intervention, the most frequently delivered intervention for psychological disorders, is often of limited effectiveness without concurrent specific psychological intervention. The book includes more than two dozen case studies, co-written by clinical psychologists and primary care physicians. It is essential reading for any psychology practitioner in a clinical setting, as well as for health care administrators.