[Psychologic problems in a surgical intensive care unit].
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Biomedical subjects
Publications and source records attributed to A Delachaux.
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Recent work on principles of pleasure and on endogenous opioïd system enlightens some regulations of mental comfort and of homeostasis of the nervous system. From this point of view, the choice of specific drugs, during the first months of their use, would give an indirect picture of the troubles which caused initially the use of these substances. The present study discloses, behind the apparent anarchy of mono- and polytoxicopathies, some constant relations between age and sex of drug-users and specific choice of drugs.
In the canton of Vaud, Switzerland, 1589 regular drug consumers used in 1977 and 1978 one or more of the following substances: cannabis, opiates, hallucinogens, amphetamines, cocaine, medicaments (principally usual sleeping pills, analgesic pills, and tranquillizers). Half of the consumers used only cannabis, or opiates, or medicaments. Amphetamines, hallucinogens, cocaine were used very seldom alone. The situation in drug associations is very different. The most popular drug associations are presented. Abuse and abstinence of alcohol and cigarettes could be analyzed among 698 drug consumers.
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The evolution of illicit drug consumption by adolescents in the canton of Vaud, 1971 to 1979, was assessed from data available by the Juvenile Court. Some results of this study are presented. The quantitative changes are then discussed in relation with changes in the social framework, such as the evolution of the ideology of delinquent adolescents, the altered concepts of repression by the police and jurisdiction, and the evolution of facilities for the care of drug users.
At the end of life, human abilities decline and diseases become more and more resistant to therapy. But it remains possible to adapt the physical and social environment to the patient's residual capacities. Biological and social medicines are tightly linked. The former is predominant as long as the old patient is self-sufficient; as soon as he becomes dependent, diseases concern more and more the social environment and the social services. During the last decade of human life, medical therapeutics give way to social therapeutics, which are the treatment of the physical and social environment for the patient's comfort.
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Not only do insurance companies have to pay in case of death, injuries or disease, they are also concerned with their prevention. This is particularly true for the "Swiss National Accident Insurance Fund" (Caisse nationale suisse d'assurance en cas d'accidents--(CNA): for them the prevention of work related accidents and occupational diseases is required by law. Preventive activities in this area are very promising. The progress in the sickness insurance programmes for preventive medicine in the general population has, however, not been as successful. To date, the legislation denies payment for preventive medical care. Why is there this difference? In the case of accidents and occupational diseases, the cause of the pathologies are for the most part exogenous and develop in well known and controlled environments. In the case of disease or invalidity in the general population, the factors are in a large part endogenous and therefore very difficult to supervise, as they develop in much more complex and uncontrolled environments. Nevertheless progress has been done in this field as well. At present, some selected scientifically proven preventive examinations could be included in insurance programmes as part of a general plan and with strict quality control of laboratory findings.
The basis of preventive medicine for the individual is composed of health education, certain examinations and preventive treatments. A coherent approach is essential for efficiency of a program and avoidance of costly and nonessential expenditures. In the Swiss health system, the doctor's office could become more and more the center of preventive medicine for the individual. It would concern a large part of the population (in the United States, 80% of the men and 90% of the women consult a doctor at least once a year); offering a direct contact with the doctor of choice, advice specific for each case and the possibility of regular examinations by the same doctors. In many situations both public and private sources are involved in preventive medicine (public health services, doctors involved in the educational system, doctors involved in controll of security of working conditions, out-patient clinics, various health organizations). A collaboration among these sources should be organized and a reasonable division of the work established. A list of examinations and preventive treatments is presented.
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