Preventing epidemic suicide in young people.
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Biomedical subjects
Publications and source records attributed to J R Ashton.
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The World Health Organization's strategy, Health for All by the Year 2000, presents a challenge to those responsible for training doctors. Doctors are needed who are concerned to promote health not just treat disease. A review of the medical undergraduate curriculum is required to achieve this. We describe a small step towards this by the restructuring of a community medicine teaching programme so that students are introduced to health promotion and the principles of Health for All.
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Analysis of routinely published abortion and fertility data for England and Wales between 1968 and 1980 shows that the age-specific abortion rates increased from 1968 until about 1973 when the rates peaked for all ages; rates then declined until 1977 but have subsequently returned to higher levels. Two factors are implicated: (1) the recent changes are related to parallel changes in the fertility rate; but (2) there is also a tendency for recent cohorts of women to resort to abortion more readily. These relationships are derived from analyses of fertility rates and abortion ratios, the proportion of conceptions that result in abortions. The results are discussed in terms of attitudes and practices related to birth control.
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An epidemic of suicide by burning in England and Wales occurred during the one-year period October 1978 to October 1979, following a widely publicized political suicide. For the 82 cases, death certificates were obtained and coroners' inquest reports sought. The victims were predominantly young single men or older married women; both groups had strong psychiatric histories; and there were no suicides which had political overtones, apart from the index case. Compared with suicides by this method in the past, a higher proportion of victims were born in the UK. It is proposed that a code of practice for the reporting of suicides by the media is required.
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In an outbreak of benign myalgic encephalomyelitis in a girls' school all the residential pupils, both those affected and those unaffected, were investigated. Special virological tests were essentially negative, but it seemed that a few girls had had a viral infection. Psychological testing showed that among younger girls the patients were more neurotic than the others. Girls with various disorders were found to have been classified as having the same disorder, because of what has been called altered medical perception. The conclusions of an international symposium on this condition were not substantiated.
Interviews with consultant gynaecologists serving the Wessex region about various aspects of their abortion work revealed considerable variations in attitudes and practice. Although the respondents referred to the same criteria in deciding whether to do an abortion, the assessments they made about the significance of these criteria were more of an individual matter. The variation in assessments partly explains the interdistrict disparities in the availability of N.H.S. abortions.
An analysis of fertility and the provision of abortion and abortion-related services in the health districts of Wessex showed considerable variation between districts in the provision of formal family-planning services. The patterns of fertility varied between the districts and there appeared to be some relationship between family-planning provision and the rates for illegitimate and "legitimated" births and induced abortion. Although the region as a whole was meeting the demand of 42% of its abortion patients within the National Health Service, there was a considerable variation from district to district which could be explained only in part by variations in the provision of resources. The main differences could be accounted for by the attitudes of the women and of their general practitioners and consultants. Of Wessex women obtaining induced abortions privately at the British Pregnancy Advisory Service (B.P.A.S.) clinic at Brighton, 85% said they would have been willing to have an N.H.S. operation locally if one had been available but that no choice had been offered. It is concluded that the differences in provision between the health districts are more likely to be explained by the attitudes of doctors to providing this service than by the wishes of women to use private medical treatment.
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