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Peer reviewers will come from the Editorial Board as well as being sourced globally for their expertise in specific areas antiviral uk buy zovirax 400mg on line. Coming from a diploma level course hiv infection medicine buy cheap zovirax 200 mg on-line, we all believed that naturopathy and herbal medicine was defined by our technical skills, formulations and treatment protocols, with instructions delivered on paper. It is easy to see why additional skills are needed to help us engage with an increasingly complex world. These skills characterise human intelligence and are becoming highly valued in the workforce as automation fulfils many traditional roles. Heading up the suite of enterprise skills is critical thinking, a skill increasingly needed by health practitioners, and sought by the community and employers. It involves developing skills to analyse a set of inter-related concepts or questions, increased awareness of psychology (cognitive biases), developed tolerance for ambiguity and frequently thinking about the way we think. One of the pivotal changes to naturopathy and herbal medicine has been the introduction of minimum bachelor degree level training and graduates with critical capacity are contributing to the growth of our profession in a changing world. Ongoing public acceptance is essential to maintaining our relevance and professional viability in a changing healthcare landscape. It presents strong evidence that naturopathy is seen by Australian consumers as being aligned with their expectations and beliefs about excellent health care and able to meet their complex health needs as a stand-alone practice alongside and as part of conventional health and medical services. Naturopaths and herbalists have undertaken activities to fortify public acceptance and secure a place in the healthcare workforce. Other than clinical practice and industry roles, these activities include publishing in peer review journals and disseminating new knowledge, competing for research funding, providing sophisticated, multi-layered and multidisciplinary education, building networks that are often nuanced and complex, inspiring policy change at government level, developing resources and building local and global collaborations. Outcomes from these activities are helping us to be heard, to be taken seriously and to meet the challenges we face as a profession. We have a bright future ahead, increased personal and community health are by far the largest need to be met by future human workers. This edition of the Australian Journal of Herbal and Naturopathic Medicine includes a conference report from Sri Lanka by Christine Thomas. This was an inspiring conference with themes of integration of Ayurveda and Western medicine, whilst preserving the integrity of traditional practice. There is a vacuum of published research for this intervention and although case studies provide limited generalisability, they seed research questions, raise profiles of interventions and develop clinical treatment options. We also have a fascinating case study and short literature review on the long-term effective naturopathic management of allergic rhinitis and sinusitis. The client was seeking to reduce dependence on pharmaceutical medications (antihistamines), which is a common goal of complementary medicine consumers. Once again Jodi Testa has been working hard and summarised the published evidence for naturopathy and herbal medicine. This includes a research project by yours truly; thank you for an accurate review, Jodi. Other summaries include investigations into the effectiveness and effects of naturopathic and herbal medicine for mental health, chronic pain, digestion, liver injury and bone health. Around the colleges, institutes and universities presents two inspiring naturopaths, Ian Breakspear and David Casteleijn, our esteemed colleagues. Finally, I would like to wish you all a very happy, restful and recuperative festive and holiday season and a wonderful 2018. Calculated by taking the difference between the percentage growth in the number of jobs by occupation and the % growth in the total labour force from 1991 to 2015. By addressing the systemic cause rather than the symptoms alone, health may be brought back into balance with Celloid Mineral supplementation. Celloid Minerals A unique modality specific to Blackmores Professional For further information contact our naturopaths on 1300 251 543 or visit It was proposed that this initiative would pave the way towards multidisciplinary research, bringing together academia and industry from the region and beyond in an innovative platform. Keywords: Sri Lanka, Ayurveda, evidence-based medicine, traditional medicine, complementary medicine, integrative medicine.

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His use of "Theorems and Proofs" is somewhat silly because piano practice is not math hiv infection rates us 2012 best 200mg zovirax. This is the first book I have found on clear step-by-step instructions on using Mental Play to antiviral foods list purchase zovirax 400 mg without prescription memorize. It contains all the fundamentals; they are described in complete detail, teaching us all the correct terminology and methodologies. It starts from how to read music, for the beginner, and advances logically all the way to advanced sight reading levels; it is especially helpful for the beginner. It is also concise, so you should read the whole book once before starting any actual drills/exercises. Then the sight reading process is broken down into its component steps of visual, neural, muscular, and aural processes that start with the music score and end up as music. This is followed by drills for learning "keyboard orientation" (finding the notes without looking at the keyboard) and "visual perception" (instantly recognizing what to play). Depending on the person, it may take from 3 months to 4 years to learn true sight 257 reading; should practice every day. This book can be browsed free at Jazz Primer: A Jazz Improvisation Primer the Outside Shore. No actual music to play; discusses the language of jazz, understanding how jazz players play, and improvisation. Detailed definitions/discussions of chords, scales, and chord/scale relationships (swing, bebop, fusion, free improvisation, etc. Suggests many names of jazz players that you should listen to ("selected discography"), and a list of 92 "jazz standards" (no music score) including blues, swing, rock, latin, ballad, and standard/modal jazz. A most comprehensive and detailed compendium of accounts of the relationship between brain (human behavior) and music, written by one of the foremost experts in this field. Although the book is not organized in a structured arrangement, the extensive index and detailed Table of Contents make it possible to locate most of what you want in this enormous assemblage of accounts, observations, and analyses. Because the subject matter is so complex and inadequately researched and understood, there are almost no theories that explain the observations or solutions to the problems. However, all the hypotheses, popular theories, and possible explanations are discussed, as well as flat statements to the effect that the phenomenon is not understood ­ something only the experts can tell us. There is precious little, if any, useful instructions on how to practice at the piano, although the headings in each Part sound so tantalizing. However, it is truly an eye opening experience to read, in vivid detail, about the enormous range of effects that music has on the brain. The entire book consists of case studies and detailed accounts of actual events and people involved with each of the topics listed in the Table of Contents: Part I: Haunted by Music 1. Discusses: free fall, scale (thumb-over method; has most detailed description of scale and arpeggio playing, P. Numerous examples on how to apply the principles of the book to compositions from Chopin, Bach, Liszt, Beethoven, Haydn, Brahms, Schumann, many others. This book is very complete; it covers subjects from the effect of music on emotions to discussions of the piano, human anatomy, and basic playing motions, to performing and recording; however, many topics are not treated in sufficient detail. A major defect of this book is the absence of any references, casting doubt on whether there was sufficient research to support the contents of the book. Recommended An excellent, comprehensive starter book on music theory, composition. Consists of five sections dealing with playing, teaching, cultural issues, musical scores, and "everything else". The contents are arranged in no particular order, with no real solutions or conclusions. Discusses the politics of art (music), opinions, judgments, and observations that pianists can relate with; whether non-pianists can understand these musings is questionable but will provide insight. Fingers = troops, but body = supply line, support, carrier ship, and manufacturing. Pros and cons of competitions (mostly cons): preparing for competitions is not making music and often becomes more like an athletic competition; is the stress and effort worth it?

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Various randomized placebo-controlled double-blind trials with sample sizes between 30-150 in different type of population are available hiv infection next day generic 400mg zovirax. Two hundred and twenty-nine participants were assigned to hiv infection kinetics cheap zovirax 400mg visa sertraline only, sertraline and contingency management, placebo and contingency management, or placebo only. Contingency management significantly improved methamphetamine use outcomes, while participants assigned to the sertraline-only condition resulted in poorer retention and lower likelihood of sustained abstinence than the other treatment conditions. The small number of treatment studies may reflect the fact that this issuehas been received less attention than the treatment for other substances. The evidence shows that fluoxetine, amlodipine, imipramine and desipramine have been tried but demonstrate very limited benefits foramphetamine dependence and abuse. Imipramine mayincrease duration of adherence to treatment in medium-term treatment. Apart from these distal benefits, no otherbenefits, in particular the proximal ones can be found. This limited evidence suggests that no treatment has been conclusively demonstrated to be effective for the treatment of amphetamine dependence and abuse. While two studies compared fluoxetine 40 mg/day (Batki et al, 2000), amlodipine 10 and 5 mg/day (Batki et al, 2001) and desipramine 100-150 mg/day (Tennant et al, 1986) with placebo, the other compared imipramine 150 mg/day with imipramine 10 mg/day (Galloway et al, 1996). Three included studies (Batki et al, 2000; Batki et al, 2001; Tennant et al, 1986), therefore, should be considered as placebo, randomised, double-blind controlled studies. The other study should be considered as a randomised, doubleblind controlled study of imipramine 150 mg/day and imipramine 10 mg/day although the investigators considered that imipramine 10 mg/day was a placebo. Short-term, proximal outcomes presented in three studies were: i) number or percentage of amphetamine positive urines (Batki et al, 2000; Galloway et al, 1996); ii) number or percentage of amphetamine-use days (Batki et al, 2000; Galloway et al, 1996); iii) frequency of amphetamine use (Batki et al, 2000) and iv) amount of amphetamine consumed (Batki et al, 2001). Significant differences were not observed for the medication at any of the doses in reducing methamphetamine use or any reports of withdrawal, craving or severity of dependence. There was no clear evidence of efficacy for the medication; however, among individuals who were abstinent at the beginning of treatment, topiramate appeared to facilitate abstinence during the second half of the trial. The "stepped-care" approach uses psychosocial interventions at various stages of drug use. It aims to increase access to treatment, provide support to help users reduce or cease use, and © Indian Psychiatric Society 2016 109 Newer and Emerging Addictions in India mitigate the social, health and legal problems associated with continued use. It is a setting where knowledge of community resources is available so that referral can easily be made to specialized drug treatment facilities or other ancillary services. It is the setting to which drug users are likely to return if referred to specialist care. It is in the community that resources for rehabilitation and reintegration are mobilized. Adopt a holistic approach that addresses the broader socioeconomic issues rather than only the drug use. Even globally, there is scanty evidence-base about effectiveness of various treatment approaches. Clearly, more research is needed in this area to expand the evidence-base globally, as well as in our country. Depression and other psychological health problems among methamphetamine dependent patients in treatment: Implications for assessment and treatment outcome. The epidemiology of amphetamine type stimulant-related admissions in Albany, Western Australia: 2008-2013. Global Synthetic Drugs Assessment Amphetamine-type stimulants and new psychoactive substances. Characteristics and harms associated with injecting versus smoking methamphetamine among methamphetamine treatment entrants. Prevention Research Quarterly: Current evidence evaluated, Drug Info Clearing House, Issues Paper, No. Neuropsychiatric consequences (atypical psychosis and complex-partial seizures) of ecstasy use: possible evidence for toxicityvulnerability predictors and implications for preventative and clinical care. Psychological morbidity and route of administration among amphetamine users in Sydney, Australia. A rating scale for evaluation for the clinical course and symptomatology in amphetamine psychosis. Physical and mental health problems in amphetamine users from metropolitan Adelaide, Australia.

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Due to stages of hiv infection to aids zovirax 800mg for sale their often complex medical situation hiv infection rate in ethiopia order zovirax 800 mg mastercard, pre-travel advice in specialised pre-travel clinics is recommended (2-5), but there are apparent obstacles to achieve optimal coverage. In fact, almost 30% of the immunocompromised patients do not seek pretravel advice at all (2, 5, 6), compared to 50-65% of travellers in general (7, 8). The components of pre-travel advice are: informing patients concerning precautions during travel, the administration of recommended and suitable vaccinations, and the prescription of malaria chemoprophylaxis and on demand antibiotics. These conflicting data led us to question the rationale for the prescription of on demand antibiotics. Data collection For the purpose of this study, we developed a structured post-travel questionnaire (Supplementary File 1). A trained medical student conducted interviews by telephone 2-4 weeks after return from travel. Information on socio-demographic characteristics, vaccination status, the prescription of malaria chemoprophylaxis and standby-antibiotics was obtained during the pretravel visit and from patient medical records. The control group consisted of immunocompetent sex- and age-matched clients from the same travel clinic. Qualitative outcomes of this study were the reasons subjects gave for the use of on demand antibiotics. In addition, the reported risk behaviour for travel-related diseases was studied: participants were asked whether they took into account the hygiene and quality of health care of a country when choosing the travel destination; the hygiene of the accommodation; and which measures they took to prevent disease. Data analysis We collected both quantitative and qualitative data of which the quantitative data were continuous or categorical. We reported mean and standard deviation for normally distributed variables, and median and the interquartile range for not-normally distributed variables. Geographical destination We grouped travel destinations into geographical regions as defined by the United Nations geoscheme (21). Differences between body mass index, educational level and smoking habits were not significant. Alcohol consumption was significantly higher in the control group, with a median of 0. Mefloquine was prescribed to one participant in each group; all others received atovaquone/proguanil. Other medications Control group Other medications Antidepressants, inhalators, anti-epileptics, antihypertensive drugs, vitamin B12 injection, vitamin K antagonists, anti-histamines, protonpump-inhibitors, laxatives, statin, glucose reducing medication. In case of a negative antibody titre, hepatitis A immunoglobulins, which give a 100% protection for several weeks depending on the immunoglobulin dose, are administered before travelling. Other reported gastrointestinal complaints were nausea, vomiting, loss of appetite and weight loss. Reported health problems other than gastrointestinal complaints were coughing, dyspnoea, nasal congestion, chest pain, fatigue and pruritus/urticaria. Of the control participants, 2 (7%) consulted a physician post-travel; none was referred to a hospital. This participant, who was known with psoriatic arthritis and treated with immunosuppressive combination therapy, was suspected of typhoid fever and received azithromycin orally; however a final diagnosis was not established. The two control participants visited because of fever and nasal congestion, and dizziness, respectively. Both recovered with spontaneous symptom resolution without further intervention (Table 3). The control participant had used antibiotics because of a dental treatment and prescription by his dentist. Risk behaviour Participants were asked "whether they had taken into account the hygiene and quality of care of a country when they chose the visited country". Controls explained that they "checked hygiene of the accommodation before staying there" or "chose a clean hotel because of the children". Measures that were taken in both groups were: drinking of bottled water; not eating food from street vendors; avoiding contact with stray dogs and cats; and not swimming in fresh water. However, the data show that vaccination is probably less effective and that the duration of post-vaccination protection is probably shorter.

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Feasibility hiv infection through precum discount 800 mg zovirax mastercard, and efficacy of combined drug and psychological therapy needs to lysine antiviral buy zovirax 400 mg fast delivery be investigated in the future l Countries like India in which majority of the treatment of substance use disorder is clinic based and where there is a substantial scarcity of mental health professionals, effective delivery of psychosocial management remains elusive. However, in our mind there are other limitations which must have been kept in mind while following and analyzing the index guideline. This practice guideline is purported to help clinicians to manage patients attending their clinics. However, the abysmally low treatment seeking might raise doubt regarding its pragmatic utility. The second problem which could make this guideline ineffectual is the problem of poor treatment retention. Due to the lack of empirical validation, the effectiveness of this most commonly practiced modality of treatment in real world setting could not be commented upon. Fourthly, the psychological interventions which have maximum empirical support are labor intensive and require special expertise. This could question the practicability of these intensive 212 © Indian Psychiatric Society 2016 Gambling Disorder interventions. The generalizability of such recommendations for our Indian population might be debated. However, in absence of any treatment related research from India, we did not have any better alternative than to extrapolate our recommendations from the Western literature. Lastly, the Pathways Model explicated by Blaszczynski & Nower102 (although not as yet fully validated) hypothesizes three routes into disordered gambling. The second subgroup is prone to depression or anxiety, and these individuals begin gambling as a means of escape or to otherwise alleviate these emotional difficulties. The third group present with antisocial and impulsive tendencies, accompanied by neuropsychological evidence of frontal cortex involvement. This model indicates that there could be an opportunity for patient treatment matching. Gambling disorder and its relationship with substance use disorders: Implications for nosological revisions and treatment. Gambling Impact and Behaviour Study: Report to National Gambling Impact Study Commission. Estimating the prevalence of disordered gambling behaviour in the United States and Canada: a research synthesis. Suicidal ideation and suicide attempts in treatment- seeking pathological gamblers. Illegal behaviours in problem gambling: Analysis of data from a gambling helpline. A review of screening and assessment instruments for problem and pathological gambling. Gambling impact and behaviour study: report to the National Gambling Impact Study Commission, 1999. Motivators for resolving or seeking help for gambling problems: a review of the empirical literature. Natural recovery and treatment-seeking in pathological gambling: results of two U. Gambling severity, impulsivity, and psychopathology: comparison of treatment- and community-recruited pathological gamblers. Natural and treatment-assisted recovery from gambling problems: a comparison of resolved and active gamblers. Abstinence versus Moderation Goals in Brief Motivational Treatment for Pathological Gambling. Treatment goal selection for female pathological gambling: a comparison of abstinence and controlled gambling. Lupi M, Martinotti G, Acciavatti T, Pettorruso M, Brunetti M, Santacroce R, et al.

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The Bible has also had a very important role in the life of the Ambo people hiv dual infection symptoms discount zovirax 400mg without prescription, and thus one may assume that the biblical character of the name has been of importance also in cases in which these names have been given after Europeans hiv infection rates 2014 order zovirax 800mg with amex. In the Ambo context, emphasising the biblical nature of names at the expense of the European aspect may thus be seen as justified. It is also a fact that in any onomastic classification in which a name belongs to one class only, one classification motive must be given a preference over the others. This class contains names that the Ambo people have adopted from the Europeans, as well as from the Namibians of European origin, with whom they have been in close contact ­ except for the biblical names carried by these people. Some European names in the data can also be explained as coming from the influence of education and media, which have brought people and events outside the Ambo area closer to the Ambo people. Some of them are originally biblical or adopted from other European naming systems, but are generally regarded as Finnish names because of their Finnish form. Kerttu < Gertrud, Maija < Maria, Heikki < Henrik, Vihtori < Victor (Vilkuna 1993, p. There are also many German, English and Afrikaans names in this class, including common hypocoristic forms of biblical names in these naming systems. Names that are not typically used as personal names in European naming systems but refer to various aspects of European culture. The origins of these names were checked in various European name books ­ German, English, Afrikaans, Dutch ­ which are listed in the bibliography of this study under the title Books of Reference. The main source for Finnish names was the list of the most common 5,000 names of the Finns since the late 19th century, presented by Kiviniemi (1982a, p. The main source for the surnames used in Namibia was the Namibian telephone directory (Telecom Namibia 92/93), and the ones for the names of Finnish missionaries were Peltola 1958 (p. The third class contains Ambo names, which were for the most part easy to differentiate from the biblical and European names. The Ndonga­English Dictionary (Tirronen 1986) was most useful for the identification and translation of these names, together with the expertise of Ms. Riikka Halme, who assisted with the translation of the Ndonga and Kwanyama names respectively. There were some names in the data which could be interpreted as both Ambo and biblical or European names. In such cases, the name was classified according to the most probable interpretation. For example, names which occurred more commonly as a 232 Analysis of the Name Data first given name or as the only baptismal name of the person, especially in the early 20th century, were more likely to be European or biblical than Ambo. It is also possible that some of the names which were classified as Ambo in this study are in fact Ambo forms of biblical or European names, even if the origins of these names were impossible to trace. A profound analysis of all these names would have been too laborious a task, considering the general aims of this study. Hence, names which looked phonotactically like Ambo ones and could not be interpreted as Ambo forms of certain biblical or European names were classified as Ambo. It should be noted that all Ambo names in the data are not Ndonga or Kwanyama but represent other Ambo varieties as well, and tracing their meanings should be left to the specialists in Ambo linguistics. Nevertheless, hundreds of the Ambo names in the data could be translated, which was sufficient for an analysis of the morphology and semantics of these names. This class contains names which could not be classified otherwise, as their origins remained unclear. Many of these name forms look as if they were biblical or European in origin, but it was impossible to find out what the original name was. This group also includes abbreviated names which most likely refer to particular existing names. Earlier, we saw that biblical names were found among the most popular names in Ambo society. In the list of the twenty most popular first given names of women in the data, there are 6 biblical names: Maria, Martta, Ester, Johanna, Loide and Elisabet.

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Between 1872 and its closure in 1913 hiv infection in toddlers zovirax 800mg with mastercard, the associated Bцsendorfer-Saal was one of the premier concert halls of Vienna hiv infection rate washington dc buy 400mg zovirax with mastercard. The company passed through various hands over the years before returning to Austrian hands in 2002. Bцsendorfer pioneered the extension of the typical 88-key keyboard, creating the Imperial Grand Model 290 which has 97 keys, and later the Model 225 which has 92 keys. More recent models have omitted this device and simply have the upper surface of the extra natural keys finished in matte black instead of white to differentiate them from the 45 standard 88. One of the earliest and most important pianists to be associated with Bцsendorfer was Franz Liszt who found that Bцsendorfer and Bechstein pianos were the only instruments capable of withstanding his tremendously powerful playing. Still today Bцsendorfer is known as a piano that will withstand the rigours of concert halls and tours. The Bцsendorfer sound is darker and richer than the purer but less full sound of the Steinway, due in part to the extra bass notes which resonate when the other strings are struck. Bцsendorfer has also developed a computer that can be fitted to most Bцsendorfer pianos to enable the direct recording of a piano performance. Brahms was born in Hamburg, Germany but spent most of his life in Vienna, Austria. He was a virtuoso pianist and is recognised as the greatest symphonic composer after Beethoven. Brahms adapted his lyrical and romantic idiom to classical structures that attach great importance to motivic development. Because of his preference for and extensive use of the sonata and variation forms he was thought by Wagner to be an insignificant tributary of music although his ability was acknowledged. Brahms is particularly satisfying in that he combines a classical foundation with a richly romantic emotional overlay. He uses block chords in the middle of the keyboard, octaves, thirds and sixths, and generally cultivates an awkwardness and difficulty in his piano writing with a view to creating original sonorities. The earliest version was composed in 1854, when Brahms was twenty-one, as a sonata for two pianos. Brahms then thought about reworking it as a symphony and it was only in 1855 that he decided to to turn it into a piano concerto. He eventually took over from the early sonata and the planned symphony only the first movement (Allegro), and composed an enrirely new slow movement (Adagio) and Rondo finale (Allegro not troppo). He later reworked the slow movement from the early sonata and used it as the second movement of his German Requiem. The concerto received its first public performance in January 1859 in Hanover and Leipzig with the composer as soloist. It was not very successful, perhaps because the audience found the orchestral introduction unusual and the piano writing not as showy as they were accustomed to. Brahms began work on the B flat piano concerto in 1878, completed it in 1881 while in Pressbaum near Vienna and dedicated it to his teacher Eduard Marxsen. The concerto is in four movements (Allegro non troppo, Allegro Appassionato, Andante, and Allegretto grazioso) rather than the three movements typical of concertos in the classical and romantic periods. The extra movement (the second movement, scherzo) makes the concerto considerably longer than most other concertos written up to that time as a complete performance lasts about fifty minutes. As critics noted at its first performance, the scherzo brings the concerto closer to being a symphony for piano and orchestra. As in his D minor piano concerto, Brahms combined elements of the classical concerto (direct opposition of soloist and orchestra, and soloist virtuosity) with the chamber music like influences of the baroque concerto grosso. The chamber music tendencies are especially strong in the slow movement (Andante) which contains an interplay of piano, cello and winds. The concerto was given its public premiиre in Budapest in 1881, with Brahms himself playing the solo part. Unlike the D minor piano concerto which was rather coolly received and struggled for general acceptance, the B flat concerto was an immediate and 47 great success. Brahms went on to perform it at a number of successful concerts in Germany, Austria and the Netherlands, some conducted by Hans von Bьlow. Mason continues: `A little later someone asked Liszt to play his own sonata, a work which was quite recent at that time, and of which he was very fond.

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Malta is known for its sunny weather and attractive beaches hiv infection rates by gender buy cheap zovirax 200 mg, but most of all for its historic sites (Rudolf and Berg 2010) anti viral anti fungal herbs generic 200mg zovirax with amex. Malta has two official languages - Maltese and English, though Maltese is regarded as the national language. Malta has had a reputable, long-standing medical history of healthcare provision, with its first hospital already functioning by 1372 (Savona-Ventura 2007), earning worldwide reputation for the nursing care offered to inpatients during World War 1. To date, the Maltese government provides comprehensive, publicly funded health care to all Maltese residents (through taxation and national insurance), covering a wide array of treatments, such as specialist treatment, hospitalisation, prescriptions, pregnancy, childbirth and rehabilitation. The public health care system operates through public hospitals and health care centres, and is overseen by the Ministry for Health with the Chief Medical Officer, Director General (Health Care Services) and Superintendent Public Health at the helm. Eight health centres provide primary care, offering preventive, curative and rehabilitative services, while secondary and tertiary care are provided through three public hospitals. For those who opt for private health care insurance or out-of-pocket payments, the island offers a strong private health system (Ministry for Health 3 2017a). Pharmacies offer services by General Practitioners, specialized physicians and allied health care professionals. In 2012, the mortality rate for Malta was estimated to be 26 deaths per 100,000 females, compared to 23 deaths in all Europe (Figure 1. Together with other southern European countries, the latter reflects a high mortality to incidence ratio, a proxy of unfavourable survival (Ferlay et al. More recent observational studies, reporting on the impact of population-based screening programmes have also been questioned due to similar inconsistencies (Jшrgensen et al. Mammography screening has thus been associated with controversy (Gшtzsche and Jшrgensen 2013) due to issues of overdiagnosis and its potential to cause harm to women through unnecessary treatments and medical procedures. These issues are related to the sensitivity of mammography in detecting slow-growing or non-aggressive lesions. However, since it is not possible to know which screen-detected cancers are potentially fatal, all screen-detected lesions are usually treated with the negative impact of overdiagnosis and associated treatment. Mammography is offered to all women over 40 years old but screening remains opportunistic in most of the country (Vutuc et al. Opportunistic screening is also widespread across Belgium, with its organized screening programme offering mammograms at two-year intervals for women aged 50-69 (Altobelli and Lattanzi 2014). Regionally 8 organized screening programmes are offered in Switzerland for women over 50, with the age limit varying between 69-74 years (Swiss Cancer Screening 2015). From 2010, a trial in England started phasing in an extension of the age range of invited women to those aged 47 ­ 49 and 71 ­ 73 (Moser et al. In Northern Ireland the screening programme, introduced in 1990, was initially aimed at 50­64-year-olds but was extended to women aged 70 in 2004. The difficulties were due to the lack of acceptability and feasibility of pilot start-ups (Ministry for Health 2017b). The invitation letter describes the location and time of the screening appointment and provides contact details of the unit for women to change their appointment, if necessary. Initially, an information booklet accompanied the invitation letter, but the content was under review together with its cost effectiveness since the beginning of 2011 and has not been issued and mailed since. Adjunct ultrasound is carried out at a subsequent (recall) appointment when deemed necessary, for cases such as dense breasts or for further evaluation of suspected mammographic abnormalities. Nevertheless, in 2010, only four countries had reached this target, with rates ranging from as low as 8% in Romania to over 80% in Finland, Slovenia and the Netherlands (Figure 1. Low screening rates may represent a system-level failure in care in some countries (Lester et al. This possibly reflects variations in the perceived costs, perceived benefits to screening, as well as facilitators and barriers to screening (Carney et al. This further highlights the need for effective interventions to increase uptake and reduce any inequalities among the population (Weller and Campbell 2009). What types of interventions (which have employed the Health Belief Model and/or Common-Sense Model of illness self-regulation) are effective at increasing mammography uptake? Which factors influence non-attendance among lifetime non-attendees and which interventions are considered appropriate to increase mammography screening uptake in Malta? To determine the socio-demographics, health status, knowledge, health beliefs and illness perceptions of women who attend or do not attend for mammography screening during their lifetime; 2. To examine the most significant predictors of lifetime mammography utilization and its non-use.

References:

  • https://merkelcell.org/wp-content/uploads/2019/01/MCC_v.2.2019.pdf
  • https://hartfordhospital.org/file%20library/services/bloodless%20medicine/bms-brochure-eng.pdf
  • https://clinicaltrials.gov/ProvidedDocs/54/NCT02607254/Prot_SAP_000.pdf

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