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Obsessiveficompulsive personality style as a perpetuating fac to cholesterol ratio nih buy generic fenofibrate 160mg line r for depression iii cholesterol foods help lower cheap fenofibrate 160 mg with mastercard. Step 3 “Put it all to age vs cholesterol chart buy genuine fenofibrate online gether” Divina is a 17fiyearfiold girl who presented to lowering cholesterol what foods to avoid discount fenofibrate on line the emergency department after disclosing suicidal thoughts to her schoolfiteacher. Her brother has recently had a series of seizures, which has been a source of concern to Divina, who is close to her brother. Her mother has had to take time off work, leading to lost income which, due to her overly responsible nature, may have led to Divina feeling pressure to work harder to support her mother and brother. In a biological sense, Divina’s recent course of prednisone for her asthma may be have predisposed her to developing a depressive illness, especially when combined with other stressors. This may have predisposed her to having a depressive illness, as she has coped with recent stressors by working harder and trying to be more productive, which was difficult to maintain leading to a sense of personal failure. There is a sense that Divina has been unable to meet the high expectations she usually sets for herself. It may also be a perpetuating fac to r for her illness if she does not develop alternative coping strategies. Divina’s father was absent for much of her life, and Divina seems to have compensated for this by becoming parentified herself, and has an unusual degree of responsibility for someone her age. Looking to the future, Divina seems to be facing the challenge of developing an identity for herself outside of her work commitments, and developing friendships and pursuing romantic relationships. These include the fact that she is intelligent, is close to her family, and has other family interstate with whom she is close to. Her ingrained sense of responsibility makes it more likely she will comply with followfiup and be compliant with antidepressant medication. Note: “Parentified” is a term used to describe young people who have taken on the role of a parent and, like Divina, have an unusual degree of responsibility for someone their age. Picador; 2015fiThis is a book written by Professor Jamison, a Professor of Psychiatry at Johns Hopkins University. In it she writes of her own experience of having bipolar disorder, the effects of the illness on her relationships, as well as her selffiidentity. It is, essentially, Professor Jamison’s own formulation about her lived experience with mental illness. Taking the time to read this book, and thinking about the issues it raises will help you to look at your patients in a more nuanced way and, hence, help with your formulation skills. American Psychiatric Pub; 2017fi this is a good introduction in to the basics of psychodynamic concepts, which are essential when formulating any patient’s presentation. Not many people are particularly enthused about doing afterfihours shifts, but they need to be done. They are also a vital part of training, as you will have the opportunity to see a range of presentations, practice your skills, and have an opportunity to discuss cases with a consultant. In general, afterfihours shifts are classified as: fi Evening shifts (usually between 1700fi2230) during weekdays fi Night shifts (between 2230 and 0830 on weekdays, and between 2030 and 0830 on weekends) fi Day shifts (usually between 0830 and 2030) on weekends For the major hospitals in our training network (Cumberland Hospital, Westmead Hospital, Black to wn and Mt Druitt Hospitals collectively, and Nepean Hospital) a psychiatry registrar needs to be onfisite 24 hours a day. Looking after the medical and psychiatric care of patients admitted to psychiatric units a. This might be to assess a patient’s mental state (particularly for patients who have been highly distressed), facilitate transfer to a psychiatric unit, or moni to r for sidefieffects to psychotropics which might have been recently commenced b. An inpatient psychiatrist may have requested a review of a patient on the ward for similar reasons c. Patients who are “mentally disordered” under the Mental Health Act also require daily review to see if they still meet the criteria for being a “mentally disordered” person, or whether they should be discharged 5. The medical aspects of covering afterfihours mainly includes basic skills that you were taught as a junior doc to r. General principles for afterfihours shifts the following principles are useful to keep in mind during these shifts: 1. Early on in your training it is expected that you will need to ask for help from the psychiatrist on call. If you are worried about the medical state of a patient, then ask for help from the medical registrar covering the hospital. Never discharge a patient without discussing this with the psychiatrist on call As you gain more experience, you may not need to call the psychiatrist on call for the more “basic tasks”. However, whether you are a basic or more senior trainee, you are expected to call the psychiatrist on call for any discharges. Try to make the psychiatrist on call’s life a bit easier As mentioned, it is vital that you call for help from the onficall consultant if you need it. Be careful about the term “medical clearance” Emergency doc to rs, or other medical staff will often refer to a patient as “medically cleared”. What this means is that they have assessed the patient and feel they are medically stable to be managed in a psychiatric ward. It is worth keeping in mind that this medical clearance may have been based upon an assessment by a doc to r more junior than you. It is your responsibility to assess for yourself whether the patient is medically stable to be in a psychiatric ward. There needs to be a psychiatry registrar in the hospital at all times this point is rather selffiexplana to ry. If you are unable to do an afterfihours shift then it is wholly your responsibility to make sure that another registrar will cover this shift for you. There will be many disgruntled people if you don’t turn up for a shift (including the psychiatrist on call). For weekend shifts, 89 ensure that you have received handover from the registrar that is ending their shift. It is equally important that you provide handover to the next registrar starting their shift. ConsultationfiLiaison Psychiatry refers to psychiatric services that are provided in the general hospital. Psychiatry is somewhat unique, in that psychiatric doc to rs can keep certain individuals in hospital against their will. Some mental health patients are unaware that they are having symp to ms of a mental illness. For instance, patients with a psychotic illness who have delusional beliefs which seem very real to them may not accept that this is a feature of their illness. This is sometimes referred to as “poor insight”, and, as a result, some of these patients may not have capacity to make decisions about their medical care. Some patients, due to their illness, may pose an immediate risk of harm to themselves and/or others. For instance, a patient with severe depression may have suicidal ideation with current plans to end their life after presenting to hospital due to a suicide attempt. A psychotic patient may also have thoughts of hurting others due to their persecu to ry beliefs. There are obvious ethical implications regarding the ability to keep people in hospital against their will. Is keeping a patient in hospital in their best interests, and are there significant benefits to be gainedfi Being in an inpatient ward may be traumatising to some patients, and may lead to a loss of rapport with mental health services. That it is important to consider the patient’s wishes regarding their treatment, and that if a patient prefers treatment in the community then this should be pursued unless there is a convincing reason why they need to be in hospital. Treating patients in the community, if at all possible, may also “free up” beds for patients who require inpatient treatment and for whom community treatment is not at that time possible. Only those patients who require hospital treatment can be kept in hospital against their will 2. Patients be kept in hospital only if they or others need protection from serious harm 3. Patients are only kept in hospital for the shortest period of time that is consistent with safe and effective care 90 4. There must be reasonable grounds for believing that care treatment or control is required for the person’s own protection from serious harm or for the protection of others from serious harm. An individual whose behaviour is so irrational that there are reasonable grounds for deciding that temporary care, treatment or control of this person is necessary to protect them or others from serious physical harm fi A mentally disordered person will most commonly be an individual who is suicidal or aggressive following a social stressor.

Other misconceptions include that the elderly choose to cholesterol test uk boots cost of fenofibrate “disengage” socially cholesterol lowering diet plan mayo clinic cheap fenofibrate 160 mg without a prescription, that depression is natural does cholesterol medication make you feel better buy 160 mg fenofibrate with visa, that intellectual decline is a normal feature of ageing and that older people are not dis tressed by the death of contemporaries or their own disabilities cholesterol ratio mg/dl buy fenofibrate overnight. These attitudes, in fact, are either in response to disability or are simply not valid assumptions. There will be individual and cultural differen ces across the world but the principle remains the same. Efforts to maximize their options through improved physical health, supportive social conditions and opportunities for personal growth would promote their improved mental health (Copeland, 2003). Conclusion this chapter has attempted to examine concepts of mental health in selected, diverse groups in various countries through a process of engaging mental health practitioners currently concerned with different population groups and inviting them to comment. A strong theme that has emerged is the centrality of mental health in enabling individuals to function constructively in their particular roles and therefore to contribute positively to their com munity. Communities in which individuals struggle to experience a positive sense of well-being and connectedness to others, to experience life as having meaning and being manageable, are largely dysfunctional. Far from mental health being a “luxury” as some might argue, it is recogni zed as fundamental to a healthy society. The practitioners consulted for this chapter clearly articulate that beliefs and actions need to be unders to od within their political, economic and social contexts and that cultural beliefs are only one element to be considered. Today there are very few homogeneous cultural groups, and socioeconomic class and urban-rural differences impact greatly on lifestyle and beliefs. There is also an appreciation that while the components of positive mental health are universal, their expression and interpretation will differ individually, culturally and in relation to the current context. Similarly, different aspects of mental health will take on particular importance and prio rity depending on the situation and context. However, while the mental health perspectives held by groups should always be acknowledged, it is clear that they are not always helpful. A constructivist approach, which “recognizes the presence of diversity as normative” (Lee, 1996, p. In this approach, no assumptions are made by the practitioner as to how individuals or groups might perceive a situation, its etiology and meaning, or how it might be addressed. Rather, the practitioner is charged with hearing the group’s cons truction of their own reality, thus avoiding simplistic, often incorrect, “cultural” explanations. This approach also allows for the process of “co-construction” between the practitioner and the target group or community in which, through a “recursive and educational process” (Lee, 1996, p. This approach provides a framework for respecting people’s conceptions of mental health while allowing for change. The challenge posed to those involved in mental health promotion is to take cognizance of these differences in order that programmes are experienced by participants as meaningful and relevant. This is particularly important when attempting to introduce programmes that may run counter to locally held beliefs and perceptions. While the general goals of programmes may be similar across groups and cultures, the focus, form and intervention strategy will vary as they respond to the norms and priorities of the particular community. Chapter 6 1 Social Capital and Mental Health Harvey Whiteford, Michelle Cullen, Florence Baingana Introduction Research over the last two decades has demonstrated that social capital is linked with economic development, the effectiveness of human service systems and community development. Social capital has also been shown to decrease transaction costs in the production and delivery of goods and services, thereby improving productivity and efficiency. Political scientists have studied the contribution of social capital to the functioning of democracy, more efficient government, decreased corruption and the reduction of inequality within a society. Social scientists have inves tigated how higher social capital may protect individuals from social isolation, create social safety, lower crime levels, improve schooling and education, enhance community life and improve work outcomes (Woolcock, 1998). The same strong ties that are needed for people to act to gether can also exclude non-members, such as the poor or minority groups. Strong ties within the group may lead to less trust and reciprocity to those outside the group. For example, drug cartels and terrorist groups may have high levels of social capital among group members, with obvious detrimental effects for those outside the group. Social interactions can have negative as well as positive effects – as good behaviour spreads, so does bad (as shown by studies on education and crime). Networks can just as easily influence and reinforce bad choi ces as they can good. Understanding the positive and negative effects on health of what is now called social capital has been an increasing focus of research in the last decade. At the same time authors have begun to speculate about and attempt to unravel possible relationships between social capital and mental health (Kawachi & Berkman, 2001; McKenzie, Whitley & Weich, 2002; Sar to rius, 2003). This chapter explores the concept of social capital, outlines the understanding at present on the relationship between social capital and health and mental health and discusses the potential for mental health promotion to enhance social capital. The narrowest conceptualization focuses on local, horizontal community associations and the underlying norms (trust, reciprocity) that facilitate coordination and cooperation for mutual benefit (Uphoff, 2000). This view primarily focuses on the positive aspects of social capital and does not necessarily include the detriments (such as exclusion and excessive demand on members). A broader conceptualization of social capital, such as that employed by Coleman (1988), incor porates a wider spectrum of social dynamics. A definition based on function, this view includes vertical associations, characterized by both hierarchy and an unequal power distribution among members within a society. This social and political environ ment includes formalized institutional relationships and structures within government and related agencies, the political regime and the legal and regula to ry systems. An integrative view of social capital recognizes that micro, meso and macro institutions co-exist and interact with each other: this view not only accounts for the virtues and vices of social capital, and the impor tance of forging ties within and across communities, but recognizes that the capacity of various social groups to act in their interest depends crucially on the support (or lack thereof) that they receive from the state as well as the private sec to r. Similarly, the state depends on social stability and widespread popular support (World Bank, 2004). Given these varying conceptualizations of social capital, it is not surprising that it also has elas tic definitions. In this chapter, social capital means “the features of social organization, such as civic participation, norms of reciprocity, and trust in others, that facilitate cooperation for mutual benefit” (Kawachi et al. Despite contention over definitional parameters, there is a growing consensus that social capital captures a concept that facilitates collective action and can promote social and economic growth and development by complementing other forms of capital (Grootaert, 1998). Although the consensus is that social capital is “social” and collective, debate continues around whether it is a form of “capital”. Capital is conceived of in two fundamentally different ways (Eatwell, Milgate & Newman, 1987). It may be thought of as a fund of resources that can be swit ched from one use to another. It may also be conceived of as a set of productive fac to rs that are embodied in the production process, the so-called “technical” concept of capital. Using the technical concept, traditional capital theory arbitrarily divided productive fac to rs (inputs) in to three groups: natural resources, human labour and man-made goods (financial and physical capital). This last was called capital goods (or often just “capital”) and was defined as produced goods that could be used as inputs for further production (Samuelson & Scott, 1975, p. Over time, the other inputs, natural resources and human labour, began to be referred to as capital as well. In the early 1960s economists such as Schultz and Becker reintroduced Adam Smith’s term human capital to refer to how educated and healthy workers productively utilized other capital inputs (Schultz, 1963; Becker, 1962). Thus the literature now routinely recognizes natural capital (soil, atmosphere, forests and water), human capital (human productivity) and physical or financial capital (man-made goods. The concept of social capital, referred to as the missing link in economic develop ment (Grootaert, 1998), has grown out of the belief that cohesive and productive groups of indivi duals are more than just the sum of their human capital. Social capital emerges from interactions that are social and external to the individual, not lodged within individuals as human capital is. It is inherent in the structure of social relationships and the refore is an ecological characteristic (Henderson & Whiteford, 2003). Using the term to mean the assets of individuals or families (Portes, 1998; Walkup, 2003) introduces confusion. Cognitive social capital is derived from “mental processes and resulting ideas, reinforced by culture and ideology, specifically norms, values, attitudes, and beliefs that contribute to cooperative behaviour” (Uphoff, 2000, p. Cognitive social capital influences behaviour, including control of risk-taking behaviour, mutual support and informal means of information exchange. Structural components of social capital are the “roles, rules, precedents and procedures as well as a wide variety of networks that contribute to cooperation” (Uphoff, 2000, p. Structural social capital has two dimensions – horizontal, reflecting ties that exist among individuals or groups of equals or near-equals, and vertical, stemming from hierarchical or unequal relations due to diffe rences in power or resource bases. Structural social capital is shaped by government policies and the formal service networks that result from their implementation.

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Alternatively ldl cholesterol levels chart australia buy discount fenofibrate 160 mg online, the condom may be removed prior to blood cholesterol levels nz order 160mg fenofibrate with mastercard sexual intercourse and the penis washed clean of any residual active compound cholesterol standards chart buy generic fenofibrate on line. Although no significant side-effects have been reported cholesterol levels in pork chops fenofibrate 160mg without prescription, to pical anaesthetics are contra-indicated in patients or partners with an allergy to any ingredient in the product. Tramadol is readily absorbed after oral administration and has an elimination half-life of five to seven hours. For analgesic purposes, tramadol can be administered between three and four times daily in tablets of 50-100 mg. Side-effects were reported at doses used for analgesic purposes (up to 400 mg daily) and include constipation, sedation and dry mouth. This mechanism of action distinguishes tramadol from other opioids, including morphine. Tramadol has shown a moderate beneficial effect with a similar efficacy as dapoxetine. However, efficacy and to lerability of tramadol would have to be confirmed in more patients and longer-term. With all antidepressant treatment for premature ejaculation, recurrence is likely after treatment cessation. Congenital penile curvature results from disproportionate development of the tunica albuginea of the corporal bodies and is not associated with urethral malformation. In the majority of cases the curvature is ventral but it can also be lateral and rarely dorsal. Patients usually present after reaching puberty as the curvature becomes more apparent with erections, and severe curvature can make intercourse difficult or impossible. Physical examination during erection (au to pho to graph or after intracavernous injection of vasoactive drugs) is useful to document curvature and exclude other pathologies [288]. Surgical treatments for congenital penile curvature generally share the same principles as in Peyronie’s disease (presented in detail in the next section). Nesbit procedure with excision of an ellipse of the tunica albuginea is the gold standard of treatment but many other techniques have been described and employed. Plication techniques are widely used including techniques producing a de-rotation of the corporal bodies [289]. Most of the time, dissection of the dorsal neurovascular bundle is required in order to avoid loss of sensation and ischaemic lesions in the glans penis [290-292]. Physical examination during erection is useful for documentation of the curvature and exclusion of other pathologies. Surgery is the only treatment option which is deferred until after puberty and can be performed at any 3 time in adult life. However, an insult (repetitive microvascular injury or trauma) to the tunica albuginea is the most widely accepted hypothesis on the aetiology of the disease [301]. A prolonged inflamma to ry response will result in the remodelling of connective tissue in to a fibrotic plaque [301-303]. Penile plaque formation can result in curvature which, if severe, may prevent penetrative sexual intercourse. Dupuytren’s contracture is more common in patients with Peyronie’s disease affecting 9-39% of patients [297, 306-308] while 4% of patients with Dupuytren’s contracture reported Peyronie’s disease [307]. The first is the acute inflamma to ry phase, which may be associated with pain in the flaccid state or painful erections and a palpable nodule or plaque in the tunica of the penis; typically a penile curvature begins to develop. The second is the fibrotic phase (chronic phase) with the formation of hard palpable plaques that can be calcified, which also results in disease stabilisation and no further progressive curvature. With time, penile curvature is expected to worsen in 30-50% of patients or stabilise in 47-67% of patients, while spontaneous improvement has been reported by only 3-13% of patients [304, 310, 311]. Pain is present in 35-45% of patients during the early stages of the disease [312]. Pain tends to resolve with time in 90% of men, usually during the first 12 months after the onset of the disease [310, 311]. In addition to the physiological and functional alteration of the penis, affected men also suffer significant distress. Validated mental health questionnaires have shown that 48% of men with Peyronie’s disease have mild or moderate depression, sufficient to warrant medical evaluation [313]. The first phase is the acute inflamma to ry phase 2b (painful erections, ‘soft’ nodule/plaque), and the second phase is the fibrotic/calcifying phase with formation of hard palpable plaques (disease stabilisation). Spontaneous resolution is uncommon (3-13%) and most patients experience disease progression 2a (30-50%) or stabilisation (47-67%). Pain is usually present during the early stages of the disease but tends to resolve with time in 90% of men. Major attention should be given to whether the disease is still active, as this will influence medical treatment or the timing of surgery. Patients who are still likely to have an active disease are those with a short symp to m duration, pain during erection, or a recent change in penile curvature. Resolution of pain and stability of the curvature for at least three months are well-accepted criteria of disease stabilisation and patients’ referral for surgical intervention when indicated [310]. The examination should start with a routine geni to urinary assessment, which is then extended to the hands and feet for detecting possible Dupuytren’s contracture or Ledderhose scarring of the plantar fascia [311]. Penile examination is performed to assess the presence of a palpable node or plaque. Measurement of penile length during erection is important because it may have impact on the subsequent treatment decisions [316]. This can be obtained by a home (self) pho to graph of a natural erection (preferably) or using a vacuum-assisted erection test or an intracavernous injection using vasoactive agents [317]. In the physical examination, include assessment of palpable plaques, penile length, extent 2a B of curvature (self-pho to graph, vacuum-assisted erection test or pharmacological-induced erection) and any other possibly related diseases (Dupuytren’s contracture, Ledderhose disease). Several options have been suggested, including oral pharmacotherapy, intralesional injection therapy and other to pical treatments (Table 8). Shockwave treatment of calcified plaques and clostridial collagenase injection in patients with densely fibrotic or calcified plaques have been also suggested [309, 321]. The results of the studies on conservative treatment for Peyronie’s disease are often contradic to ry making it difficult to provide recommendations in the everyday, real-life setting. This is due to several methodological problems including uncontrolled studies, limited number of patients treated, short-term follow-up and different outcome measures [321]. Moreover, the efficacy of conservative treatment in distinct patient populations in terms of early (inflamma to ry) or late (fibrotic) phases of the disease is not yet available. A double-blind, placebo-controlled crossover study failed to show a significant effect on penile deformity or plaque size [323]. Moreover, there is conflicting evidence as to long-term cardiovascular effects of vitamin E usage at large doses, which urologists use for penile deformity treatment [324]. Preliminary studies reported an improvement in penile curvature, penile plaque size, and penile pain during erection [326]. In a prospective double-blinded controlled study in 41 patients with Peyronie’s disease, Potaba (12 g/day for 12 months) improved penile pain significantly, but not penile curvature or penile plaque size [327]. In another similar study in 103 patients with Peyronie’s disease, Potaba decreased penile plaque size significantly, but had no effect on penile curvature or penile pain [328]. However, the pre-existing curvature under Potaba remained stable, suggesting a protective effect on the deterioration of penile curvature. Treatment-related adverse events are nausea, anorexia, pruritus, anxiety, chills, cold sweats, confusion and difficulty concentrating, but no serious adverse events were reported [329]. Preliminary studies reported that tamoxifen (20 mg twice daily for three months) improved penile pain, penile curvature, and reduced the size of penile plaque [330]. However, a placebo controlled, randomised study (in only 25 patients, at a late stage of the disease with a mean duration of 20 months) using the same treatment pro to col, failed to show any significant improvement in pain, curvature, or plaque size in patients with Peyronie’s disease [331]. Colchicine Colchicine has been introduced in to the treatment of Peyronie’s disease on the basis of its anti-inflamma to ry effect [332]. Clinical data should be interpreted with caution since they come from only uncontrolled studies. Similar results have been reported in another uncontrolled retrospective study in 118 patients [334]. Reported treatment related adverse events with colchicine are gastrointestinal effects (nausea, vomiting, diarrhoea) that can be improved with dose escalation [332]. The combination of vitamin E and colchicine (600 mg/day and 1 mg every twelve hours, respectively) for six months in patients with early-stage Peyronie’s disease resulted in significant improvement in plaque size and curvature, but not in pain compared to ibuprofen 400 mg/day for 6 months [335]. Acetyl esters of carnitine Acetyl-L-carnitine and propionyl-L-carnitine are proposed to inhibit acetyl coenzyme-A and produce an antiproliferative effect on human endothelial cells. This may eventually suppress fibroblast proliferation and collagen production, thus reducing penile fibrosis.

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Draft American national standard: evaluating the effectiveness of hearing conservation programs cholesterol numbers purchase fenofibrate 160mg on line. American national standard: determination of occupational noise exposure and estimation of noise-induced hearing impairment cholesterol drug new buy fenofibrate 160 mg on-line. American national standard: methods for measuring the real-ear atten uation of hearing protec to cholesterol pregnancy cheap fenofibrate 160mg mastercard rs cholesterol lowering foods menu buy generic fenofibrate 160mg on line. A survey of states’ workers’ compensation practices for occupational hearing loss. Noise-induced hearing loss: the energy principle for recur rent impact noise and noise exposure close to the recommended limits. Equivalent-continuous noise level as a measure of injury from impact and impulse noise. Measurement of the real-world attenuation of E-A-R Foam and UltraFit brand earplugs on production employees. Attenuation performance of four hearing protec to rs under dynamic movement and different user ftting conditions. Effect of periodic rest on hearing loss and cochlear damage following exposure to noise. The infuence of a company hearing conservation program on extra audi to ry problems in workers. In: Proceedings of the International Congress on Noise as a Public Health Problem, Dubrovnik, Yugoslavia. Procedures for the measurement of occupational noise exposure: a national standard of Canada. Effect of an improved hearing conservation program on earplug performance in the workplace. A feld investigation of noise reduction afforded by insert-type hearing protec to rs. Criteria for short time exposure of personnel to high intensity jet aircraft noise. Report by the Inter national Institute of Noise Control Engineering Working Party. Information on levels of environmental noise requisite to protect public health and welfare with an adequate margin of safety. Occupational Safety and Health Administration: occu pational noise exposure; proposed requirements and procedures. Department of Labor: occupational noise exposure; hearing conservation amendment; fnal rule. A new procedure for feld testing of earplugs for occupational noise reduction [Dissertation]. Hearing protection—personal protection—overview and philosophy of personal protection. O to to xic effects of chemicals alone or in concert with noise: a review of human studies. Analysis of a hearing conservation program data base: fac to rs other than workplace noise. Interaction of continuous and impulse noise: audiometric and his to logical effects. Occupational noise exposure and hearing loss characteristics of a blue-collar population. Critical analysis of the effectiveness of secondary prevention of occu pational hearing loss. Noise-induced hearing loss as infuenced by other agents and by some physical characteristics of the individual. Etude des risques auditifs auxquels sont soumis les salaries agricoles en exploitations forestieres et en scieries. Acoustics—draft pro posal for noise rating numbers with respect to conservation of hearing, speech com munication, and annoyance. Acoustics—assessment of occupational noise exposure for hearing conservation purposes. Acoustics—determination of occupational noise exposure and estimation of noise-induced hearing impairment. In: Proceedings of the International Congress on Noise as a Public Health Problem, Dubrovnik, Yugo slavia. Prolonged exposure to a stressful stimulus (noise) as a cause of raised blood pressure in man. Impulse noise induced hearing loss in industry and the energy concept: a feld study. Field investigations of noise reduction afforded by insert-type hearing protec to rs. Department of Health, Education, and Welfare, Public Health Service, Center for Disease Control, National Institute for Occupational Safety and Health. Observa tions, supervisor report, and self-report as measures of workers’ hearing protection use. Test of the health promotion model as a causal model of workers’ use of hearing protection. The role of expectancies in workers’ compliance with a hearing loss prevention program. Department of Health, Education, and Welfare, Public Health Service, Center for Disease Control, National Institute for Occupational Safety and Health, pp. Noise exposure as related to productivity, disciplinary actions, absenteeism, and accidents among textile workers. Noise annoyance with regard to neuro physiological sensitivity, subjective noise sensitivity and personality variables. Exposure to impulse noise, hearing protection and combined risk fac to rs in the development of sensory neural hearing loss. Transient cognitive defcits and high-frequency hearing loss in weanling rats exposed to to luene. Toluene-induced hearing loss in rats evidenced by the brainstem audi to ry-evoked response. Real ear attenuation of personal ear protective devices worn in industry [Thesis]. Evaluation of different criteria for signifcant threshold shift in occupational hearing conservation programs. Evaluation of additional criteria for signifcant threshold shift in occupational hearing conservation programs. Development of a new standard labora to ry pro to col for estimating the feld attenuation of hearing protection devices. Impact of an industrial hearing con servation program on occupational injuries for males and females [Abstract]. Occupational noise exposure and noise-induced hearing loss: sci entifc issues, technical arguments and practical recommendations. Report prepared for the Special Advisory Committee on the Ontario Noise Regulation. Comparison of short and long-term sampling strat egies for fractional assessment of noise exposure. Industrial impulse noise: crest fac to r as an additional parameter in exposure measurements. Impulse noise and hand-arm vibration in rela tion to sensory neural hearing loss. Empowering the worker to prevent hearing loss: the role of education and training. Identifcation of the minimum noise level capable of producing an asymp to tic temporary threshold shift. Hearing loss in weavers and drop forge hammermen: comparative study on the effects of steady-state and impulse noise. Impulse noise-induced hearing loss in drop forge opera to rs and the energy concept. The ability of mildly hearing-impaired individuals to discriminate speech in noise. Noise induced hearing loss: a possible marker for high blood pressure in older noise-exposed populations.

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