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United Stales. Whereas in Britain the doctor of first contact is regularly a general practitioner, in the United States the nature of first-contact care is less consistent. General practice in the United States has been in a slate of decline in the second half of the 20th century especially in metropolitan areas. The general practitioner, however, is being replaced to some degree by the growing field of family practice. In 1969 family practice was recognized as a medical specialty after the American Academy of General Practice (now the American Academy of Family Physicians) and the American Medical Association created the American Board of General (now Family) Practice. Since that time the field has become one of the larger medical specialties in the United States. The family physicians were the first group of medical specialists in the http://aravaonline.freehostia.com//index5.html arava tablets The developing countries themselves, lacking the proper resources, have often been unable to generate or imple¬ment the plans necessary to provide required services at the village or urban poor level. It has, however, become clear that the system of health care that is appropriate for one country is often unsuitable for another. Research has established that effective health care is related to the special circumstances of the individual country, its people, culture, ideology, and economic and natural resources. http://aravaonline.freehostia.com//index5.html arava tablets Other developing countries. A main goal of the World Health Organization (WHO), as expressed in the Alma-Ata Declaration of 1978, is to provide to all the citizens of the world a level of health that will allow them to lead so¬cially and economically productive lives by the year 2000. By the late 1980s, however, vast disparities in health care still existed between the rich and poor countries of the world. In developing countries such as Ethiopia, Guinea, Mali, and Mozambique, for instance, governments in the late 1980s spent less than $5 per person per year on public health, while in most western European countries several hundred dollars per year was spent on each person. The disproportion of the number of physicians available between developing and developed countries is similarly wide. http://aravaonline.freehostia.com//nutmeg-and-arava-interaction.html nutmeg and arava interaction China. Health services in China since the Cultural Rev¬olution have been characterized by decentralization and dependence on personnel chosen locally and trained for short periods. Emphasis is given to selfless motivation, self-reliance, and to the involvement of everyone in the community. Campaigns stressing the importance of pre-ventive measures and their implementation have served to create new social attitudes as well as to break down divisions between different categories of health workers. Health care is regarded as a local matter that should not require the intervention of any higher authority; it is based upon a highly organized and well-disciplined system that is egalitarian rather than hierarchical, as in Western societies, and which is well suited to the rural areas where about two-thirds of the population live. In the large and crowded cities an important constituent of the health-care system is the residents' committees, each for a population of 1,000 to 5,000 people. Care is provided by part-time personnel with periodic visits by a doctor. A number of residents' committees are grouped together into neighbourhoods of some 50,000 people where there are clinics and general hospitals staffed by doctors as well as health auxiliaries trained in both traditional and Westernized medicine. Specialized care is provided at the district level (over 100,000 people), in district hospitals and in epidemic and preventive medicine centres. In many rural districts people's communes have organized cooperative medical services that provide primary care for a small annual fee. http://aravaonline.freehostia.com//arava-prescription.html arava prescription Teaching. Physicians in developed countries frequently prefer posts in hospitals with medical schools. Newly qualified physicians want to work there because doing so will aid their future careers, though the actual experience may be wider and better in a hospital without a medical school. Senior physicians seek careers in hospitals with medical schools because consultant, specialist, or professorial posts there usually carry a high degree of prestige. When the posts are salaried, the salaries are sometimes, but not always, higher than in a nonteaching hospital. Usually a consultant who works in private practice earns more when on the staff of a medical school. http://aravaonline.freehostia.com//index5.html arava tablets Modern factories usually have arrangements for giving first aid in case of accidents. Depending upon the size of the plant, the facilities may range from a simple first-aid station to a large suite of lavishly equipped rooms and may include a staff of qualified nurses and physiothera¬pists and one or perhaps more full-time physicians. http://aravaonline.freehostia.com//imuran-and-arava-taken-together.html imuran and arava taken togetherThe influx of patients into hospitals and private clinics after the passage of the national health insurance acts of 1961 had, as one effect, a severe reduction in the amount of time available for any one patient. Perhaps in reaction to this situation, there has been a modest resurgence in the popularity of traditional Chinese medicine, with its leisurely interview, its dependence on herbal and other "natural" medicines, and its other traditional diagnostic and therapeutic practices. The rapid aging of the Japanese population as a result of the sharply decreasing death rate and birth rate has created an urgent need for expanded health care services /or the elderly. There has also been an increasing need for centres to treat health problems resulting from environmental causes. http://aravaonline.freehostia.com//arava-versus-methotrexate.html arava versus methotrexate Specialties in medicine. At the beginning of World War II it was possible to recognize a number of major medi¬cal specialties, including internal medicine, obstetrics and gynecology, pediatrics, pathology, anesthesiology, ophthal¬mology, surgery, orthopedic surgery, plastic surgery, psy¬chiatry and neurology, radiology, and urology. Hematology was also an important field of study, and microbiology and biochemistry were important medically allied specialties. Since World War II, however, there has been an almost explosive increase of knowledge in the medical sciences as well as enormous advances in technology as applica¬ble to medicine. These developments have led to more and more specialization. The knowledge of pathology has been greatly extended, mainly by the use of the electron microscope; similarly microbiology, which includes bacte-riology, expanded with the growth of such other subfields as virology (the study of viruses) and mycology (the study of yeasts and fungi in medicine). Biochemistry, sometimes called clinical chemistry or chemical pathology, has con¬tributed to the knowledge of disease, especially in the field of genetics where genetic engineering has become a key to curing some of the most difficult diseases. Hematology also expanded after World War II with the development of electron microscopy. Contributions to medicine have come from such fields as psychology and sociology espe¬cially in such areas as mental disorders and mental hand¬icaps. Clinical pharmacology has led to the development of more effective drugs and to the identification of adverse reactions. More recently established medical specialties are those of preventive medicine, physical medicine and re-habilitation, family practice, and nuclear medicine. In the United States every medical specialist must be certified by a board composed of members of the specialty in which certification is sought. Some type of peer certification is required in most countries.http://aravaonline.freehostia.com//arava-is-available-rev-july-2006.html arava is available rev july 2006 http://aravaonline.freehostia.com//index5.html arava tabletsMost pregnant women can he safely delivered in sim¬ple circumstances without an elaborately trained staff or sophisticated technical facilities, provided that these can be called upon in emergencies. In developed countries it was customary in premodern times for the delivery to take place in the woman's home supervised by a qualified midwife or by the family doctor. By the mid-20th century women, especially in urban areas, usually preferred to have their babies in a hospital, either in a general hospital or in a more specialized maternity hospital. In many developing countries traditional birth attendants supervise the deliv¬ery. They are women, for the most part without formal training, who have acquired skill by working with others and from their own experience. Normally they belong to the local community where they have the confidence of Theie is no national health service, as such, in the United Stales. Most physicians in the country have traditionally been in some form of private practice, whether seeing patients in their own offices. clinics, medical centres, or another type of facility and regardless of the patients' in¬come. Doctors are usually compensated by such state and federally supported agencies as Medicaid (for treating the poor) and Medicare (for treating the elderly); not all doc¬tors, however, accept poor patients. There are also some state-supported clinics and hospitals where the poor and elderly may receive free or low-cost treatment, and some doctors devote a small percentage of their time to treat¬ment of the indigent. Veterans may receive free treatment at Veterans Administration hospitals, and the federal gov¬ernment through its Indian Health Service provides med¬ical services to American Indians and Alaskan natives, sometimes using trained auxiliaries for first-contact care. http://aravaonline.freehostia.com//index.html affect arava side In the developed countries. Those concerned with pro¬viding health care in the developed countries face a differ¬ent set of problems. The diseases so prevalent in the Third World have, for the most part, been eliminated or are readily treatable. Many of the adverse environmental con¬ditions and public health hazards have been conquered. Social services of varying degrees of adequacy have been provided. Public funds can be called upon to support the cost of medical care, and there are a variety of private insurance plans available to the consumer. Nevertheless, the funds that a government can devote to health care are limited and the cost of modern medicine continues to in¬crease thus putting adequate medical services beyond the reach of many. Adding to the expense of modern medical practices is the increasing demand for greater funding of health education and preventive measures specifically directed toward the poor. http://aravaonline.freehostia.com//arava-medicine.html arava medicineCosts of health care. The costs to national economics of providing health care are considerable and have been growing at a rapidly increasing rate, especially in countries such as the United States, Germany, and Sweden; the rise in Britain has been less rapid. This trend has been the cause of major concerns in both developed and developing countries. Some of this concern is based upon the lack of any consistent evidence to show that more spending on health care produces better health. There is a movement in developing countries to replace the type of organization of health-care services that evolved during European colo¬nial times with some less expensive, and for them, more appropriate, health-care system. http://aravaonline.freehostia.com//arava-leflunomide.html arava leflunomide Support services for the elderly provided by private or state-subsidized sources include domestic help, delivery of meals, day-care centres, elderly residential homes or nursing homes, and hospital beds either in general medical wards or in specialized geriatric units. The degree of acces¬sibility" of these services is uneven from country to country and within countries. In the United States, for instance, although there are some federal programs, each state has its own elderly programs, which vary widely. However, as the elderly become an increasingly larger part of the pop¬ulation their voting rights are providing increased leverage for obtaining more federal and state benefits. The gen¬eral practitioner or family physician working with visiting health and social workers and in conjunction with the pa¬tient's family often form a working team for elderly care. http://aravaonline.freehostia.com//arthritis-drug-arava.html arthritis drug arava Numerous laws are administered through the ministry's bureaus and agencies, which range from public health, en¬vironmental sanitation, and medical affairs to the children and families bureau. The various categories of institutions run by the ministry, in addition to the national hospitals, include research centres for cancer and leprosy, homes for the blind, rehabilitation centres, for the physically handicapped, and port quarantine services.http://aravaonline.freehostia.com//index5.html arava tablets The vast number of nonmedically qualified health staff, upon whom the health-care system greatly depends, in-cludes both full-time and part-time workers. The latter include so-called barefoot doctors, who work mainly in rural areas, worker doctors in factories, and medical workers in residential communities. None of these groups is medically qualified. They have had only a three-month period of formal training, part of which is done in a hospi¬tal, fairly evenly divided between theoretical and practical work. This is followed by a varying period of on-the-job experience under supervision.