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Colorectal cancer screening is one of the only cancer screenings that has the possibility to prevent cancer by removing pre-cancerous polyps discount albendazole 400mg otc antiviral medication side effects, in addition to being highly effective at detecting cancer early order albendazole mastercard hiv infection rate malawi. With appropriate screening follow up cheap 400mg albendazole overnight delivery antiviral injection, colorectal cancer screening is the most effective intervention to decrease late-stage diagnosis buy albendazole 400mg lowest price hiv infection natural history. Colorectal Cancer Strategy 2 By June 30, 2017, promote health system infrastructure that supports effective colorectal cancer screening services through a coordinated, patient-centered approach. Rationale: Health provider adherence to evidence-based recommendations for the prevention and management of risk factors for colorectal cancer will improve quality of care for and prevent colorectal cancer. Colorectal Cancer Strategy 3 By June 30, 2017, remove cost barriers to receiving colorectal cancer medical services from screening through diagnosis. Rationale: The Affordable Care Act mandates the provision of evidence-based preventive screenings with no cost-sharing for clients. However, in some cases, clients receive bills for a colorectal cancer screening procedure. Rationale: Cancer survivorship plans will be required of Commission on Cancer (CoC) accredited cancer centers in 2015. Evidence-based chronic disease self- management programs are a community resource available to survivors and cancer centers. Living Well with Chronic Conditions, Walk with Ease and the Oregon Tobacco Quit Line are evidence-based resources available to cancer survivors in many communities. Health Promotion and Chronic Disease Prevention • 5 Year Plan 25 Appendix A — Data sources The information and measures in this plan are drawn from multiple sources. Data represented in this plan are the most current available at the time of publication. Cigarette consumption information is measured using tobacco tax revenue collected by the Oregon Department of Revenue. The number of packs of cigarettes sold is calculated by dividing the cigarette tax receipts by the tax rate per pack. Mortality rates are estimated from information recorded on State of Oregon Death Certificates Statistical File. This data file includes all deaths occurring in Oregon and deaths of Oregonians that occurred out-of-state. The Oregon Tobacco Quit Line data come from registration information provided by Alere Wellbeing Inc. Information includes the number of Living Well programs that have occurred, the number of participants who attended those programs, and the self-reported chronic conditions of the participants. The Oregon State Cancer Registry reports state- and county-level cancer incidence, mortality, stage of diagnosis data for the top 10 cancers, including colorectal cancer. These destructive diseases cause in vineyards several damages every year, and they are of rapidly growing concern in all wine producing countries. The worldwide economic cost for the replacement of dead grapevines is roughly estimated to be in excess of 1. Vine trunk diseases are very harmful for the sustainability of the winemaking heritage because the pathogens responsible for these diseases attack the long-lasting organs, causing the death of vines on shorter or longer term. Esca, Eutypa and Botryosphaeria dieback are the leading players of these decay diseases. As well as mature vineyards being affected, those being planted as replacement can also be affected. Others like Petri disease or Black-foot disease (Campylocarpon, Cylindrocladiella, Dactylonectria, Ilyonectria and Neonectria spp. The general symptoms express themselves at the wood level through sectorial and/or central necrosis, by the presence of brown streaking or cankers, and at the foliar level by discoloration and drying, which can occur suddenly (Larignon et al. In young vineyards, external symptoms such as stunted growth, reduced vigor, retarded or absent sprouting, shortened internodes, sparse and chlorotic foliage with necrotic margins, wilting, dieback and death should appear due to black-foot or Petri disease affected vines (young vine decline), but they are frequently indistinguishable (Gramaje and Armengol, 2011). In addition, characteristic symptoms of vines affected by these diseases are sunken necrotic root lesions with a reduction in root biomass and root hairs. The life cycle and epidemiology are very similar for all the known fungi that cause trunk diseases (Berstch et al. These diseases are cryptic and their symptoms usually take several years to develop. Pruning wounds are the main point of entry for fungal spores, but also invasion of mechanical and frost wounds are possible. Fruiting bodies produced in dead wood and their spores are released in the presence of water, dispersed by wind, and finally, could infect fresh new wounds (Rolshausen and Kiyomoto, 2007). This is probably the most relevant threat for vitivinicultural sector nowadays (Rubio and Garzón, 2011). Several factors (Rubio and Garzón, 2011) could be involved in recent trunk diseases development: i) Ban of sodium arsenate, the only mean known to control Esca. These usually focused to have grape yield during the first years and, giving a poor pruning wound protection. Finally, other relevant problem is the assumption that the involved fungi are endophytic, which implies that they may live asymptomatically a part of their life in a plant, but should then, at some point and associated with plant stress, modify their behavior and becomepathogenic, thereby leading to the expression of the disease symptoms (Hofstetter et al. Recently, these diseases have been observed to be in rapid extension and to affect even 2- or 3-year-old plants. Nowadays, trunk diseases of grapevines appear often in vineyards that are over 7-year-old (Díaz and LaTorre, 2013). Figures show the average percentage of incidence cumulate in vine and the disease evolution and also the yield impact along its productive life (Munkvold et al. Therefore, it is a major concern of wine growers since the sodium arsenate was banned in 2001, which was the only effective molecule against the esca. The increase of symptoms was investigated and the incidence reached values higher than 10% for Botryosphaeria dieback and 25% for Eutypa dieback in French vineyards (Bruez et al. Usually symptoms occur from 8 -10 years; only just occasionally they are evident on younger vines. It was I note that the incidence of the disease depend on the varietal susceptibility: on plants of 15-18 -year average incidence may fluctuate respectively around 12 to 19 % for white grapes, around 8 to 10 % for the black grapes. In some regions under extreme conditions of central and southern Italy where epidemiological studies have been carried out (such as Tuscany, Marche, Abruzzi, Apulia, and Sicily), esca incidence has reached 60% to 80% in some old vineyards (Romannazzi et al. Botryosphaeria dieback and Esca are the major diseases of adult grapevines and they cause considerable damages and economic losses. Surveys of young vine decline showed that, at the rootstock, black foot disease and Petri disease were dominant but other wood diseases like Botryosphaeria dieback were also present. From the tissues above the graft union, Botryosphaeria dieback was prevailing but black foot and Petri disease were also present (Rego et al. In Australia, yield losses of up to 1,500 kg/ha have been reported for Shiraz vineyards (Wicks and Davies, 1999 in Sosnowski et al. There are four major grapevine trunk diseases, all of them caused by different fungi.

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As early communi- ties consolidated people more closely albendazole 400mg free shipping hiv symptoms immediately after infection, severe epidemics of plague purchase albendazole 400 mg without a prescription antiviral therapy journal, smallpox order albendazole 400mg with mastercard antiviral cold sore, and syphilis occurred generic albendazole 400mg otc antiviral eye drops for cats. The bubonic plague and its coinfections, measles and smallpox, were the most devastating of the epidemic diseases. Starting in the lower Volga it spread to Italy and Egypt in 1347 on merchant ships carrying rats and feas infected with the plague bacillus, Yesinia pestis. The disease apparently was unknown in the New World prior to the appearance of the Spanish and Portuguese conquistadors. Cortez was routed in battle in 1520 but was ultimately victorious as smallpox killed more than 25% of the Aztecs over the next year. He reported that 1000 persons per day died in Tlaxcala, with ultimately 150,000 total dead. At the least, it was appreciated that the skin lesions and scabs could transmit the disease. It was known that survivors of the infection were immune to reinfection after further exposure. The practice of inoculation, or variolation, whereby people were intentionally exposed to smallpox was practiced in China, Africa, and India centuries before the R1 practice would be adopted in Europe and the Americas. Syphilis became epidemic in the 1490s as a highly contagious vene- real disease in Spain, Italy, and France. One theory proposes that it began as a tropical disease transmitted by direct (nonsexual) contact. After the frst accounts of syphilis, it was reported to spread rapidly through Europe and then North America. In keeping with the hypothesis that syphilis was a recently emerged disease, mortality from syphilis was high in these early epidemics. In his treatise Airs, Water and Places, Hippocrates dismissed supernatural explanations of disease and instead attributed illness to characteristics of the climate, soil, water, mode of life, and nutrition surrounding the patient. Galen combined his practical experience caring for gladiators with experiments, including vivisections of animals, to study the anatomy and physiology of man. It was over a thousand years before Andreas Vesalius (1514–1564), who based his work on dissections of humans, was able to correct Galen’s errors in anatomy. Plague was rec- ognized to be contagious; however, the control measures focused primarily on quarantine and disposal of the bodies and the possessions (presumably contaminated) of the victims. Although it was observed that large numbers of rats appeared during an epidemic of plague, the role of rats and their feas was not appreciated. Given that leprosy progresses slowly, quarantine of cases late in disease likely had little effect on the epidemic spread. In the Middle Ages lepers were literally stricken from society as leprosy became increasingly equated with sin. Some R1 even required lepers to stand in a dug grave and receive the “Mass of Sepa- © Jones and Bartlett Publishers. I forbid you to leave your house unless dressed in your recognizable garb and also shod. I forbid you to wash your hands or to launder anything or to drink at any stream or fountain, unless using your own barrel or dipper. I forbid you to enter any tavern; and if you wish for wine, whether you buy it or it is given to you, have it funneled into your keg. I command you, if accosted by anyone while traveling on a road, to set yourself downwind of them before you answer. I forbid you, wherever you go, to touch the rim or the rope of a well without donning your gloves. Fracastoro (1478–1553) was much more than just an author of the popular poem on syphilis. Although revolutionary, Fracastoro did not realize that the seeds of a disease were microbes, and he held to ancient beliefs that they were infuenced by planetary conjugation particularly “nostra trium superiorum, Saturni, Iovis et Martis” (our three most distant bodies: Saturn, Jupiter, and Mars). He postulated that the environment became polluted with seminaria and that epidemics occurred in association with certain atmospheric and astrologic conditions. The Observation and Care of Patients Medical practice was gradually transformed by the introduction of disease- specifc treatments during the Renaissance era. Peruvian bark, or cinchona, was imported into Europe for the treatment of malaria around 1630. Based on the observation that smallpox disease conferred immunity in those who survived, intentional inoculation of healthy people to induce immunity was attempted. This process was known as variolation and was advocated by Thomas Jefferson (1743–1826), Benjamin Franklin (1706–1790), and Cotton Mather (1663–1728). Mather learned of it from a man he enslaved, Onesimus, who was innoculated with smallpox in a cut as a child in Africa. He performed the frst vaccine clinical trial by inoculating 8-year-old James Phipps (1788–1853) with lesions contain- ing cowpox (vaccinia virus) and later showed that the boy was immune to variolation, or challenge with variola virus. Changes in the practice of clinical medicine in the 1600s began to dif- ferentiate diseases from one another. One of the earliest advocates of careful observation of patients’ symptoms and their disease course was the London R1 doctor Thomas Sydenham (1624–1689). His approach departed from Galen and Hippocrates, who focused on the individual and their illness rather than on trying to differentiate specifc diseases. After Sydenham, the Italian physician Giovanni Morgagni (1682–1771) inaugurated the method of clinicopathologic correlation. His book De sedibus et causis morborum per anatomen indagatis (On the Seats and Causes of Diseases, Investigated by Anatomy), based on over 700 autop- sies, attributed particular signs and symptoms to pathologic changes in the tissues and organs. The infuence of Sydenham and Morgagni on medicine can be seen in Benjamin Rush’s (1745–1813) description of dengue among patients afficted in the 1780 Philadelphia epidemic. The pains in the head were sometimes in the back parts of it, and at other times they occupied only the eyeballs. In some people, the pains were so acute in their backs and hips that they could not lie in bed. A few complained of their fesh being sore to the touch, in every part of the body. From these circumstances, the disease was sometimes believed to be a rheuma- tism. This new way of thinking about diseases, requiring careful clinical observa- tion, differentiation, and specifc diagnosis, led naturally to the search for specifc, as opposed to general, causes of illness. Expanding on the concept of careful clinical observation of individuals, epidemiologists in the 1800s observed unusual epidemics and performed con- trolled studies of exposed persons. Epidemiologic theories about the means of transmission of various infectious diseases often preceded the laboratory and clinical studies of the causative organisms. Peter Panum (1820–1885) recorded his observation of an epidemic of measles on the Faroe Islands in 1846. Remarkably, the attack rates among those under 65 years old was near 97%, but older persons were completely spared. This demonstrated that immunity after an attack of natural measles persists for a lifetime.

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In order for health promotion to develop in all areas of health care a recognition of the have the fullest impact order albendazole with paypal hiv infection rates nz, it requires to be resourced and value of a social model of health discount albendazole 400 mg antiviral resistance definition, alongside a clinical valued within the wider public health agenda buy albendazole 400mg cheap nuevo xl3 antiviral. While effective and accessible clinical services Recent changes that have seen health promotion activity are imperative discount 400 mg albendazole amex antiviral quizlet, it is also essential that we recognise the within Scottish Health Boards move to a community other social determinants of health. As has been said level within Community Health Partnerships may have many times, health is not just about the absence of advantages, but there is also a need to maintain a disease, but about well being and the experience of the central focus and critical mass of expertise at a Health individual in relation the world around them. In specifc areas, such as sexual health, it From a gender perspective, this is greatly infuenced may not always be appropriate to coordinate resources by the role of men in society and the family. Much has been done, but there is a long way to examine how gender impacts on the development go to improve Scotland’s international standing in the of individuals from an early age, and in turn how this league of men’s health outcomes. There are real opportunities in relation to policy de- Public health policy in Scotland must recognise the velopment; our challenge is in maximising the impact value of health promotion as a vital aspect of health im- these have on the lives of men in Scotland and ulti- provement. Men’s Health Forum Scotland exists to promote men’s health and well-being in Scotland. It seeks to improve the quality of men’s lives through raising public, personal and policy awareness of men’s health and well- being issues, challenging stereotypes and developing an understanding of men’s changing roles in society. Through an inclusive and co-operative approach, it wishes to identify and establish positive policies regarding men’s health and to foster communication and respect for and between men. The Men’s Health Forum Scot- land equally recognises mutual beneft in working with women’s interests and concerns and works in partner- ship with women’s health interests towards mainstreaming a gendered approach to health in Scotland. Mark Ward has been National Coordinator of Men’s Health Forum Scotland since June 2004. Mark has played a leading role in the development of the organisation over the past fve years, and has initiated a number of innovative projects with the support of a dedicated staff team and charity trustees. As a result of people’s career problems and the related resources and skills, going choices, which are still highly gender-specifc, men’s further than purely presenting a gender comparison of work often involves physical effort and exposure to health indicators. Such working conditions resources can be accessed in national gender-sensitive mean a high health risk. Men and women are affected to different degrees by mental It has long been known that gender is a key factor in the disorders, with men getting less frequent treatment development of human health and disease. In Switzerland, the Gender Health Project, in the Multisectoral Health men generally ask for less medical care than women. Policy Division, contributes to improving and maintaining As far as check-ups are concerned, men under 70 the health of women and men in Switzerland. The Gender Health centre for the promotion of health and for prevention) Project is involved agenda-setting, transfer of information, ran the platform for male health, amongst other things coordination, prevention and the promotion of health. The main causes of death are cardiovascular ifed employees, advice for qualifed employees on diseases and cancer. Men subjectively consider their work with men that is specifc for target groups, initia- state of health to be good, and this positive view is tion of pilot projects (www. Their behaviour as regards health is riskier 65 Men’s health in Switzerland The response of the Swiss government Male health is a priority in prevention programmes at the management tool to support qualifed employees in gen- national and cantonal levels, especially in the areas of pre- der-sensitive work (www. The great- sensitive work have associated young men and men in net- est need for prevention, and the greatest potential for pre- works on specifc topics. In this work, on the premise that work on addiction is more effective if VäterNetz. Gender-appropriate work on prevention group for men and equality): This working group de- and addiction attempts to deal equitably with the different votes itself to setting up interdisciplinary exchanges of needs and experience of men and women, and the realities research results and experience from projects in the of their lives, so it makes a substantial contribution to de- areas of gender and men. We need to ensure that whatever is made available and the institutions involved are organised appro- Ô Männer. Since the launching of this package of measures, organisations of Swiss men and of fathers is an as- sociation representing interest groups, acting at the a wide range of gender-related measures to prevent ad- federal level, and it sets the national agenda regard- diction have started, contracted to the federal government, ing policy on topics related to men and fathers. The objective is to implement a new policy on men including by lobbying Non-governmental organisations and national foundations from the male perspective. This is intended to make have also picked out the target groups boys and men, when a contribution to equal opportunities useful in life focussing on the topic of gender. Swiss Health Promotion has developed a project health and in education and socio-political interest groups. Specifc prevention for men is required above all need to have consistent calls for and implementation in the area of mental health (stress caused by working of gender mainstreaming. Experts in the area of conditions detrimental to health, depression); violence prevention and health promotion need simple access (domestic and outside the home); accidents (road traffc); to tools and good practice proposals. Appropriate responsibility Thus the statement “for male health – see under for this should be supported as broadly as possible. Coaching organisations and health professionals in their work with youngsters and men is one of his main duties. According to the Administration on Ag- ing, more than half of elderly widows now living in poverty Ô Men are leading in 9 out of the top 10 causes of were not poor before the death of their husbands. According to the United States of America’s men and its overall economic well-being. Census Bureau, the ratio of men to women in the early Scientifc studies have shown that regular medical ex- retirement years (age group 65-69) reduces to 85 men ams, preventative screenings, regular exercise, and per 100 women. The growing disparity in this statistic healthy eating habits can help save lives. Men’s health is also major concern for employers in the United States, who often pay the high costs of medical care and lose the productivity of their employees due to absenteeism and presenteesim. The suicide rate tes in 2007 was $174 billion, including $116 billion among Army soldiers reached its highest level in three in excess medical expenditures and $58 billion in decades in 2008. As a nation, the United States must reduced national productivity pay better attention to their needs and the needs of Ô Among men age 18 and older, 67 percent do not their families. This can be attributed to cultural attitudes that cancer in the United States among men, accounting for have been ingrained in American boys and men for 25 percent of all male cancer cases, with African Amer- decades. When a boy is 5 years newly diagnosed with prostate cancer this year alone old and falls down and skins his knee, his mother tells and almost 29,000 will die. Costs associated with pros- him to shake it off – when he is 50 years old and having tate cancer detection and treatments exceed $8 billion chest pain, he believes it is just indigestion but really it annually and represent 8% of cancer and 0. Prostate cancer rates increase sharply with age, resulting in 2/3 of the In response to these alarming statistics and societal annual prostate cancer expenditures in the U. Men’s 380 of these men will have lost their lives Health Network then worked closely with key in- ternational men’s health organizations in estab- On the cardiovascular health front, men and their fami- lishing and recognizing International Men’s Health lies face steep challenges: Week. In 2004 cardiovascu- suing proclamations every June recognizing Men’s lar disease caused the deaths of 410,628 males Health Week in their state. That role is currently being flled year 1997 by Joint Appropriations Conference Committee by Men’s Health Network. And we are called to rec- Cancer ognize and honor how critical every father is to that Ô Unwillingness of men to historically address sen- foundation. They are sitive issues within the media (impotence, inconti- mentors and role models. Despite this, through the efforts of Men’s Health Net- The passage of National Men’s Health Week in 1994. This week gives health key members of the United States House of Repre- care providers, public policy makers, the media, and sentatives to establish a Congressional Men’s Health individuals an opportunity to encourage men and boys Caucus whose primary purpose is to promote legis- to seek regular medical advice and early treatment for lation that will improve the health of men and their disease and injury.

A systematic review of case series reports that patients treated with levodopa therapy for four to six years have approximately a 40% likelihood of experiencing motor 69 3 complications cheap albendazole 400 mg otc primary hiv infection timeline. A variety of drug treatments have been suggested as helpful in managing motor complications cheap 400mg albendazole with mastercard hiv infection rate in uganda. Much of the evidence is derived from carefully selected patient populations cheap albendazole express licorice antiviral, and the results may not be easily generalised to the average ‘real life’ clinic population generic 400mg albendazole hiv infection rates by population. Non-motor features, particularly psychiatric and cognitive problems, often limit the therapeutic options available, and patients are often susceptible to deterioration following even minor changes in their medications. As the disease advances, the management of patients (and their families) becomes increasingly complex, and may involve many different healthcare workers. The importance of good communication in such complex management cannot be overemphasised. These decisions should be made by specialists in combination with the patient and their carers. Infusion 3 therapy is associated with a risk of serious adverse events and requires adequate back-up resources. D subcutaneous apomorphine infusions may be considered for the management of severe motor complications, but should only be provided in units with sufficient experience and resources. There is insufficient evidence to support the routine use of intraduodenal levodopa. The aetiology of daytime sleepiness and sleep attacks in Parkinson’s disease is likely to be multifactorial with dopaminergic cell death, altered night-time sleep architecture and the 3 effect of antiparkinsonian medication all thought to be associated. Dopaminergic 4 drugs, and dopamine agonists in particular, have been associated with increased sleepiness in some patients. This study contained small numbers (12 patients completed) and was of short duration (two 2-week blocks). This was a small - 142 1 study of short duration and there was no effect of the drug on daytime sleepiness. As these are available without prescription and may be expensive it is important to establish the level of benefit or harm that these might confer. Antioxidant therapies such as tocopherol (vitamin e) are proposed to offer protective benefit against free radical generation and possibly delay the progression of Parkinson’s disease. Reported adverse effects with coenzyme q10 were not significantly different from that in the placebo group (p=0. The most frequently reported adverse effects in both placebo and coenzyme q10 groups were viral infection, diarrhoea, acute hearing loss, night sweats, nausea and bronchitis. A large placebo controlled trial (n=800) investigated the effect of selegiline or tocopherol on slowing functional decline in patients with early, untreated Parkinson’s disease. There were no significant differences in the rate of change in secondary response variables between subjects assigned to tocopherol and those not assigned to tocopherol. The trial revealed no evidence of any beneficial effects of tocopherol (2,000 iu/day) in either slowing functional decline or ameliorating the clinical features of Parkinson’s disease. Patients were crossed over to the alternative therapy after three weeks with one week washout period. It increases renal sodium reabsorption and expands plasma volume through the renin aldosterone system. Patients were crossed over to the alternative therapy after three weeks with one week washout period. The midodrine group experienced adverse events (mostly pilomotor reactions, pruritis, paraesthesia, urinary retention and supine hypertension) more frequently than the placebo group (p=0. Adverse effects (mostly pruritis/tingling of the scalp) were reported by 22% of the placebo group versus 27% of the midodrine treatment groups. Supine hypertension was reported for 8% of the midodrine treated patients versus 1% for the patients taking placebo. The primary end point of the fall in standing diastolic bP was significantly reduced with treatment compared to placebo 1+ (p=0. There was a significant reduction in the fall in diastolic bP by pyridostigmine alone (bP fall of 27. No significant differences were seen in the supine bP measures, either systolic (p=0. Midodrine is an unlicensed drug and domperidone, fludrocortisone and pyridostigmine are used ‘off label’ in this indication. Gait freezing that occurs when a patient’s parkinsonism is undertreated (so called ‘off’ freezing, ie in the presence of significant residual tremor, rigidity, or bradykinesia) may respond to an - 154,155 1 increase in dopaminergic replacement therapy. Gait freezing that occurs when the patient’s 4 parkinsonism is well controlled (‘on’ freezing) is difficult to treat and may be worsened by increasing dopamine replacement therapy. B injection of botulinum toxin into the calf muscles of people with Parkinson’s disease who have significant gait freezing is not recommended. This section considers the evidence relating to the pharmacological treatment of these mental health disorders. The withdrawal of anticholinergic medication, 4 amantadine, selegiline and dopamine agonists can also be considered along with the optimisation 2++ of levodopa therapy (without causing psychosis). In a proportion of patients these approaches will not substantially improve cognition. Three systematic reviews of pharmacological therapy have been identified but no trials were identified in relation to psychotherapy. There was insufficient evidence to support the efficacy or lack of efficacy of any other antidepressant. Results indicated 1+ significant reductions in depression ratings following both antidepressant treatment and placebo administration. Mild adverse events were twice as frequent in the desipramine group as in the other groups. It has been suggested that decreased ++ 2 cerebral activation in both occipital temporal parietal regions and frontal eye fields may be involved in altering visual attentional pathways. Patients receiving quetiapine showed no significant difference to placebo groups, although it was not possible to include data from these trials in a meta-analysis. The other systematic review was published before the above study and did not include any trials that were not included in the later publication. Clozapine is associated with agranulocytosis and regular monitoring of total white blood cell 183 4 count and absolute neutrophil count is necessary for patients treated with this drug. Clozapine is effective in treatment of psychosis and also, in some cases, improved motor function. Where patients are not distressed by hallucinations, given the fact that antipsychotic medication might worsen the motor symptoms, a clinical decision may be made either not to treat symptoms or rationalise dopaminergic therapy. B where weekly monitoring of blood is not possible on a consistent basis, low-dose quetiapine should be considered as an alternative antipsychotic for the treatment of patients with psychosis in Parkinson’s disease. These points are provided for use by health professionals when discussing Parkinson’s disease with patients and carers and in guiding the production of locally produced information materials. The helpline is a confidential service staffed by registered nurses and advisors who offer advice, information and support to anyone affected by Parkinson’s disease. A number of local support groups throughout Scotland are available to help patients and their carers meet with people in a similar situation. Samaritans is available 24 hours a day to provide confidential and emotional support for people who are feeling despair and distress.