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1.
Sci Rep ; 14(1): 4062, 2024 02 19.
Artículo en Inglés | MEDLINE | ID: mdl-38374163

RESUMEN

The negative effect of caponization on the structural, geometric and mechanical parameters of femur and tibia has been shown in a few studies. Nevertheless, its influence on tibia bone microarchitecture is still largely unknown. Therefore, this study aimed to assess the effect of castration on the microstructural parameters of the trabecular and compact bone of tibia bone in crossbred chickens. The experiment involved 96 roosters derived from crossing Yellowleg Partridge hens ([Formula: see text]-33) and Rhode Island Red cockerels (R-11) fattened until the 16th, 20th and 24th week of life. Animals were randomly divided into 2 groups of 48 each. Group I (control) consisted of intact roosters and group II (experimental) consisted of birds subjected to caponization at the 8th week of age. The castration surgery had no influence on some properties within compact bone such as osteon diameter On.Dm, osteon perimeter On.Pm, osteon area On.Ar, osteocyte lacunar number Ot.Lc.N, osteon bone area On.B.Ar, osteon wall thickness On.W.Th as well as thick-mature collagen content in all analyzed age groups of animals. Nevertheless, our results demonstrate that castration caused a decrease of Haversian canal area Hc.Ar, osteocyte lacunar area Ot.Lc.Ar and osteocyte lacunar porosity Ot.Lc.Po among the 16-week-old birds, decrease of Haversian canal perimeter Hc.Pm and increase of fraction of bone area On.B.Ar/On.Ar among 16- and 24-week-old individuals and also an increase of osteocyte lacunar density Ot.Lc.Dn in the osteons of the oldest roosters. Additionally, some microstructural parameters of trabecular bone show the negative effect of caponization. The youngest 16-week-old capons were characterized by thinnin the trabecular in the epiphysis part of tibia. Moreover, in the case of 24-week-old, there is an increase in the trabecular separation Tb.Sp with simultaneous decrease of trabecular number Tb.N compared to roosters, which may suggest the increase of the bone resorption among the oldest individuals. The increased bone turnover in the epiphysis part of the tibia bone also indicates changes in the collagen fibers distribution, where among 20-week-old animals there is a decrease in the content of immature thin collagen fibers with simultaneous increase in the content of mature thick collagen fibers. Furthermore, among the oldest 24-week-old individuals we can observe the increased thick-to-thin collagen ratio, which may be a sign of slowing down in bone formation.


Asunto(s)
Pollos , Tibia , Humanos , Masculino , Animales , Femenino , Fémur , Epífisis , Colágeno
2.
Sci Rep ; 13(1): 14512, 2023 09 04.
Artículo en Inglés | MEDLINE | ID: mdl-37667027

RESUMEN

The presented study focuses on assessing the effect of caponization on the densitometric, osteometric, geometric and biomechanical parameters of tibial bones in crossbred chickens. The study was carried out on 96 hybrids between Yellowleg Partridge hens (Z-33) and Rhode Island Red cockerels (R-11) aged 16 weeks, 20 weeks and 24 weeks. Birds were randomly assigned to 2 groups-the control group (n = 48; which consisted of intact roosters) and the experimental group (n = 48, which consisted of individuals subjected to caponization at the age of 8 weeks). The caponization had no effect on the densitometric, osteometric and geometric parameters (except the horizontal internal diameter of 16-week-old individuals) of tibia bone, as well as the content of calcium (Ca), phosphorus (P) and the Ca/P ratio in the bone mineral fraction in all analyzed age groups of animals. However, it contributes to a lower percentage of ash in the bones of capons at 20 and 24 weeks of age compared to cockerels. On the contrary, some mechanical and material parameters show the negative effect of caponization. Ultimate load and bending moment decreased in capons in all of the analyzed age groups of animals and yield load, stiffness and ultimate stress also decreased but only in the group of 20-week-old and 24-week-old individuals. This can contribute to the weakening of the capon bones, and in the perspective of prolonged maintenance to their deformation and even fracture.


Asunto(s)
Calcificación Fisiológica , Calcinosis , Animales , Femenino , Masculino , Calcio de la Dieta , Pollos , Homeostasis , Tibia
3.
Animal ; 17(10): 100960, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37690335

RESUMEN

The skeletal system of young animals undergoes a series of intensive and rapid changes. In this study, we aimed to verify the hypothesis that geese exhibit a distinct pattern of bone growth compared to gallinaceous species. Specifically, we hypothesised that geese would experience an accelerated growth rate in the humerus bone, which can be attributed to the increased wing mobility facilitated by their rearing in free-range systems. This need for access to both ground and water environments contributes to the unique demands placed on their skeletal development. We focused on evaluating the mechanical properties and geometry of the humerus as the forelimb bone, and the tibia as the hindlimb bone. The 320 geese used in this study were divided into 12 groups according to sex (females and males) and age (0-,1-,3-,6-,8-,12-,14-week-old). To assess bone mechanical properties, a three-point bending test was performed, along with densitometry and morphological measurements. The tibiae of the geese showed the most intensive growth until 6 weeks of age and then stabilised. The wing bones (humerus) showed only slight changes in the first weeks after hatching, and then a rapid growth between the third and sixth week, both in terms of mechanical and morphological properties. This is most likely due to a change in the geese's living environment during this period, i.e., allowing them to leave their enclosures and enter open space, which gives them the opportunity to use their wings, resulting in the rapid growth of the wing bones to support increasing muscle mass in this area. This study increases our understanding of bone growth and development in domesticated birds, specifically waterfowl species, and highlights the importance of rearing methods on the proper bone development and functionality of the entire skeletal system, and thus, on their welfare.

4.
Sci Rep ; 12(1): 14882, 2022 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-36050419

RESUMEN

Acrylamide (ACR) is a toxic compound commonly found in fried, baked and heat-processed starchy foods. The current study investigated the time-dependent effects of maternal exposure to non-toxic ACR doses on the oxidative stress, liver function, and basal blood morphology of the rat offspring. Pregnant, Wistar rats were randomly divided into the control group or the groups administrated with ACR (3 mg/kg b.w./day): long exposure for 15 days, medium exposure for 10 days and short exposure for 5 days during pregnancy. Body mass, blood morphology and hematology, serum concentrations of growth hormone, IGF-1, TNF-α, IL-1ß, IL-6 and insulin, liver histomorphometry, liver activity of beclin1, LC2B and caspase3, markers of oxidative stress and the activity of antioxidative enzymes in blood serum and the liver were measured in offspring at weaning (postnatal day 21). Even short prenatal exposure to ACR led to oxidative stress and resulted in changes in liver histomorphometry and upregulation of autophagy/apoptosis. However, the most significant changes were observed following the long period of ACR exposure. This study has shown for the first time that ACR is responsible for changes in body mass in a time-dependent manner, which could lead to more serious illnesses like overweight and diabetes later in life.


Asunto(s)
Acrilamida , Estrés Oxidativo , Acrilamida/toxicidad , Animales , Femenino , Hígado , Embarazo , Ratas , Ratas Wistar , Destete
5.
Pol J Vet Sci ; 23(1): 77-88, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32233304

RESUMEN

Fumonisins are highly toxic metabolites produced by Fusarium proliferatum and Fusarium verticillioides. Little is known about the effects of a chronic low level of fumonisins on intestinal structure and innervation in monogastric animals, even though the intestine is the first organ exposed to fumonisins. The influence of the most prevalent strains of fumonisins, FB1 and FB2, on intestinal and liver morphology, the enteric nervous system and intestinal epithelial cell prolif- eration was investigated in an experimental rat model of fumonisin intoxication. Adolescent (5-weeks-old), male Wistar rats were randomly divided into a control group (C group) not treated with fumonisins or intoxicated with fumonisins (FB group). FB1 together with FB2 were daily administered intragastrically at a dose of 90 mg/kg body weight for 21 days. The damaging effect was assessed by determination of the activity of ALAT and AspAT. Samples from the small intes- tine and liver were taken and blood samples were collected to determine the activity of gamma- -glutamyl transferase (GGT) and amylase. The exposure to FBs resulted in histopathological degenerative alterations in hepatocytes, including mild vacuolar degeneration and ballooning. FB exposure was also toxic in the duodenum and jejunum, where significant changes in morphology, cell proliferation, collagen wall fibres and innervation were observed. Taken together, the results obtained strengthen the hypothesis that chronic exposure to FBs could induce intestinal damage, including damage to the enteric nervous system and may have consequences for general health.


Asunto(s)
Fumonisinas/toxicidad , Intestinos/efectos de los fármacos , Animales , Colágeno , Intestinos/inervación , Intestinos/patología , Hígado/efectos de los fármacos , Masculino , Distribución Aleatoria , Ratas , Ratas Wistar
6.
Poult Sci ; 98(11): 5613-5621, 2019 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-31222275

RESUMEN

This study focused on analyzing the effects of inclusion of modern hybrid rye to corn-wheat diet on mechanical properties of bones and tendons. A total of 224 broiler chickens were fed a diet without rye inclusion or a diet containing 15% of hybrid rye cv. Brasetto. The diets were either unsupplemented or supplemented with xylanase (minimum activity 1000 FXU/g, dose 200 mg/kg of feed). Each dietary group consisted of 56 birds. On day 42, selected chickens (n = 7 from each group) were slaughtered. Tibia were analyzed for mineralization, geometry, and biomechanical characteristics of bone mid-diaphysis. The mechanical properties of digital flexor III tendon were also assessed. Bone mineral density and bone ash percentage did not differ when both diets were given without xylanase. Enzyme supplementation increased bone mineral density (P < 0.01) in both dietary groups, whereas bone ash percentage (P < 0.01) increased only for corn-wheat diet. Rye inclusion had no effect on bone mid-shaft geometrical traits related to tibia weight-bearing capacity (cross-sectional area, cortical index, and mean relative wall thickness). Performed bending test showed no effect of hybrid rye inclusion on bone mechanical endurance. When xylanase was supplemented, bone length (P < 0.01) and weight (P < 0.05) decreased, whereas yield load (P < 0.01), stiffness (P < 0.05), Young modulus (P < 0.05), elastics stress (P < 0.01), and ultimate stress (P < 0.01) increased, irrespective of rye presence. The tendon tensile strain test showed that in corn-wheat diet enzyme supplementation positively influenced rupture force (P < 0.05) and tendon stiffness (P < 0.01). Xylanase supplementation increased the value of energy required to tendon rupture, irrespective of rye inclusion (P < 0.05). Study showed that modern hybrid rye varieties can be introduced to corn-wheat diets of broiler chickens in the aspect of animal welfare related to the development and homeostasis of musculoskeletal system, irrespective of xylanase supplementation. The enzyme addition positively affected biomechanical properties of bones and tendons.


Asunto(s)
Huesos/fisiología , Pollos/fisiología , Endo-1,4-beta Xilanasas/metabolismo , Secale/química , Tendones/fisiología , Alimentación Animal/análisis , Fenómenos Fisiológicos Nutricionales de los Animales/efectos de los fármacos , Animales , Fenómenos Biomecánicos , Dieta/veterinaria , Suplementos Dietéticos/análisis , Endo-1,4-beta Xilanasas/administración & dosificación , Masculino , Distribución Aleatoria , Triticum/química , Zea mays/química
7.
Animal ; 13(12): 2773-2781, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31113501

RESUMEN

Gut microbiota have been shown to play a critical role in the maintenance of host health. Probiotics, which regulate gut microbiota balance, could serve as an effective alternative to antibiotic growth promoters. Since changes in the gastrointestinal tract, caused by a variety of different strains, groups and amounts of microorganisms, may be reflected in its histological structure, the aim of the present study was to examine the effects of rising doses of a mixed probiotic preparation on the structure and development of the small intestine of female turkeys. Eighty, three-day-old, healthy, female turkeys (Big-6 breed) were used in the current (16-week) study. The turkeys were randomly allocated to four weight-matched (59.70 ± 0.83 g) groups (n = 20), according to probiotic treatment dose (0, 107 cfu•g-1, 108 cfu•g-1 or 109 cfu•g-1, in 500 g•1000 kg-1) (cfu - a colony-forming unit). Three, non-genetically modified strains of probiotic cultures obtained from poultry, four bacterial and one yeast culture, were used. Histomorphometric analysis of the structure of the small intestinal wall of the duodenum and jejunum was performed. All probiotic doses used in the current study exerted a beneficial effect on the histological structure of the small intestine; however, the observed effect was dose and region dependent. Significant increases in villi height, crypt depth, villi and crypt width, mucosa thickness, epithelial height, enterocyte number, absorption surface and intestinal ganglia geometric indices were observed, specifically in the duodenum of birds receiving an intermediate dose of probiotic (108 cfu•g-1). The probiotic doses used in the current study differed significantly in their effect on the small intestine (P < 0.01), with the intermediate dose (108 cfu•g-1) significantly improving 58% of the parameters assessed, compared to the control. The duodenum was more susceptible to the favourable effects of the probiotic than the jejunum (56% v. 31% improvement in the parameters assessed) (P < 0.01). The weakest favourable effect was observed in the group that received the highest dose of probiotic.


Asunto(s)
Suplementos Dietéticos/análisis , Microbioma Gastrointestinal/efectos de los fármacos , Probióticos/administración & dosificación , Pavos/anatomía & histología , Alimentación Animal/análisis , Animales , Peso Corporal , Dieta/veterinaria , Enterocitos/efectos de los fármacos , Femenino , Tracto Gastrointestinal/anatomía & histología , Tracto Gastrointestinal/efectos de los fármacos , Tracto Gastrointestinal/microbiología , Intestino Delgado/anatomía & histología , Intestino Delgado/efectos de los fármacos , Distribución Aleatoria
8.
Br Poult Sci ; 59(6): 689-697, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30229673

RESUMEN

1. The aim of study was to investigate whether the impact of the yeast Saccharomyces cerevisiae on the histological structure of the intestine, innervation of the small intestine wall, and basal biochemical serum parameters in Japanese quail was sex dependent. 2. One-day-old healthy male and female Japanese quail were fed either a basal diet containing no yeast (control group) or the basal diet plus 1.5% (15 g/kg of diet) of yeast (S. cerevisiae inactivated by drying). Samples from the duodenum and jejunum were taken from each bird at the age of 42 days. Blood samples were collected at this age and the concentrations of glucose, total protein, creatinine, uric acid, lipid profile (total cholesterol, low density lipoproteins (LDL), high density lipoproteins (HDL) and triacylglycerols (TG)), alanine aminotransferase (ALAT), aspartate aminotransferase (AspAT), lactate dehydrogenase (LDH), amylase (AMY), calcium, phosphorus and iron were determined. 3. Female quail fed diets supplemented with yeast had significantly lower total cholesterol and amylase activity than the control females. The concentration of HDL was higher in the male quail than in the females, irrespective of the treatment. An opposite effect was observed in LDL. The diet treatments influenced the activity of AspAT, which was significantly less in the male quail fed diets with 1.5% yeast. 4. Supplementation with S. cerevisiae increased the myenteron, submucosa and mucosa thickness, villus length and thickness and size of absorptive surface, while the number of villi and enterocytes were decreased in the duodenum in males. Female quail showed an increased absorptive surface in the jejunum. The Meissner (submucosal) plexuses were influenced by the feeding and sex to a greater extent than the Auerbach plexus (in the muscularis propria). 5. The results demonstrated that S. cerevisiae (1.5%) in the diet caused significant positive effects in Japanese quail, exerting an effect on the morphology of the small intestine in a sex-dependent manner.


Asunto(s)
Coturnix/fisiología , Dieta/veterinaria , Mucosa Intestinal/crecimiento & desarrollo , Saccharomyces cerevisiae , Amilasas/sangre , Alimentación Animal , Animales , Aspartato Aminotransferasas/sangre , Colesterol/sangre , Colágeno/análisis , Suplementos Dietéticos , Duodeno/química , Femenino , Tracto Gastrointestinal/anatomía & histología , Yeyuno/química , Lipoproteínas HDL/sangre , Lipoproteínas LDL/sangre , Masculino , Factores Sexuales
9.
J Anim Physiol Anim Nutr (Berl) ; 102(1): e299-e308, 2018 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-28503899

RESUMEN

The aim of the study was to evaluate the effect of the diet, mother type and sex of the offspring on the mechanical and geometric parameters of long bones as well as bone tissue density in minks. Primiparous and multiparous dams were supplemented with ß-hydroxy ß-methylbutyrate (a metabolite of leucine, at the daily dosage of 0.02 g/kg of body weight) and/or 2-oxoglutaric acid (a precursor of glutamine, at the daily dosage of 0.4 g/kg of body weight) during gestation. The diet did not influence bone tissue density and the length of the humerus. An increase in the length of the femur was noted in male offspring delivered by multiparous dams. The diet resulted in an increase in the weight of the humerus in males from multiparous dams and a decrease in offspring from primiparous dams. Heavier femora were noted in male offspring delivered by both types of dams. The maximum elastic strength of the humerus was higher in the offspring delivered by multiparous than primiparous dams, irrespective of the offspring sex. The diet resulted in reduction in the ultimate strength of the femur in the male offspring delivered by primiparous dams. Only females born by multiparous dams, irrespective of the diet, showed a significant increase in the cross-sectional area of the humerus, while a significant decline was noted in males delivered by multiparous dams and in all the offspring delivered by primiparous dams. An increase in the cross-sectional area of the femur was noted in the offspring delivered by multiparous dams, while reduction was observed in the offspring delivered by primiparous dams. These results have shown for the first time that the presence of ß-hydroxy-ß-methylbutyrate or 2-oxoglutaric acid in the diet of pregnant primiparous or multiparous dams unambiguously affects the geometry and mechanical properties of offspring's long bones.


Asunto(s)
Densidad Ósea/efectos de los fármacos , Desarrollo Óseo/efectos de los fármacos , Ácidos Cetoglutáricos/farmacología , Visón/crecimiento & desarrollo , Valeratos/farmacología , Alimentación Animal/análisis , Fenómenos Fisiológicos Nutricionales de los Animales , Animales , Peso Corporal/efectos de los fármacos , Dieta/veterinaria , Femenino , Masculino , Paridad , Embarazo , Fenómenos Fisiologicos de la Nutrición Prenatal
10.
Poult Sci ; 97(2): 695-700, 2018 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-29155964

RESUMEN

The efficiency of the musculoskeletal system of broiler chickens, in particular during locomotion and in ensuring its supportive function, depends directly on the adequate function and mechanical endurance of soft tissues, including tendons. However, little is known whether the properties of musculoskeletal soft tissues can be influenced by changes of dietary protein. We substituted soybean meal with raw chickpea seeds as the primary protein source in the diet and studied the effects it had on the mechanical and thermal properties of drumstick tendons in broiler Ross 308 chickens. In the experiment, 160 chicks were divided into 2 groups, receiving in their diet either soybean meal (n = 80) or chickpea seeds (n = 80). The experiment lasted 42 days. The physical condition of the drumstick tendons was analyzed on the basis of a tensile test and the results of thermal denaturation as measured by a differential scanning calorimetry. The mechanical evaluation of tendon tensile strength of the broilers fed with chickpea seeds demonstrated an increase in the ultimate strain (for over 22%, P < 0.04) and total energy absorbed by the tendon until rupture (for over 57%, P < 0.05) as when compared to the group fed with soybean meal. Thermal analysis demonstrated alterations in tendon collagen cross-linking as transition onset temperature decreased (from 63.8 to 61.8°C, P < 0.001), whereas the calorimetric enthalpy increased (from 16.2 to 22.1 J⋅g-1, P < 0.05) in the group fed with chickpea seeds. In summary, this study demonstrated that dietary protein source can impact the physical properties of tendons and showed that thermal analysis can be a useful tool for studying the effect of nutrition on the development and structural changes in tendons of broiler chickens.


Asunto(s)
Pollos/fisiología , Cicer/química , Colágeno/química , Proteínas en la Dieta/análisis , Glycine max/química , Tendones/fisiología , Alimentación Animal/análisis , Animales , Fenómenos Biomecánicos , Rastreo Diferencial de Calorimetría/veterinaria , Dieta/veterinaria , Masculino , Distribución Aleatoria
11.
Br Poult Sci ; 58(3): 312-318, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28102084

RESUMEN

1. The aim of the study was to investigate the effects of caponisation on bone development of males of two native breeds in Poland. 2. The weight, length and cross-sectional area of tibiae and femora were measured, densitometric measurements and tests of strength were determined and dimensions were calculated. 3. Breed and caponisation did not influence bone weight and length. Higher mechanical strength of the femur was found in entire males, mainly in the Polbar breed. Tibial strength was reduced in capons of the Green Partridge breed. Maximum elastic strength was greater in the Polbar, irrespective of caponisation. Bone cross-sectional area was influenced by breed, while caponisation reduced femoral bone mineral density in both breeds. 4. Caponisation thus increased growth rate but had adverse effects on bone development. 5. Caponisation had fewer negative effects in the Polbar than in the Greenleg Partridge.


Asunto(s)
Densidad Ósea , Desarrollo Óseo , Pollos/fisiología , Fémur/fisiología , Orquiectomía , Tibia/fisiología , Factores de Edad , Crianza de Animales Domésticos , Animales , Fenómenos Biomecánicos , Pollos/crecimiento & desarrollo , Densitometría/veterinaria , Fémur/química , Masculino , Polonia , Tibia/química
12.
Am J Psychiatry ; 142(2): 181-6, 1985 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-3918467

RESUMEN

After nearly 15 years of nondiscriminatory coverage, the largest plan in the Federal Employees Health Benefits Program cut its coverage of care for mental illness disproportionately to coverage for other health care in 1981 and 1982. "Catastrophic" coverage for inpatient mental illness care was introduced by many of the plans in 1984. The authors review the reductions in coverage from economic and clinical perspectives, highlighting the impact of the disparity between the coverage for mental illness and other medical conditions. The model of catastrophic protection for treatment of mental illness set forth in the Federal Employees Health Benefits Program does not bode well for the patient and family who must cope with such a financial contingency.


Asunto(s)
Gobierno , Planes de Asistencia Médica para Empleados/economía , Seguro de Salud/economía , Seguro Psiquiátrico/economía , Planes de Seguros y Protección Cruz Azul/economía , Planes de Seguros y Protección Cruz Azul/tendencias , Deducibles y Coseguros/economía , Planes de Asistencia Médica para Empleados/tendencias , Gastos en Salud/economía , Hospitalización/economía , Humanos , Seguro Psiquiátrico/tendencias , Estados Unidos
14.
Pediatrics ; 68(1): 87-92, 1981 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-7195546

RESUMEN

To demonstrate the presence of discriminable awake states in preterm infants, facial behaviors and visual fixation to a single patterned stimulus were recorded. Five healthy preterm infants born at a mean of 29 weeks' gestation were followed from 30 to 35 weeks' postmenstrual age. Behaviors (eye openness, movements, mouthing, and vocalizations) were recorded simultaneously with visual fixation measured by the corneal reflection technique. Test time was determined by the duration of time the infant remained awake before crying or closing eyes. The presence of both quiet awakeness and drowsiness was demonstrated. Younger infants spent more time in drowsiness, whereas older infants had more quiet awakeness. Visual pattern fixation was observed as early as 30 weeks. Fixation time increased with increasing postmenstrual age. More fixation was observed during quiet awakeness than during drowsiness.


Asunto(s)
Párpados/fisiología , Fijación Ocular , Recien Nacido Prematuro , Vigilia/fisiología , Movimientos Oculares , Humanos , Lactante , Recién Nacido , Fases del Sueño/fisiología
15.
Hosp Community Psychiatry ; 27(6): 398-400, 1976 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-950226

RESUMEN

The National Health Planning and Resources Development Act of 1974 establishes a five-tiered system for health planning that begins with the Secretary of Health, Education, and Welfare and reaches the local level through areawide health systems agencies. The author describes the implications of the law for mental health services, focusing particularly on its impact at the local level. He describes the functions of the health systems agencies, points out limitations in their authority, and emphasizes that cooperation of community organizations and agencies is essential if they are to be effective in improving health and mental health care and treatment.


Asunto(s)
Planificación en Salud , Legislación Médica , Trastornos Mentales/terapia , Humanos , Programas Nacionales de Salud , Estados Unidos
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