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Improving Nutrition Outcomes using the Multiphase Programmatic Approach (P160848) hypertension and exercise atenolol 100mg mastercard. Countdown to prehypertension uptodate order atenolol in india 2030: tracking progress towards universal coverage for reproductive arteria pancreatica magna atenolol 50mg low cost, maternal, newborn, and child health. The Johns Hopkins Team for Strengthening Community-based Primary Health Care in Madagascar. An Assessment of the National Community-Based Primary Health Care and Nutrition Services in Madagascar with Proposed Options for Immediate Strengthening. Antananarivo, Madagascar: Bureau Central de Coordination des Projets, Unitй de Coordination des Projets & Unitй Programme National de Nutrition Communautaire, Republic of Madagascar 2018. Misoprostol Policy and Scale-Up for the Prevention of Postpartum Hemorrhage in Madagascar: Country Report 2016. Renforcer la santй communautaire а Madagascar: priorisation et coыts des paquets de services de santй. Scaling-up Community Health in Madagascar: Prioritization and Costing of the Health Service Packages. Ending Preventable Child and Maternal Deaths: 10 Innovation Highlights from Madagascar. Providing free pregnancy test kits to community health workers increases distribution of contraceptives: results from an impact evaluation in Madagascar. They promote good nutrition, sanitation, and hygiene, and link families to essential services. Currently, their tasks at the community level include: vaccination, growth monitoring, sanitation, water source protection and water treatment, disease surveillance, health and nutrition talks, provision of contraceptives and supervising traditional birth attendants and village health and water committees. From the early 1990s, the country witnessed a number of community health programs and strategies, and the government started focusing on community approaches. They usually work in different health programs depending on the health needs and requirements of their community. Over time, the community health program has evolved to become one of the key drivers for improvement of key indicators within the health sector. The overall goal of the Malawi government is "to ensure that people in Malawi attain the highest possible level of health and quality of life. This has led to a high proportion of teenage pregnancies (25%) with subsequent adolescent childbirth at 29%, and adolescents accounting for 20% of maternal deaths. These include a progressively steady decline in under-five mortality from 242 in 1990 to 64 in 2015. However, more efforts are needed at both the facility level and the community level to ensure continued progress in these indicators. The disease affects six million people per year and is the leading cause of morbidity and mortality in under-five children and in pregnant women. The magnitude of the problem should not be underestimated, as it accounts for over 30% of outpatient visits and is ranked third on the list of conditions that result in Years Lost to Disability. These needs have more to do with the functioning of the health system, as highlighted below. Inadequate human resources for health Malawi continues to experience vacant positions in the health sector in all cadres at all levels the primary, secondary and tertiary levels. However, one quarter of the population lives more than eight kilometers from a facility at present. According to Malawi Service Provision Assessment Survey,8 of 509 government health facilities 37% did not have regular electricity, 9% did not have an improved water source, 78% did not have a client latrine, 31% did not have communications equipment, and 7% did not have a functioning ambulance. Maintaining the existing ambulances so that they are functional is an additional challenge, especially in remote areas with poor road conditions. The government of Malawi has its own share of challenges relating to health care equipment. Although this could be attributable to a number of issues, the most notable ones are funding shortages, high prices, weak supply chain management, lack of drug storage spaces, unreliable information systems, irrational use of medicines, and "leakage" and pilferage due to corruption. The Malawi health sector has numerous stakeholders, most of who run parallel supply chains for health commodities that are uncoordinated with each other. This leaves the government with limited power to control the procurement, storage and distribution of drugs. Need for robust and reliable health information system the health sector in Malawi, like any other government sector, faces major challenges in data management. This in turn creates structural challenges and weakens the mainstream monitoring and evaluation system. Most health facilities are not able to collect and submit the required data on time. This problem is compounded by overreliance on manual data collection and manual reporting processes, which make it difficult to record, extract, share and use the data. For those systems that are computerized, interoperability among systems is a major challenge. In the event that the condition is too critical to handle, the case is referred to a district hospital. Malawian health centers and hospitals are distributed in such a way that top tier hospitals are in urban centers, which tend to be overcrowded due to referrals. Health workforce: Malawi is one of the 57 countries with a crisis in human resources for health. Recruitment is through a centralized system operated by the Health Services Commission. However, the process varies from district to district depending on local health needs. Malawi has a medical school where doctors, physiotherapists and pharmacists are trained. The enrollment numbers for these schools are small, although they have been growing 234 Health for the People: National Community Health Worker Programs from Afghanistan to Zimbabwe over the years. However, in 2008, the colleges graduated 39 physicians and 656 nurses across the country. Health facilities are responsible for the reporting of notifiable communicable diseases and deaths that occur at the facility. Population-based surveys, for example, Demographic and Health Surveys, are also used to measure outcomes and produce impact data. Medical products, vaccines and technologies: Malawi is overwhelmed with drug shortages in hospitals. This can be attributed to weak procurement and supply chain systems, poor storage facilities and mismanagement of funds. This exceeds the Abuja target for governments in Africa to allocate at least 15% of their budget for health. However, the government is weak in enforcement of regulations, implementation of policies, and accountability.
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The first group of students did not receive any portion of the program prehypertension risk factors discount 100mg atenolol visa, the second group received half of the program while they were in year ten hypertension jnc 8 guidelines pdf buy atenolol visa, and the third group received both years of the program blood pressure chart 60 year old effective atenolol 100mg. The outcome measures used in the study included changes in attitudes, knowledge of risk factors, sexual activity, and age at first intercourse. The schools were paired according to class size, location, and racial/ethnic distribution, and then randomly assigned to the treatment or control group. Of 812 eligible students, 582 enrolled in the six schools at the beginning of the study obtained written parental consent to participate. Students were surveyed at baseline (522 students), with the first follow up at the end of the seventh grade (503 students). The following year 459 students had useable surveys at the beginning of eighth grade, and 422 students had useable surveys at the end of eighth grade. A comparison of baseline characteristics between treatment and control groups revealed some significant differences between groups, however the way the differences might have positively or negatively affected the results is not obvious. At baseline, 44 percent of the seventh grade males and 81 percent of the seventh grade females reported being virgins. By the beginning of ninth grade, the difference between these rates was still significant at 27 percent and 12 percent, respectively. By the end of ninth grade, the difference between groups was still significant, with rates of 39 percent versus 24 percent. The differences between groups remained statistically significant in the ninth grade, with rates of 18 percent versus 7 percent at the beginning of the school year, and 27 percent versus 17 percent by the end of the school year. For male students, those in the control group were significantly more likely to have engaged in sexual intercourse by the end of eighth grade (29 percent versus 8 percent), with rates of 42 percent versus 22 percent at the beginning of ninth grade, and 61 percent versus 39 percent at the end of ninth grade. Within - 384 - control populations, there was no annual increase in correct answers when asked questions to test their knowledge of these issues. With regard to the use of birth control/condoms at the time of last intercourse for female, nonvirgin students, treatment group females were significantly more likely to report usage than were control group females at all three measurement points. No significant differences in virginity or use of birth control/condoms were observed among male participants at any time during the study. Nationally, programs are supported with federal, state, local, foundation, and agency funds. Abstinence is presented as the best way to prevent unintended pregnancy and sexually transmitted diseases. The program also teaches that young teens are not yet mature enough to handle the consequences of sexual activity. The life-skills component includes activities that help students build decisionmaking skills, set goals for their lives, learn how to say no to sex, and negotiate within relationships. Sexuality education refers to a broad-based curriculum covering physical growth and the development of healthy sexual attitudes and values. Contraceptive education covers methods of contraception, how such methods are used, and their effectiveness in preventing pregnancy and sexually transmitted diseases. The five Human Sexuality sessions were taught by hospital nurses and health educators. The first four sessions were given - 385 - either in the same week or weekly over four weeks. The fifth session, which was designed to reinforce the material, was given one to three months later. Session 2 focused on the influence of the media, while session 3 focused on peer pressures and how to respond to them, as well as the need to set a "stopping point" in physically expressing affection. Session 4 helped students develop assertiveness skills in resisting pressures to have sex. Staffing the student leaders were recruited from among eleventh and twelfth graders, and each received 20 hours of initial training, followed by monthly two-hour training sessions. Student leaders learned to present information, conduct discussions, teach assertiveness skills, and lead role-playing. Study results were mixed with respect to use of birth control, with Howard (1992) reporting no program effects, and the study by Aarons et al. However, a large-scale replication in California did not produce any of the positive effects seen in the Atlanta study. The California program replication, called the Education Now and Babies Later initiative, took place from 1992 to 1994. The California program, however, may not have been a faithful replication for several reasons. The program was randomly delivered to classrooms within the same school, with some students receiving the program and some receiving the standard sexuality curriculum offered by the school. It is possible that, given the peer pressure associated with sexual activity, providing only some of the students with the program makes it less effective. The study did not find any significant effects with the students who were taught by peer leaders; in addition it was found that some of the teen leaders were not sufficiently trained or lacked experience. This identifies a problem with the replication given that the Human Sexuality program in Atlanta provided that information. It has been used in several locations throughout the United States, Great Britain, Canada, and New Zealand. The updated materials are available for purchase from the Jane Fonda Center at Emory University ( Wingrove, "Postponing Sexual Intercourse Among Urban Junior High School Students: A Randomized Controlled Evaluation," Journal of Adolescent Health, Vol. McCabe, "Helping Teenagers Postpone Sexual Involvement," Family Planning Perspectives, Vol. Cagampang, "The Impact of the Postponing Sexual Involvement Curriculum Among Youths in California," Family Planning Perspectives, Vol. Tripp, "School Sex Education: An Experimental Programme with Educational and Medical Benefit," British Medical Journal, Vol. The theoretical background for the program is based on managing depression through a two-process model of control. The sample of 48 students was drawn from three elementary schools with a total population of about 500 students in grades 3 through 6. Second, teachers and counselors were asked to identify any children whom they believed had significant problems involving depression. The semistructured interviews were conducted by trained interviewers and covered such depressionrelated symptoms as unhappiness, guilt, and low self-esteem. A total of 51 children met these criteria, and 3 chose not to participate in the study. The resulting sample included 26 boys and 22 girls, with 30 Caucasian (63 percent) and 18 ethnic minority (primarily African American) children. Children were treated in four small groups of fewer than six children per group, with each group led by two cotherapists. Assessment of the clinical interview scores revealed that the treatment group decline of 12. However, a different statistical test, which controlled for pretest scores, did not indicate a significant difference in mean posttest scores between groups.
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But the larger need is for communities to arrhythmia upon waking order 50mg atenolol overnight delivery create more viable systems of child care that do not tolerate unsafe and unstimulating settings prehypertension numbers buy atenolol 50mg overnight delivery, actively promote and reward high-quality care blood pressure chart monitor order 100 mg atenolol fast delivery, stem the tide of staff turnover, and enable parents at all income levels to avail themselves of quality care for their children (Kagan and Cohen, 1996; National Association of State Boards of Education, 1991; National Research Council, 1990). Most research on neighborhood effects has focused on adolescents, whose time away from their homes may make them more susceptible than young children to neighborhood influences. This scenario is changing rapidly, however, as very young children are spending increasing amounts of time in settings other than their homes and with adults other than their parents. Moreover, there is substantially less attention paid to rural communities than to urban communities in this area of research and intervention. During this period, urban poverty has been especially concentrated in the Midwest, in such cities as Chicago, Detroit, Cleveland, and Milwaukee, as well as in New York. This profile of cities may change with the findings from the 2000 census, since concentrated urban poverty is a slowly moving target. Residence in high-poverty urban neighborhoods is much more likely for black and Hispanic than white children (Kasarda, 1993). Perhaps surprisingly, most poor children do not live in high-poverty urban neighborhoods. The most recent data, from the 1990 census, show that only 15 percent of all poor children live in high-poverty urban neighborhoods (Jargowky, 1997, Table 3. More than one-quarter of all poor children lived outside metropolitan areas altogether, while one-third lived in urban neighborhoods with poverty rates below 20 percent. The combination of family and neighborhood poverty, however, is much more prevalent among black than either Hispanic or white children. Some 27 percent of poor black children lived in high-poverty urban neighborhoods, compared with 20 percent of Hispanic and only 3 percent of white children. These children thus experience the double risk of family and neighborhood poverty. William Julius Wilson (1987) galvanized empirical research on community and neighborhood effects with his description and analysis of conditions in high-poverty, inner-city Chicago neighborhoods. He documented the poor employment prospects, poor marriage pool, violence, and high mobility that were endemic to these neighborhoods. He also provided explanations of structural changes that produced these conditions as well as of how life in high-poverty urban neighborhoods affects the families and children living in them. Wilson hypothesized that massive changes in the economic structure of inner cities, when combined with residential mobility among more advantaged blacks, have resulted in homogeneously impoverished neighborhoods that provide neither resources nor positive role models for the children and adolescents who reside in them. Proponents of stress theory, such as Earls and Buka (2000), emphasize the damaging developmental consequences of exposure to violence and to physiological hazards, such as ambient lead and asthma-inducing air pollutants. For other theorists, the extent of social organization in a neighborhood may well matter for families with young children. Neighborhoods in which parents frequently come into contact with one another and share values are more likely to monitor the behavior of and potential dangers to children (Sampson, 1992; Sampson and Groves, 1989). Contact among parents may lead them to share ways of dealing with the problem behavior of their children, encouraging their talents, connecting to community health and other resources, and organizing neighborhood activities (Klebanov et al. They point out that families formulate different strategies for raising children in high-risk neighborhoods, ranging from extreme protection and insulation to assuming an active role in developing community-based networks of "social capital" that can help children at key points in their academic or labor market careers. However, interactions between preschool children and their kin, neighbors, religious communities, child care, and health systems suggest that neighborhood influences may begin long before adolescence (Klebanov et al. Despite ample theoretical reasons to suspect that neighborhood conditions influence development and behavior, the task of securing precise, robust, and unbiased estimates of neighborhood effects has proved remarkably difficult (Duncan and Raudenbush, 1999; Manski, 1993). The major challenge facing those who seek to understand how family contexts affect early development is that parents usually select these environments. They decide where to live, where and how much to work, and whether and when to place their babies in child care and which child care settings to use. Thus, effects on children that are ascribed to such factors as neighborhoods may, in fact, really be effects of parent selection. Compounding this problem is the high mobility that characterizes families with young children. Nearly one-fourth of young children ages 1 to 5 move to a new home during the course of a year, with moves only slightly more common among black and Hispanic than among white young children. A final problem is that of isolating the effects of conditions in the worst urban neighborhoods from effects caused by the more general range of neighborhood conditions. Representative population surveys typically draw relatively few families from high-poverty urban neighborhoods. Analysts using these surveys base estimates of neighborhood effects on relative differences among more advantaged, mostly white families and children. If neighborhood conditions matter more for disadvantaged than advantaged children, as some have found (Cook et al. Every 10 years, the Census Bureau provides information that can be used to construct neighborhood-based measures, such as the of Sciences. Such data are available for census tracts (geographic areas encompassing 4,000 to 6,000 individuals, with boundaries drawn to approximate neighborhood areas) as well as larger geographically defined areas. One striking result in broad-based studies of neighborhood effects on young children is that there are many more differences in families and children within neighborhoods than between them. As a result, in one study, neighborhood factors such as poverty, male joblessness, and ethnic diversity were found to account for only a small share of the differences across 5- to 6-year-old children in problem behaviors and academic achievement (Klebanov et al. The presence or absence of affluent, high-income neighbors, rather than of poor neighbors, related more strongly to child and adolescent outcomes. This may not be a direct effect of income per se; it may derive from the differing social and interpersonal resources that are available in higher-income neighborhoods, as emphasized in social organization theories of neighborhood influence, as well as their greater support for sustaining academic achievement and other positive efforts (Darling and Steinberg, 1993). Neighborhood factors also do not account for much of the variation in parental mental health and family management practices. However, we caution against drawing more practical policy conclusions from these patterns of explained variance (Cain and Watts, 1972; Duncan and Raudenbush, in press; Rosenthal and Rubin, 1982). The cost-effectiveness of a neighborhood intervention depends on effect sizes relative to cost, and socially profitable intervention policies are quite possible in the context of a small amount of explained variation. The neighborhood study of Sampson, Raudenbush, and Earls (1997) is noteworthy for its focus on the "collective efficacy" of neighborhoods. Collective efficacy combines social cohesion (the extent to which neighbors trust each other and share common values) with informal social control (the extent to which neighbors can count on each other to monitor and supervise youth and protect public order). They find that collective efficacy so defined relates strongly to neighborhood levels of violence, personal victimization, and homicide in Chicago, after controlling for social composition and previous crime. One could imagine that lower levels of neighborhood violence and crime might change parenting practices in ways that benefit young children, although that possibility has not yet been tested with these or other data. Taken together, this picture of at best modest neighborhood influences based on population samples is at odds with more specialized studies focused on very bad neighborhoods. For example, in a sample of patients in a Boston pediatric clinic, Taylor and colleagues (1992) found that 1 in 10 children witnessed a violent event prior to age 6, while Buka and colleagues (Buka and Birdthistle, 1997; Buka et al. Psychiatric problems ranging from posttraumatic stress and aggression to externalizing behavioral disorders are more common among children and youth who witness violence (Singer et al. Among physiological hazards, lead poisoning continues to pose a threat to the healthy development of children, and disproportionately to lowincome children of color living in central cities. As described in Chapter 8, excess lead in blood has been tied to such neurobehavioral problems as attention deficits, and poor children are disproportionately at risk for exposure to lead (Brody et al. Epidemiologists have linked the elevated levels of lead in poor urban children to old housing stock, which often still contains lead-based paint and other environmental contaminants, such as leaded gasoline.
Attrition analyses revealed no significant differences between study completers and dropouts hypertension 34 weeks pregnant purchase 100 mg atenolol overnight delivery. The initial pool of 118 participants with primary anxiety disorders had all been referred from community sources artaria string quartet order atenolol australia, and 24 children subsequently dropped out of the study blood pressure medication nifedipine cheap atenolol 100mg on line. Of the 94 children included in the final analysis, 55 were diagnosed at intake with overanxious disorder, 22 with separation anxiety disorder, and 17 with avoidant disorder. Children were excluded if they displayed psychotic symptoms, if their primary diagnosis was simple phobia, or if they were currently using antianxiety medications. After intake, participants who met the eligibility criteria were randomly assigned to either the 16-week Coping Cat program (60 children) or the 8-week waiting list control condition (34 children). Of the study participants, 58 percent of the intervention group was male compared with 68 percent of the control group. The majority of the sample was Caucasian (87 percent of the intervention group versus 82 percent of the control group). Groups were compared for pretreatment differences in terms of age, gender, race, and all dependent variables, and no significant differences were found between groups. Outcomes for the treatment group were assessed posttreatment (16 weeks), while outcomes for the wait-list control group were assessed after the waiting-list period (8 weeks). Flannery-Schroeder and Kendall (2000) assessed the effects of Coping Cat in a sample of 37 children aged 8-14 years. Subjects were referred by a clinic and had all been diagnosed with an anxiety disorder, including 21 children with generalized anxiety disorder, 11 with separation anxious disorder, and 5 with social phobia. Exclusion criteria for participation included having a disabling physical condition, psychotic symptoms, or currently using antianxiety or antidepressant medication. The initial study sample included 45 children, and 8 children subsequently dropped out of the study. Analyses of pretreatment group differences in terms of age, gender, race, family income, and parent levels of education revealed no significant differences among groups. In a comparison of pretreatment dependent variable scores across groups, some means on child-reported measures were found to differ significantly. Treatment outcomes were assessed via clinician interviews; child selfreports of anxiety, depression, coping skills, self-perception, loneliness, friendship, and recall of treatment curriculum; parent reports of child behavior, anxiety, coping skills, social activities, and peer relationships; and teacher reports of classroom behavior. Specifically, the intervention group had better outcome scores than the control group on o o o o o · anxiety measures fear scores perceived ability to cope with most-dreaded situations frequency of negative thoughts during the past week depression Parent reports: Similar to the child self-report measures, all of the parent assessments of child behavior and anxiety showed significant, positive effects for the intervention. Specifically: o o · · Intervention group parents rated their children more positively on all four behavior scales, including internalizing behavior, social behavior, health, and externalizing behavior. Teacher reports: No significant differences were found for either the internalizing or externalizing behavior scores. Behavioral observations: No significant differences were found between groups for the behavioral observation measures when looked at individually. However, when scales were merged into a single score, a significant effect was found that favored the intervention group. Of the control participants, only 6 percent did not qualify for their primary anxiety disorder diagnosis after the waiting-list period (8 weeks). Child self-reports: All of the child report measures found either significant or marginally significant positive effects favoring the intervention group. These included · o o o o o · significant effects for reductions in anxiety significant effects for reduction of fear significant improvements in ability to cope with dreaded situations a significant reduction in the frequency of negative thoughts during the past week a marginally significant effect for reduced depression. Behavioral observations: Significantly better outcomes were found for the intervention group for two anxious behaviors-trembling voice and fingers in mouth-while differences between groups were not found for absence of eye contact. Significant group differences were found on the state anxiety and trait anxiety scales of the State-Trait Anxiety Inventory. Both treated groups improved their self-reported coping from pretest to posttest, while the control group did not. An analysis of a combination of the measures assessing social functioning showed no significant differences among groups. Probable Implementers Community-based child and youth organizations, school psychologists, private therapists, mental health centers and clinics. Funding Previous funding for the implementation and evaluation of Coping Cat has been provided by the National Institute of Mental Health. Sources for current funding of program implementation may include mental health agencies, private service providers, and school districts. Implementation Detail Program Design the Coping Cat program provides children and youth with information about anxiety and ways of coping with situations that previously caused anxiety and fear. Behavioral training strategies such as cognitive restructuring, modeling, guided imagery, simulation, real-life exposure, role-playing, relaxation training, and contingent reinforcement are used. Children are taught how to verbally reinforce their own successful coping and are encouraged to practice using the coping skills when anxiety-provoking situations arise. Curriculum the first eight sessions of the Coping Cat program involve an introduction of the basic concepts, followed by practice and reinforcement of the skill. In Session 3, children construct a hierarchy of anxiety-provoking situations so that they can distinguish anxious reactions from other types of reactions and can identify their own particular somatic responses. In Session 4, children are taught how to relax outside of the sessions by listening to a cassette tape containing personalized relaxation content. Session 5 consists of teaching the child to recognize and assess self-talk during anxious situations and to reduce self-talk that is anxiety provoking. Session 6 emphasizes coping strategies such as coping self-talk and verbal self-direction, as well as developing appropriate actions to help cope with anxious situations. Session 8 comprises reviewing concepts and skills covered in the previous sessions. In Sessions 10 to 13, the child is exposed to imaginary and real situations that cause increasing levels of anxiety. The final session is used to discuss the therapy experience, to review the skills, and to encourage the child to think about how to apply the skills in everyday life. All three studies of Coping Cat found that participants experienced a wide range of significant, positive outcomes when compared with control group participants. Findings for child self-report measures were the most robust across the studies, while parent reports and behavioral observations were somewhat mixed. No significant program impacts were found in any of the studies for teacher reports of classroom functioning. The major limitation in all three of the studies was the use of a short-term wait-list control group. While the authors cite ethical problems with forcing a 16-week or more delay in providing treatment to control group participants, the strength of the study findings is limited by the short-term nature of the follow-up measurement of outcomes. In addition, the studies are limited by the fact that outcomes were assessed at different times for the intervention and control groups. The study was limited by numerous pretest differences between groups; however, the results do not suggest the superiority of either method of program delivery. An evaluation of a Dutch adaptation of the Coping Cat program suggests that the addition of a cognitive parent-training group to the program does not result in additional benefits. Results indicated significant differences between both treatment groups and the control group, but no differences between the treatment groups themselves.
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Kinnish 1996 the peer relations of preschool children with communication disorders one direction heart attack atenolol 100mg discount. Breslau 1986 Very low birth weight infants: Effects of brain growth during infancy on intelligence quotient at 3 years of age pulse pressure of 80 order atenolol no prescription. Wright 1991 Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Network [see comments] blood pressure vs pulse pressure buy atenolol 100 mg otc. Schuele 1998 Facilitating peer interaction: Socially relevant objectives for preschool language intervention. A Synthesis of Child Research Conducted As Part of the National Evaluation of Welfare-to-Work Strategies. Brooks-Gunn 2000 the effects of early maternal employment on later cognitive and behavioral outcomes. Zajac 1993 Environmental enrichment and the behavioral effects of prenatal exposure to alcohol in rats. Valente 1995 Mother-child interaction quality as a partial mediator of the roles of maternal depressive symptomatology and socioeconomic status in the development of child behavior problems. Huie 1985 the effects of prior group experience, age, and famimliarity on quality and organization of preschool social relationships. Man-Shu 1985 Insight into the time-course of emotion among Western and Chinese children. Risley 1995 Meaningful Experiences in the Everyday Experiences of Young American Children. Cicchetti 1996 Altered neuroendocrine activity in maltreated children related to symptoms of depression. Miller 1992 Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Rodning 1999 Relationship-based intervention with at-risk mothers: Outcome in the first year of life. Dunn 1997 Early experiences with family conflict: Implications for arguments with a close friend. Nachmias 1995 Adrenocortical responses to the Strange Situation in infants with disorganized/ disoriented attachment relationships. Stanley-Hagan 1999 the adjustment of children with divorced parents: A risk and resiliency perspective. Hart 1993 Issues of taxonomy and comorbidity in the development of conduct disorder. Rutstein 1984 Socio-economic factors in infant and child mortality: A cross-national comparison. Chaplin 1998 State regulations: Effects on cost, quality, availability, and use of child care programs. Twentyman 1984 A multimodal assessment of behavioral and cognitive deficits in abused and neglected preschoolers. Sternman 1982 Temporal distribution of sleep states, somatic activity, and autnomic activity during the first half year of life. Kilburn 1992 Estimating the demand for child care and child care costs: Should we ignore families with non-working mothers? Matheson 1992 Sequences in the development of competent play with peers: Social and socialpretend play. Norris 1997 Adding two school age children: Does it change quality in family child care? Phillipsen 1992 Gender and friendship: Relationships within peer groups of young children. Whitebook 1992 Thresholds of quality: Implications for the social development of children in centerbased child care. Chen 1997 When and what parents tell children about race: An examination of race-related socialization among African American families. Barr 1986 Increased carrying reduces infant crying: A randomized controlled trial. Herschkowitz 1996 Structural and neurobehavioral delay in postnatal brain development of preterm infants. Pollitt 1993 Reversal of developmental delays in iron-deficient anaemic infants treated with iron. Shisheva 1998 Integrative coordination of circadian mammalian diversity: neuronal networks and peripheral clocks. Infant Health and Development Program 1990 Enhancing the outcomes of low-birthweight, premature infants: A multisite, randomized trial. Institute of Medicine 1996 Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment. Benjamin 1991 Towards a Culturally Competent System of Care: Programs Which Utilize Culturally Competent Principles. Cohen 1991 Infant cardiac activity: Developmental changes and relations with attachment. McDermott 1989 Family caregiver costs of chronically ill and handicapped children: Method and literature review. Jacobson 1999 What teratogenic insult can reveal about underlying components of cognitive and emotional function in infants and school-age children. Burton 1999 Dynamic dimensions of family structure in low-income African American families: Emergent themes from qualitative research. Wang 1999 Fourteen-year follow-up of children with and without speech/language impairments: Speech/language stability and outcomes. Walker 1991 A follow-up evaluation of the Houston Parent-Child Development Center: School performance. Gold 1992 Mechanisms of stress: A dynamic overview of hormonal and behavioral homeostasis. Newport 1989 Critical period effects in second language learning: the influence of maturational state on the acquisition of English as a second language. Rothbart 1991 Components of visual orienting in early infancy: Contingency learning, anticipatory looking, and disengaging. Slater 1996 Early experience and plasticity of song in adult male zebra finches (Taeniopygia guttata). Corman 1995 the impact of child health and family inputs on child cognitive development. Hester 1997 Prevention of conduct disorder through early intervention: A social-communicative perspective. Kahn 1995 Starting Right: How America Neglects Its Youngest Children and What We Can Do About It. Gentry 1988 Phonological and spatial processing abilities in language- and reading-impaired children. Liebman 1999 Moving To Opportunity in Boston: Early Impacts of a Housing Mobility Program. Rosenbaum 1992 the education and employment of low-income black youth in white suburbs.
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For example blood pressure 150100 order atenolol amex, it may be said that clients manifest overt aggressive hostility in an impulsive manner when hypertension treatment jnc 7 purchase 100mg atenolol mastercard, in fact blood pressure numbers mean discount atenolol uk, they punch you on the nose. They include language that is so vague and unclear that it cannot be falsified or considered wrong. The results of the study showed very little correspondence between the definitions these latter two points are critical if reports are to address the referral question in a manner that is amenable to subsequent, appropriate intervention. Perhaps psychologists can, however, lead the way toward competent reporting of findings. The problem is most readily seen when the psychologist is clearly using the same theories or drawing the same conclusions in every report. A psychologist who adheres exclusively to behavioral principles, for example, will attribute all child problems to faulty reinforcement histories. One can imagine the skepticism that may be engendered by a psychologist who concludes that a child whose school performance has just deteriorated subsequent to a traumatic head injury merely needs more positive reinforcement to bring his grades up to pre-trauma levels. Problems may also occur if a psychologist draws conclusions that are clearly in conflict with the data collected for a child. A psychologist may decide not to make a diagnosis, in seeming contrast to rating scale findings of significant T-scores on the majority of scales. If a clear argument for resolving this incongruity is not made, the consumer of the report may well suspect biases. The psychologist who routinely does not reconcile high T-scores with a lack of a diagnosis may soon be labeled as unwilling to diagnose regardless of assessment results. The reverse situation can also be problematic, wherein the psychologist makes a diagnosis without any clear indications of significant symptomatology or impairment. Report Length Psychologists, more so than other groups, complain about the excessive length of reports (Tallent, 1993). Perhaps long reports are used to disguise incompetence, fulfill needs for accountability, or impress others. The possibility that length is a cover for other ills is offered in the following example: A business executive likes to relate the anecdote about the occasion when he assigned a new employee to prepare a report for him. Dismayed, the executive pointed out that the required information could be presented on one, certainly not more than two, pages. It may also be worth considering that the Ten Commandments are expressed in 297 words, the Declaration of Independence is in 300 words, and the gettysburg Address is in 266 words. Number Obsession the clinician must always keep clearly in mind that the child is the lodestar of the evaluation, and the numbers obtained from personality tests and the like are only worthy of emphasis if they contribute to the understanding of the child being evaluated. One way to think of the scores is as a means to an end, with the end being better understanding of the child. Just as a high temperature reading can be symptomatic of a host of disorders from influenza to appendicitis, so, too, a pathognomic behavioral sign can reveal a host of possible conditions. One horrendous error often made when reporting test scores is a psychologist reporting a score and then saying that it is invalid. If a test score is invalid, how does it serve the child to have this score as part of a permanent record? In all likelihood, the flawed results would not be reported; rather, the patient would be required to retake the test. We suggest that one does not have to report scores for a test just because it was administered. This stance applies to scores that are deemed invalid or circumstances in which the psychometrics underlying the scores are questionable. In these situations, disregarding the information from the measure or providing only descriptions of the responses may better inform case conceptualization. The referral was made simply because a second opinion is required for reimbursement purposes the psychologist is seeking a diagnosis of traumatic brain injury in order to bolster her court testimony Failure to address Referral Questions Tallent (1993) points out that psychologists too often fail to demand clear referral questions, and as a result, their reports appear vague and unfocused. Psychologists should insist that referral sources present their questions clearly, and if not, the psychologist should meet with the referring person to obtain further detail on the type of information that is expected from the evaluation (Tallent, 1993). Many agencies use referral forms to assist in this process of declaring assessment goals. On occasion, the referral question(s) can be insidious and, consequently, place the psychologist in the position of disappointing the referral source before the evaluation is even initiated. One study evaluated teacher preferences for and comprehension of varying report formats (Wiener, 1985). This study required a group of elementary school teachers to read and rate their comprehension of and preferences for three different reports for the same child. Parents are concerned that John is aware of the risks of th is poor adherence but seems apathetic. Results of Consultation: Patient appears depressed and seems knowledgeable about diabetes and his diabetes regimen. In particular, his parents noted that he appears sad most of the time, lacks energy, has reduced his contact with friends, and does not seem interested in activities that he used to enjoy. Rating scales completed by patient and his mother showed moderate levels of depression. Signed Title Date Figure 16. It used some jargon, such as acronyms, to shorten length; conclusions were drawn without reference to a data source; and recommendations were given without elaboration. It used headings such as reason for referral, Learning Style, Mathematics, Conclusions, and recommendations. The question-and-answer report was similar to the psychoeducational report in many ways, but it did not use headings per se. These are intriguing results in that they hint that length may be overrated as a problem in report writing and that teachers may prefer a question-and-answer report format. This finding is interesting because this format is rarely used in reports from clinical assessments. In a follow-up study with parents using the same methodology, Wiener and Kohler (1986) found that teachers and parents have similar preferences. An interesting additional finding was that parents with a college education comprehended reports better than parents with only a high school diploma. Parents also tended to prefer the question-and-answer format to the other two formats, although the difference in preference scores between the psychoeducational and question-and-answer reports failed to reach statistical significance. The results of these two studies suggest that the two most frequent consumers of child and adolescent psychological reports, parents and teachers, consider the clarity of reports to be more important than their absolute length. They also show a preference for reports that have referral questions as their focus. Cognizance of these two findings may benefit psychologists who write reports for children and adolescents. Define abbreviations and acronyms Acronyms are part of the idiosyncratic language of psychological assessment. They can greatly facilitate communication among psychologists, but they hinder communication with non-psychologists.
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The examiner may draw such a conclusion despite the fact that she appeared friendly and outgoing when she was observed on the school playground and seemed to arrhythmia life expectancy cheap 50mg atenolol mastercard interact openly with her family members arrhythmia heart murmur generic 100 mg atenolol overnight delivery. This client may not hypertension blood pressure discount 50 mg atenolol overnight delivery, in fact, be pathologically shy; rather, she may be adhering to a prohibition against making eye contact with a male because of cultural values that suggest that this is a sexually seductive behavior (or an indication of a lack of respect) that is deemed inappropriate for her (Hasegawa, 1989). The clinician, however, must also remember the importance of individualizing interpretation. It may be assumed by some that Vietnamese and Chinese children have similar values due to early Chinese domination and the inculcation of Vietnamese culture with Confucian ethics. Classifying children by race, culture, or language background is an appealing approach for researchers and clinicians alike that is fraught with errors, primarily due to the tendency to overgeneralize a particular group of people (Zuckerman, 1990). Inclan and Herron (1985) cite the "culture of poverty" as another subculture that may affect a variety of groups. This "culture" is formed by a clash between those who have achieved material wealth and prosperity and those who struggle to achieve economic parity with little hope of doing so. Children reared in a culture of poverty possess identifiable characteristics: an orientation to present time, inability to delay gratification, impulsivity, sense of predetermined fate, resentment of authority, alienation and distrust of others, and lack of emphasis on rigor, discipline, and perseverance (Inclan & Herron, 1989). They note that some impoverished parents of adolescents may be assessed by a therapist as being too rigid and controlling their youngsters at a time when parents should be giving their children more freedom. It is possible, however, that poor parents may be all too familiar with the culture of poverty and may be seeking control, not for its own sake, but rather to ensure that their child or adolescent does not fall prey to the negative consequences of the behavior associated with that culture (Inclan & Herron, 1989). These examples demonstrate the need for clinicians to develop an enlarged knowledge base in order to deal effectively with their referral population. Just as clinicians need to have knowledge of behavioral principles, psychometrics, child development, child psychopathology, and physiological psychology to conduct an evaluation competently, it is increasingly clear that they must know the history, culture, and language of their community extremely well in order to not use assessment procedures inappropriately, and to avoid making naпve and inappropriate interpretations. Guidelines for Assessing Children from Diverse Backgrounds Resources for assessing children from diverse groups are now more readily available. Numerous sets of guidelines provide specific advice for the psychologist who is unsure of what procedures to use in questionable situations. The Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations give specific and helpful advice to the clinician seeking to carry out a competent evaluation of a child for whom cultural/social/linguistic issues loom large (see A good example of the guidance to be gained from such publications deals with the frequently occurring situation of a language difference between the examiner and the child or other family members. Moreover, the next guideline, 6b, highlights the potential threat to validity of using a translator who has a dual relationship with the client. There are, however, more formal (some are quantifiable) methods for assessing acculturation. In fact, it has been argued that the ready availability of such measures warrants their routine use in assessment practice (Geisinger, 1992). Marin (1992) defines the constructs relevant to assessing ethnic identity and acculturation. He cites three components of ethnic identity: (1) "birth and gestational history, (2) culture-specific behaviors and practices. Several instruments are now available for assessing the ethnic identification of individuals and the degree to which acculturation has taken place. Dana (1993) provides a detailed compendium of measures of acculturation and identification with a particular culture. The guidelines indicate the need to collect information, such as the number of generations of residence within the dominant culture, number of years of residence, dominant language fluency, community resources, and so on. Conclusions the child psychologist of today has to become steeped in various ethical, legal, professional, language and cultural issues, and standards of practice that face the profession. It is necessary for the practitioner to seek this knowledge through experiences during graduate school and beyond. Continuous professional development is especially important in order to achieve fairness in the assessment process. Knowledge of cultural, linguistic, technology change, and other effects on assessment remains in its infancy, thus portending considerable change in the future. While psychometric evidence of content-, construct-, or criterion-related validity test bias can be found, little compelling evidence of bias is found for various groups residing in the United States. As a result, the focus has now changed to implicate test misuse as the major contributing factor in improper assessment of children. The renewed focus on test use comes at a time when psychologists are seeking to improve test use for various cultural and linguistic groups. The emic perspective refers to behavior that is thought to be specific to a culture, whereas the etic perceptive presupposes the behavior theory and laws of psychology that are applicable crossculturally. The Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations give specific and helpful advice to the clinician seeking to carry out a competent evaluation of a child for whom cultural/ social linguistic issues provide threats to test validity. Evaluation, diagnosis, or intervention in a professional context, competence C h a p t e r 5 Planning the Evaluation and Rapport Building Chapter Questions l l l l l l l Why is it important to carefully plan an evaluation? What are some of the important considerations in determining whether or not a child should be tested and who should do the testing? What is rapport and why is it more difficult to develop in the clinical assessment of children and adolescents than in many other clinical endeavors? What are some of the important strategies that can aid in developing rapport with children and adolescents? Non-specifics in Clinical Assessment A recurrent theme in this text is that an assessor needs to have knowledge of several areas of basic research to appropriately select and interpret psychological tests for children and adolescents. In this chapter, we consider another area of competence crucial to clinical assessment that goes beyond knowing how to administer specific tests. It is rather difficult to discuss this competence in objective terms because it relates to difficult topics for research and, as a result, there is only limited objective data to guide this practice. Instead, much in this chapter is guided by clinical experience, not just our own experience, but the experience of other practicing 81 P. Many of the issues discussed involve clinical skills that are difficult to teach, but often require refinement based on practical experience in testing children and adolescents. Many useful guides for practicing clinicians have been published that deal with the non-specifics of psychotherapy. In this chapter, we attempt to deal with the non-specifics in the clinical assessment of children and adolescents. One critical component of setting an appropriate context for an evaluation is careful planning. In the following section, we discuss a basic framework for designing clinical assessments for children and adolescents. Within this basic framework, however, evaluations must be tailored to the needs of the individual case. As a result, it is inappropriate to develop specific guidelines for designing evaluations. Instead, in this section we attempt to provide a framework for designing assessments that can be tailored to most assessment situations.
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However heart attack 25 cheap atenolol 50 mg mastercard, accessibility and functionality of health facilities remain key bottlenecks to prehypertension risk factors order atenolol without a prescription effective service delivery enrique iglesias heart attack buy discount atenolol 100mg line. A 2014/2015 health facility assessment found that nearly half of all health facilities struggled without a primary power source, 43% did not have working incinerators, and 13% did not have access to a safe water source. Additionally, an average of 41% of health care workers deployed and actively working at public health facilities were not on the government payroll in 2015. This has resulted in a large proportion of health workers in the country not receiving consistent pay for their employment. Between 2010 and 2015, the country witnessed a 37% increase in the number of health care workers (a 30% increase in physicians and a 5060% increase in physician assistants, nurses, and midwives as a combined group). In 2015, the number of health professionals (inclusive of the aforementioned four categories) had reached 8. Community-based services are vital to the health of populations living in these communities. Those communities within five kilometers of a health facility would continue to access services at the nearest health facility. The Community Health Services Division at the central level in Monrovia is responsible for coordinating the management, implementation, and monitoring of the program and related standard operating policies and procedures. The Community Health Services Division conducts monthly coordination meetings with partners and programs implementing at the community level via a national-level steering committee. This committee serves as a multidisciplinary group of government and partner stakeholders who provide strategic guidance, technical expertise, and support on activities relating to the implementation of community health services in the country. During these meetings, stakeholders come together to review and plan against various aspects of ongoing programmatic rollout, with the goal of shared regional learning to inform future programming iteration and build institutional knowledge systems. Findings from these meetings are synthesized into action plans to advance at the national and subnational levels. Finally, this fourth module of training includes basic first aid skills for responding to common injuries when patients cannot be transferred easily to a health facility. Following the finalization or the recruitment process across the country in 2016 and 2017, most were male. These candidates were then interviewed and given a literacy test assessing basic arithmetic and reading comprehension skills. Meeting this criterion proved to be more challenging than anticipated due to a shortage of trained health workers, particularly in the most remote settings. In such circumstances, public health school graduates were recruited to fill the remaining positions. It began by recruiting master trainers who have strong facilitation skills and knowledge of community health service delivery. The use of adult learning techniques, including education through listening, is emphasized throughout the curriculum. An important facet of this program, especially in the early stages of its implementation, is the joint supportive supervision encouraged by the central level to take place in the counties with participation of the District Health Team, Community Health Focal Person, and partners (as is relevant). Supervision at the health facility is conducted to ensure the provision of quality care at all levels and the referral of patients to a functioning health facility. Central-level Community Health Service Division staff conduct quarterly supportive supervision to the County Health Team to provide coaching to County Health Team staff. A standardized data collection platform analyzes supervision visit data from central and county levels to inform quality program implementation. For this reason, a key selection criterion is that the individuals must come from and reside in the communities they serve. They meet monthly at the health facility to discuss community health activities and facilitate strong links between the health facility and the catchment area communities. Across Liberia, there are varying levels of formation and activation of community structures. This is signed by the County Health Officer and the Community Health Department Director. Additional formal recognition is provided in the form of photo identification cards with a unique identification number, signifying their formal role within the public health system. The Community Health Services Division is expected to conduct monthly coordination meetings with community-level partners and implementers in which programmatic outputs and trends are discussed in order to implement targeted improvements. Participatory review is conducted on a national level during quarterly and annual review meetings, as described further in the Governance section. Note that ongoing revisions to cost estimates are being undertaken to reflect estimates based on ongoing analyses of implementation expenses. Moreover, these estimates reflect only the direct implementation costs of the program and for the most part do not include many components of central or county-level technical assistance, or any additional technical assistance investments to be identified as the program evolves. Data quality assurance measures are being introduced to ensure accuracy of treatment, reporting, and data entry. This resulted in staggered implementation of the program among the counties, and in some counties having fewer than six months of complete implementation before funding and management of the program was fully turned over from partners to the County Health Teams. Moreover, a medium-term strategy that considers both donor and domestic resources may be critical for keeping the external assistance in play. Efforts are also being made to identify champions and create coalitions across the Government of Liberia to advocate both domestically and internationally for ongoing stable financial support. Comprehensive Mapping of Community Health Volunteers and Community Health Structures in All Health Districts of Liberia. Monrovia, Liberia: Ministry of Health and Social Welfare, Government of Liberia 2013. Psychosocial effects of an Ebola outbreak at individual, community and international levels. Road Map for Accelerating the Reduction of Maternal and Newborn Morbidity and Mortality in Liberia. Monrovia, Liberia: Ministry of Health and Social Welfare, Government of Liberia 2015. Paying and investing in last-mile community health workers accelerates universal health coverage. The country has the fourth highest prevalence rate of chronic malnutrition in the world. The insufficient number of health professionals, their maldistribution, and the shortage of facilities result in limited and unequal access to health and nutrition services. Roles/responsibilities Both cadres take part in the promotion of health of the community and in the prevention and treatment of diseases and conditions. Impact Madagascar has made modest gains in maternal, neonatal, and child health and nutrition, and progress has been slow and stagnant at times. With a surface area of 587,047 square kilometers, it extends 1,500 kilometers from north to south and reaches a width of 500 kilometers from east to west. The country stands out for its diversity of fauna and flora, its landscapes and its cultural values as well as for its significant development potential in the sectors of agriculture, natural resources (mining, oil, and forestry) and tourism.