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We also know that Pam must be heterozygous since she has a son Phillip with color blindness medications you can take while pregnant cheap benazepril master card. Since the male child receives the Y chromosome from his father symptoms thyroid cancer buy online benazepril, male individuals inherit the recessive allele for color blindness from their mother since the allele is on the X chromosome and the male individual receives the X chromosome from his mother medicine grace potter generic 10mg benazepril. Because males have only one locus, the terms homozygous and heterozygous lack meaning for describing their sexlinked genes (the term hemizygous is used in such cases). However, even though the chance of a female inheriting a double dose of the mutant allele is much less than the probability of a male inheriting a single dose, there are females with sex-linked disorders. A color-blind daughter may be born to a color-blind father whose mate is a carrier. However, because the sex-linked allele for color blindness is relatively rare, the probability that such a man and woman will mate is low. Normally, only females can have both alleles, because only they have two X chromosomes. Orange patches are formed by populations of cells in which the X chromosome with the orange allele is active; black patches have cells in which the X chromosome with the black allele is active. A normal human gamete is a haploid cell so there should be only 22 chromosomes present in the normal human gamete. Since the somatic cell is normal, there should be one pair of sex chromosomes and 22 pair of autosomes in this somatic cell. Since the human male determines the sex of the individual, the sperm could either contain an X chromosome or it could contain the y chromosome. In these cases, one gamete receives two of the same type of chromosome and another gamete receives no copy (see figure below). If either of the aberrant gametes unites with a normal one at fertilization, the offspring will have an abnormal number of a particular chromosome, a condition known as aneuploidy. If a chromosome is missing (so that the cell has 2n - 1 chromosomes), the aneuploid cell is monosomic for that chromosome. If the organism survives, it usually has a set of symptoms caused by the abnormal dose of the genes associated with the extra or missing chromosome. If such an error takes place early in embryonic development, then the aneuploid condition is passed along by mitosis to a large number of cells and is likely to have a substantial effect on the organism. Because the cells are trisomic for chromosome 21, Down syndrome is often called trisomy 21. Down syndrome includes characteristic facial features, short stature, heart defects, susceptibility to respiratory infection, and mental retardation. Although people with Down syndrome, on average, have a life span shorter than normal, some live to middle age or beyond. Most of these conditions appear to upset genetic balance less than aneuploid conditions involving autosomes. This may be because the Y chromosome carries relatively few genes and because extra copies of the X chromosome become inactivated as Barr bodies in somatic cells. People with this disorder, called Klinefelter syndrome, have male sex organs, but the testes are abnormally small and the man is sterile. Even though the extra X is inactivated, some breast enlargement and other female body characteristics are common. Monosomy X, called Turner syndrome, occurs about once in every 5,000 births and is the only known viable monosomy in humans. Although these X0 individuals are phenotypically female, they are sterile because their sex organs do not mature. When provided with estrogen replacement therapy, girls with Turner syndrome do develop secondary sex characteristics. X-Y system "In mammals, the sex of an offspring depends on whether the sperm contains an X chromosome or a Y. X-O System "In grasshoppers, roaches and some other insects, there is only one type of sex chromosome, the X. Sex of the offspring is determined by whether the sperm has an x chromosome or no sex chromosome. Z-W System "In birds, some fishes and some insects, the sex chromosome present in the ovum (not the sperm) determines the sex of offspring. Haplo-diploid system "There are no sex chromosomes in most species of bees and ants. Chromosomal Rearrangements Do chromosomal rearrangements always lead to cytogenetic disorders? All of the F2 progeny showed a phenotype that was intermediate between the two parental (P) phenotypes. Half of the F1 progeny had the same phenotype as one of the parental (P) plants, and the other half had the same phenotype as the other parent. All of the F1 progeny resembled one of the parental (P) plants, but only some of the F2 progeny did. A monohybrid cross involves a single parent, whereas a dihybrid cross involves two parents. A monohybrid cross produces a single progeny, whereas a dihybrid cross produces two progeny. A monohybrid cross involves organisms that are heterozygous for a single character, whereas a dihybrid cross involves organisms that are heterozygous for two characters. A monohybrid cross is performed only once, whereas a dihybrid cross is performed twice. A monohybrid cross results in a 9:3:3:1 ratio whereas a dihybrid cross gives a 3:1 ratio. A cross between homozygous purple-flowered and homozygous white-flowered pea plants results in offspring with purple flowers. What was the most significant conclusion that Gregor Mendel drew from his experiments with pea plants? What is genetic cross between an individual showing a dominant phenotype (but of unknown genotype) and a homozygous recessive individual called? Two plants are crossed, resulting in offspring with a 3:1 ratio for a particular trait. Two characters that appear in a 9:3:3:1 ratio in the F2 generation should have which of the following properties? It was important that Mendel examined not just the F1 generation in his breeding experiments, but the F2 generation as well, because a. When crossing a homozygous recessive with a heterozygote, what is the chance of getting an offspring with the homozygous recessive phenotype?
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Also symptoms tracker cheap 10 mg benazepril with amex, because conduct disorder is associated with family disorganisation medications in checked baggage buy discount benazepril, parental criminality and parental psychological adjustment difficulties treatment mastitis order benazepril, professionals from adult mental health and justice systems may be involved. Aetiological theories Since the distinction between oppositional defiant disorder and conduct disorder is a relatively recent development, most theories in this area have been developed with specific reference to conduct disorder but have obvious implications for oppositional defiant disorder, which is probably a developmental precursor of conduct disorder in many cases. Some of the more influential theories about the aetiology of conduct disorder are listed in Table 10. Biological theories Biological theories have focused on the roles of genetic factors, hormonal factors, arousal levels and neuropsychological deficits in the aetiology of conduct problems. Genetic theory There are many lines of research which focus on genetic and constitutional aspects of children with conduct disorder, and these are guided by the hypothesis that biological factors underpin antisocial behaviour in youths. Arousal theory Children with conduct disorders have lower arousal levels than normal children, according to this theory, and so are less responsive to rewards and punishments (Raine, 1988). They have an impaired capacity for responding to the positive reinforcement that often follows prosocial behaviour or for avoiding punishments associated with antisocial behaviour. It is assumed that this abnormally low arousal level is inherited, and the results of twin studies partially support this (Kazdin, 1995). Treatment based on this hypothesis must involve highly structured and intensive learning situations if social rules are to be learned. Rule following should be immediately and intensely rewarded on a variable interval schedule, since this leads to learning that is maximally resistant to extinction. These treatment implications of arousal theory have been incorporated into the design of residential token economies for delinquent adolescents; behavioural parent training programmes; school-based behavioural programmes; and treatment foster care (Patterson, 1982; Chamberlain, 1994; Patterson et al. Neuropsychological deficit theory Neuropsychologically based deficits in verbal reasoning and executive functioning, according to this position, underpin self-regulation difficulties that contribute to conduct problems. They may also lead to underachievement, which leads to frustration, and this contributes to aggressive behaviour. This position is supported by a substantial body of evidence that documents verbal reasoning and executive function deficits in children and teenagers with conduct problems, by studies that confirm a strong association between reading difficulties and conduct problems, and by studies that show that unsocialised conduct problems are associated with self-regulation problems (Moffit, 1993; Shapiro and Hynd, 1995). Remedial interventions that facilitate the development of language and academic skills are the principal types of treatment deriving from this theory. Psychodynamic theories Classical psychoanalytic theory points to superego deficits and object relations theorists highlight the role of disrupted attachments in the development of conduct problems. Superego deficit theory Aichorn (1935) argued that antisocial behaviour occurs because of impoverished superego functioning. The problems with superego functioning were thought to arise from either overindulgent parenting on the one hand or punitive and neglectful parenting on the other. With overindulgent parenting, the child internalises lax standards and so feels no guilt when breaking rules or behaving immorally. In such cases any apparently moral behaviour is a manipulative attempt to gratify some desire. With punitive or neglectful parenting, the child splits the experience of the parent into the good, caring parent and the bad, punitive/neglectful parent and internalises both of these aspects of the parent quite separately, with little integration. In dealing with parents, peers and authority figures, the child may be guided by either the internalisation of the good parent or the internalisation of the bad parent. Typically at any point in time such youngsters can clearly identify those members of their network who fall into the good and bad categories. Residential group-based milieu therapy, where staff consistently and compassionately enforce rules of conduct which reflect societal standards, is the principal treatment to evolve from this theoretical perspective. Within such a treatment programme children gradually internalise societal rules, integrate the good and bad parental introjects, and develop a more adequate superego. While there is little evidence for the effectiveness of psychoanalytically based treatment for conduct disorders (Kazdin, 1995), it has provided important insights into the impact of working with such youngsters on the dynamics within multidisciplinary teams. For example, in my clinical experience, conduct-disordered youngsters who have internalised good and bad parental representations into the superego typically project good parental qualities onto one faction of the multidisciplinary team (typically the least powerful) and bad parental qualities onto the other team members (typically the most powerful). These projections elicit strong counter-transference reactions in team members, with those receiving good projections experiencing positive feeling towards the youngster and those receiving bad projections experiencing negative feelings towards the youngster. Inevitably this leads to team conflict, which can be destructive to team functioning if not interpreted, understood and worked through. Attachment theory Bowlby (1944) pointed out that children who were separated from their primary care takers for extended periods of time during their first months of life failed to develop secure attachments and so, in later life, did not have internal working models for secure, trusting relationships. Since moral behaviour is premised on functional internal working models of how to conduct oneself in trusting relationships, such children behave immorally. Treatment according to this position should aim to provide the child with a secure attachment relationship or corrective emotional experience, which will lead to the development of appropriate internal working models. While the provision of a secure attachment experience within the context of out-patient weekly individual therapy is an ineffective treatment for children with conduct disorder, a secure attachment relationship is a central treatment component in some effective interventions, such as treatment foster care (Chamberlain, 1994). Here, the foster parents provide the child with a secure attachment experience and couple this with good behavioural management. Cognitive theories Problems with social information processing and social skills deficits are the principal factors highlighted in cognitive theories of conduct problems. Children with conduct disorders attribute hostile intentions to others in social situations where the intentions of others are ambiguous. The aggressive behaviour of children with conduct disorders in such situations is, therefore, intended to be retaliatory. The aggression is viewed as unjustified by those against whom it is directed, and this leads to impaired peer relationships. The reactions of peers to such apparently unjustified aggression provides confirmation for the aggressive child that his peers have hostile intentions, which justifies further retaliatory aggression. Social skills deficit theory A second line of research highlights the social skills deficits of children with conduct disorders (Spivack and Shure, 1982). These children lack the skills to generate alternative solutions to social problems, such as dealing with an apparently hostile peer. They also lack the skills to implement solutions to social problems such as these. There is a small but growing body of data which shows that group-based social problemsolving skills training is an effective component of broad multisystemic intervention packages for delinquent adolescents (Kazdin, 1995; Chamberlain, 1994). Social learning theories Modelling and coercive family processes have been identified by social learning theory as central to the development and maintenance of conduct problems. Modelling theory Bandura and Walters (1959) have taken the position that aggression, characteristic of children with conduct disorders, is learned through a process of imitation or modelling. In some instances it may be the behaviour displayed by the parents that the child imitates. It is this aggression and neglectful hostility that aggressive children are imitating. This position is supported by a large body of evidence, particularly that which points to the intrafamilial transmission of aggressive behaviour (Kazdin, 1995).
- Whether surgery is an option
- Adults: 150 to 310
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- Soaking of the wound
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- Parathyroid biopsy
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Cilia E Cilia Digestive tract Hairlike cilia are located on the ventral surface of planarians medicine ketorolac purchase benazepril 10 mg on line. Some adult tapeworms that live in animal intestines can be more than 10 m in length and consist of 2000 proglottids medications 4h2 benazepril 10 mg discount. A fluke is a parasitic flatworm that spends part of its life in the internal organs of a vertebrate symptoms joint pain and tiredness purchase benazepril with visa, such as a human. For example, blood flukes of the genus Schistosoma cause a disease in humans known as schistosomiasis. False A Adult flukes are about 1 cm long and the Life Cycle of the Fluke live in the veins of the human digestive tract. Fluke embryos that are encased in a protective capsule pass out of the body with human wastes. Fertilization occurs and embryos pass out of the intestine and the cycle can begin again. Human host Larva B Free-swimming larvae develop from embryos and enter their snail hosts. After you read this section, list one disease from this section that can be prevented by frequent hand washing. Roundworms move in a thrashing fashion due to the alternating contraction and relaxation of the muscles. Roundworms have a pseudocoelom, a fluid-filled body cavity partly lined with mesoderm. Make Flash Cards For each page, think of two questions a teacher might ask on a test. Infer Why are children more likely than adults to be infected by certain types of roundworms? There are about 1200 species of nematodes (roundworm parasites) that cause disease in plants. They are particularly attracted to plant roots, causing a slow decline of the plant. Instead of using chemical pesticides, nematodes can be introduced to kill weevils that damage plants. Pinworms are highly contagious because eggs can survive on surfaces up to two weeks. The roundworm enters through the mouth if an individual eats infected pork or wild game that is raw or undercooked. Hookworm infections are common in humans in warm climates where they walk on contaminated soil in bare feet. Use the term in a sentence that explains how a person might contract this disease. What questions do you have about the movement and body systems of these two animals? Snails, slugs, squid, octopuses, and some other animals that live in shells either in the ocean or on the beach are mollusks. Members of the phylum Mollusca, or mollusks, include both slow-moving slugs and fast, jet-propelled squid. Some mollusks, including oysters, live most of their lives attached to the ocean floor. All mollusks have bilateral symmetry, a coelom, a digestive tract with two openings, a muscular foot, and a mantle. A coelom is a fluid-filled body cavity that is completely surrounded by the mesoderm. Compare and Contrast As you read this section, use one color to highlight the ways in which all mollusks are the same. Compare the similarities and differences in the structures of a snail and a squid. For most mollusks that live in water, eggs and sperm are released at the same time. Hermaphrodites are plants or animals that have both female and male reproductive organs. Many gastropods, the largest class of mollusks, produce both eggs and sperm, and fertilization takes place within the animal. Most of these larvae will swim freely in the water until they settle down on the ocean floor. The eyes can range from simple cups that detect light to complex eyes with irises, pupils, and retinas. What is the difference between an open circulatory system and a closed circulatory system? They are a system of tiny strands that contain a rich supply of blood for transporting gases. In snails and slugs that live on land, the mantle cavity appears to have become a primitive lung. Wastes pass from the coelom into the mantle cavity and are expelled from the body by the pumping of the gills. Mollusks have well-developed circulatory systems that include either a two- or three-chambered heart. In an open circulatory system, blood moves through vessels and into open spaces around the body organs. In an open circulatory system, body organs are directly exposed to blood that contains nutrients and oxygen. In a closed circulatory system, blood moves through the body, but the blood is entirely enclosed in the blood vessels. Three classes, Gastropoda, Bivalvia, and Cephalopoda include the most common and the best-known species. Most gastropods, such as snails, abalones, conches, periwinkles, whelks, limpets, cowries, and cones have a shell. When these sea slugs feed on jellyfish, the poisonous nematocysts of the jellyfish are taken into the tissues of the sea slug. When a fish tries to eat the sea slug, the nematocysts are discharged into the predator and the predator is repelled.
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There are truly touching stories of people who have forgiven someone who committed horrible crimes or brutal abuse against them symptoms stiff neck purchase line benazepril. There are people who have been unfaithful and symptoms endometriosis order benazepril australia, in that way medicine 7253 cheap 10mg benazepril with visa, devastated their spouse, alienated their children and disrupted the entire family; yet they were forgiven (not usually, but sometimes). There are many cases where someone lost control and killed a child, a parent, or a loved one; and yet the family may forgive them. There are so many atrocities in war-loss of limbs, blindness, brain damage, post-traumatic stress disorders-and often the veteran forgives his/her government that sent him/her to war and may even forgive the enemy. Some people irresponsibly cause horrible things to happen in crimes and in accidents, such as drunk driving, but some of these people are forgiven. There is a wonderful mythical law of nature that the three things we crave most in life -happiness, freedom, and peace of mind - are always attained by giving them to someone else. They learn to control their fantasies of retaliation and their nightmarish visions of the awful events to the extent that their emotions do not dominate their lives. Still there are many people who carry bitter hatred against the person or organization that hurt them or their loved one for the rest of their lives. That is a great emotional burden that usually brings with it depression, stress, other mental disorders and often various physical ailments (high blood pressure, heart disease, and poor general health). People who can not forgive often can hardly accept any solution other than continued punishment for life. There has been increasing interest in studying forgiveness during the last decade or two. Fifteen to twenty new self-help and pop psychology books about forgiving have appeared in bookstores in the last 10 years. Science journals have published over 1,200 articles since 1997, mostly about the health benefits of reducing stress by psychological techniques, including forgiveness. When we have to deal with conflicts or anger and have to wrestle with moral dilemmas, we are probably prone to think more about forgiveness. There have been several major world conflicts with other countries in the last 50 years. For example, there have been very controversial wars, heavy casualties have been suffered, ethnic conflicts keep reoccurring, suicidal bombers are hard to understand and disturbing, countries using torture and 146 attempting genocide are appalling, etc. Such issues and religion-based terrorism raise ethical questions about how to make peace and to deal with the perpetrators. There is a rising interest in psychology and the fantastic technology that enables scientists to see the brain at work. Two or three groups of psychologists are researching ways to facilitate forgiveness. Techniques for facilitating forgiveness Wade and Worthington (2005) have done a remarkable review of the two most common treatment procedures for helping a patient forgive a person who has hurt them. Most of the research used by these authors involved treatment in groups but the techniques used are similar to what most individual therapists would recommend to their clients for reducing anger and grudges. The group treatments were several weeks long and consisted of 20 or so exercises or techniques. Many of the methods were developed or revised by two groups of psychologists headed by Enright and Fitzgibbons (2000) and Worthington (2001). Although the two groups take a somewhat different approach, their groups do rather similar things. Also, your feelings-fears, rage, resentment of what was happening-and how appropriate you think your feelings were. Understand how they saw the situation, their motivations and feelings, and try to understand them in light of their history and see them as an ordinary human as much as possible. Encouraging the victim to remember times in their lives when they may have hurt someone. Note any similarity between how they were hurt and how they had hurt someone else. If you are willing to do so at this point, make a commitment to trying to forgive them. Replace "you-were-awful" thoughts with stories of people who weathered hard times and forgave the people who were mean to them. This extensive meta-analysis of several possible steps in forgiving (as described above) generally provides moderate empirical support for using these methods to help people forgive. While clinicians have several such procedures that might help forgivers, very little research has been done comparing specific methods for specific hurts. Likewise, little is known yet about which methods of teaching these self-help skills work best. Nor do we know the characteristics of therapists who are best suited 147 for this kind of therapy. Nor has the science been done to determine the characteristics of the better forgivers or which kinds of offenses are easiest or hardest to forgive. These questions could be answered if there were enough support for the needed studies. Fortunately, some controversy is building among researchers in this area (this is fortunate because disagreements among scientists increase the amount of research that is done in the area). The person who inflicted the hurt does not even need to know that anyone is trying to or has forgiven him or her. The forgiver benefits from great relief of physical stress and from gaining mental comfort. So, the process is highly rewarding to the forgiver, regardless of whether the relationship survives or not. The strongest arguments for involving the offender or the abuser, at least in certain violent circumstances, have been made by Dr. This commission wanted to get the perpetrators, including the notorious police death squads led by Eugene de Kock, and the black victims to understand each other better. Gobodo-Madikizela found that the black citizens were unable to relate to the police officers. She believed that it was natural for victims of oppression to hold on to their intense anger in order to distance themselves from the people who had hurt them and other blacks. They were reluctant to see the officers as understandable real people until psychologists, like Dr. Gobodo-Madikizela, were able to get some of the South African police to apologize and show remorse for what they had done. Commander Eugene de Kock, himself, was one of many police who confessed to horrible acts and appeared to be truly remorseful. As the blacks saw the police break down their own emotional walls and express feelings of sorrow, regrets, and shame, the blacks were able to see the officers as real human beings, rather than arrogant, evil monsters. Then as they talked to each other and shared more about the history of the police perpetrators, their family backgrounds, their police training and indoctrination, the complex process in which prejudice and violent attitudes develop, gradually the police looked less evil. If the abused person can also start to see some of his/her own wrong-doings and selfish-angry urges, then the perpetrator becomes even more like a fallible human being-more like the victim. But, of course, the memories of the fears, threats, and the dead relatives will never go away. So the South African Truth and Reconciliation Commission approach (involving both the offender and the victim) may frequently fail to work well.
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It is important to treatment jones fracture cheap benazepril 10mg mastercard highlight this crucial contextual difference medications quinapril benazepril 10 mg lowest price, when inviting parents and children to symptoms ptsd benazepril 10mg embark, once again, on a programme which they view as having been ineffective. From a psychological perspective, both nocturnal and diurnal enuresis may be most effectively treated with programmes that have an enuresis alarm as their central component (Kaplan and Busner, 1993). If the child wets the bed the dampness of the sheet closes a circuit of wires in the pad and the alarm sounds. By a process of conditioning, after a number of trials, the child comes to associate the desire to void the bladder with the process of awakening. For diurnal enuresis, a mini-pad is placed in the underwear and a small vibrating alarm is discreetly placed under the clothing in contact with the skin. If the child begins to urinate, the circuit in the pad is closed and the vibrating alarm alerts the child to the necessity to use the bathroom. By a process of conditioning, the desire to urinate comes to be associated with the wish to visit the bathroom. Treatment failures are due to using an alarm that is not loud enough to awake the child fully; not supervising children urinating in the bathroom following waking; and not persisting with the programme for long enough. The average relapse rate for treatment with an enuresis alarm is about 40 per cent. About 68 per cent of these relapsers can be successfully re-treated (Kaplan and Busner, 1993). Demoralisation following relapse may prevent parents from re-treating their children using the enuresis alarm following treatment. A variety of strategies has been incorporated into pad-and-bell programmes to decrease the relapse rate to around 20 per cent (Kaplan and Busner, 1993; Barclay and Houts, 1995; Azrin et al. Psychoeducation the central feature of psychoeducation is that the parents and child must be helped to view the enuresis as a developmental delay: a failure to learn a set of habits due to a delay in the development of the neural pathways that govern bladder control. Pointing out that relapses are inevitable is important, since it pre-empts relapse-related demoralisation. Rehearsal With rehearsal of toileting, an hour before retiring the child lies on the bed, counts to 50, walks to the toilet, attempts to urinate and returns to bed. This routine is conducted on the first night of treatment and throughout treatment after each episode of wetting, once the sheets have been changed. Cleanliness training and reward systems Cleanliness training aims to increase the probability that children will avoid bed wetting by reinforcing bladder control and requiring children to take responsibility for managing the consequences of wetting their beds. With cleanliness training, children are required to change their sheets and pyjamas following each episode of wetting. Retention control training Retention control training aims to help children increase functional bladder capacity while awake, and this in turn is expected to reduce the probability of bed wetting. With retention control training, at a pre-set time each day the child is given fluid to drink and asked to tell the parent when he wishes to urinate. At this point he is asked to delay urination for three minutes and the next time for six minutes and so on until he can delay for 45 minutes. Overlearning Overlearning aims to help children increase functional bladder capacity while asleep. With Overlearning, after 14 consecutive dry nights the child is given 4 ounces of water to drink 15 minutes before bedtime each night. If the child remains dry for two more consecutive nights the amount is increased to 8 ounces, and so on until the child consumes the number of ounces obtained by adding two to her age in years. So a 6-year-old would be required to drink 8 ounces, which is the average normal bladder capacity for a 6-year-old. If a wet bed occurs, the amount of water consumed is reduced by 2 ounces, and then the child gradually increases the amount taken each night by 2 ounces once two consecutive dry nights are achieved. With dry bed training, an intensive programme of training occurs on the first night. Following this, the child drinks fluids and sleeps with the pad and bell situated so that a parent or professional (if the treatment is conducted under professional supervision) can awake when the child wets the bed. The child is taken to the bathroom and asked if she can refrain from urinating for one more hour. If the child wets the bed, the parent or professional awakened by the alarm supervises the child changing sheets and pyjamas, and 20 trials of rehearsal of toileting, before returning to sleep. Following this night of intensive training, on subsequent nights the child is only woken once per night and no additional fluids are given. On the second night the parents wake the child after two hours and ask her to urinate. Each night the waking time is advanced by 30 minutes if and only if the bed is dry. Typically treatment for nocturnal enuresis spans 12 weeks for children who wet once per night and up to 16 weeks for those who wet more than once per night (Houts and Mellon, 1989). Parents either alone or with their children usually attend a series of 10 training and monitoring sessions, with sessions being spaced further apart as treatment progresses. However, in a proportion of cases less intensive contact may lead to good results, as long as adequate support materials are provided. Hunt and Adams (1989) showed that parents given well-designed home treatment manuals and a demonstration video pack required less than two and a half hours of professional input and their children made gains comparable to those of more intensive behavioural programmes. Treatment of encopresis Reviews of treatment outcome studies show that joint paediatric and psychological treatment programmes can lead to recovery for up to 77 per cent of children (Buchanan, 1992). Treatment should be tailored to target significant predisposing or maintaining factors identified in the formulation. Psychoeducation With psychoeducation parents and children must be helped to view the encopresis as a developmental delay or an understandable physical problem. This process is more complex for encopresis than for enuresis, since a variety of mechanisms contribute to the problem. These neural pathways may be likened to telephone lines for explanatory purposes, and it may be explained that some children soil because they are not getting the message that they need to defecate. Such neural problems may occur as a result of a specific medical condition; a specific developmental delay; or as part of a more general developmental delay. Second, if a child has a large rectum, it can hold many stools and when this occurs the rectum grows larger and develops strong walls. Third, if laxatives are given to treat such chronic constipation, some loosening of the edges of the faecal mass may occur, and this may seep out through the anus unnoticed because the anus may have become insensitive to sensations arising from soft stools, due to the prolonged presence of the large faecal mass. Fourth, when eventually some large hard faeces are passed, considerable pain may be experienced and in the worst cases an anal fissure develops. This leads to avoidance of defecation, since defecation precipitates immediate and intense pain.
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Preexisting cardiovascular disease and conditions such as asthma and cystic fibrosis are encountered more commonly because of modern medical management that has allowed more women thaninthepasttoconsiderpregnancy medications post mi cheap benazepril 10 mg with visa. Asageneralrule symptoms e coli 10mg benazepril with amex, mostpregnanciescomplicatedbythesemedicalconditions are considered "high risk" for maternal and fetal morbidity and mortality symptoms 97 jeep 40 oxygen sensor failure order on line benazepril. Good outcomes often require frequent maternal and fetal assessment and the ability torespondinatimelyfashiontochangesintheclinical statusofeitherthemotherorherfetus. Elective delivery for medical and surgical conditions is indicated when deteriorating maternal or fetal status occurs in the presence of a term fetus or when there is evidenceoffetallungmaturity. Obstetricians and other providers should focus on the mitigationoftheeffectsandpreventionofmedicalconditions that may complicate pregnancy. The increased prevalenceofobesityinpregnantwomenintheUnited Statesandelsewherehasresultedinmetabolicdysregulation (metabolic syndrome) that increases inflammation and insulin resistance. The risk of some medical disorders, such as diabetes, hypertension, and heart disease,isincreasedduetoexcessivebodyweightduring pregnancy. Physical activity and a healthy diet are very importantbefore,during,andafterpregnancy. Surgical conditions that may complicate pregnancy include appendicitis, cholecystitis and cholelithiasis, acutepancreatitis,bowelobstruction,abdominaltrauma, or torsion of an adnexal structure such as an ovarian tumor. When trauma is evaluated during pregnancy, the possibility of intimate partner abuse must be ruled out, as in women who are not pregnant. Laparoscopyisbecomingmore common during pregnancy, and guidelines have been published that should increase the safety for both the pregnantwomanandherfetus. Mostoftheconditionsdiscussedinthischapterarenot unique to pregnancy and understanding the causes, diagnosis, and management of them is based on the sameprinciplesthatwouldapplyinthenonpregnant woman. Important issues for the management of medical and surgical problems during pregnancy include how the physiologic changes of pregnancy may affect the diagnosis and clinical course of the disease,aswellashow the disease may affect the pregnancy,withparticularattentiontothefetus. The most common medical and surgical disorders that may complicate pregnancy are covered in this chapter. Thissyndromeconsistsofagroupof risk factors for diabetes, coronary heart disease, and stroke that occur together (central obesity, insulin resistance,andhyperlipidemia). Glucose crosses the placenta easily by facilitated diffusion, causing fetal hyperglycemia that stimulates pancreatic -cells, and results in fetal hyperinsulinism. There is a direct correlation between birth defects in diabetic pregnancies and increasing glycosylated hemoglobin A1C (HbA1C) levels in the first trimester. Fetal hyperglycemia and hyperinsulinemia later in pregnancy, especially in the third trimester, cause fetal overgrowth and macrosomia that predispose to birth trauma, including shoulder dystocia and Erb palsy. Fetal demise is most likely due to acidosis, hypotension from osmotic diuresis, or hypoxia from increased metabolism, coupled with inadequate placental oxygen transfer. Pregestationaldiabetesisgenerallyassociatedwith a higher rate of maternal and fetal complications due to the greater difficulty in achieving glycemic control, the higher rate of congenital malformations, andthehigherlikelihoodofvasculardisease. Maternal complications include worsening nephropathy and retinopathy,agreaterincidenceofpretermpreeclampsia, and a higher likelihood of diabetic ketoacidosis. Hypoglycemia is also much more common because of the need for insulin therapy and stricter glycemic control attempted during pregnancy. Fetal complications include an increased rate of abortions, anatomic birth defects, fetal growth restriction, and prematurity. In the United States, rates appear to range from 6-12%, depending on the population studied and the diagnostic criteria used. Overall, 80-90% of diabetes in pregnant women is gestational, and about 10% is pregestational. Rising levels of human placental lactogen, progesterone, prolactin, and cortisol in pregnancy are some of the primary factors associated with progressive insulin resistance during pregnancy. Pregestational diabetes mellitus refers to diabetes present before pregnancy and may be either type 1 or type 2 diabetes. This classification is helpful for assessing disease severity and the likelihood of complications (Table16-1). This timing recognizes the progressive nature of insulin resistance in pregnancy due to rising levels of hormones such as human placental lactogen, and thetestwillidentifymostwomenwithgestationaldiabetes while allowing for several weeks of therapy to reduce potentially adverse consequences. If a first-trimester screen is done and is found to be negative, it should be repeated at 24 to 28 weeks. Caloric intake is divided into 20% at breakfast, 30% at lunch, 30%atdinner,and20%atabedtimesnack. Patientswithdiabetesshouldbeencouraged to engage in mild to moderate aerobic exercise. Managementofgestationalandpre- gestationaldiabetesrequiresateamapproachinvolvingpatienteducationandcounseling,medical-nursing assessments and interventions, strategies to achieve maternaleuglycemia,andavoidanceoffetal-neonatal compromise. Ideally, this team should include the patient,obstetrician,maternal-fetalmedicinespecialist,clinicalnursespecialist,nutritionist,socialworker, andneonatologist. Caloricrequirementsarecalculatedonthebasis usually managed with diet and exercise alone, but if euglycemiacannotbeachieved,anoralhypoglycemic agent (glyburide) or insulin should be added. Glyburide does not appear to enter the fetal circulation in appreciable quantities, and it has been used successfully to treat gestational diabetes after the first trimester. Insulinisthemedicationofchoicetomaintaineuglycemia in pregnancy and is the recommended therapy in women with pregestational diabetes. Antepartum Obstetric Management Aside from achieving euglycemia, adequate surveillanceshouldbemaintainedduringpregnancytodetect and possibly mitigate maternal and fetal complications. Inadditiontoroutineprenatalscreeningtestsfor of ideal body weight: 30kcal/kg for those patients 80-120%ofidealbodyweight,35to40kcal/kgforthose C H A P T E R 16 Common Medical and Surgical Conditions Complicating Pregnancy 205 womenwithpregestationaldiabetes,a detailed obstetric ultrasonic study, fetal echocardiogram, and maternal serum -fetoprotein should be obtained in the second trimester to check for congenital malformations. Thisisespecially important if the first trimester HbA1C is significantly elevated (>8. Abnormalities of fetal growth are most likely to be presentinthethirdtrimesterandcanbeconfirmedby ultrasound. The timing of delivery depends on fetal and maternal status and the degree of glucose control. If the mother is breastfeeding, 500 calories/dayshouldbeaddedtotheprepregnancydiet. Contraception counseling should involve advising the patient that estrogen-containing oral contraceptivesarenotrecommendedforwomenwithadvancedstagediabeteswithvasculardisease. Normal Thyroid Physiology during Pregnancy With the increase in glomerular filtration rate that occursduringpregnancy,therenalexcretionofiodine increasesandplasmainorganiciodinelevelsarenearly halved. Goiters caused by iodine deficiency are not likelyifplasmainorganiciodinelevelsaregreaterthan 0. The estrogen-mediated increaseinthyroid-bindingglobulinduringpregnancy results in a pronounced rise in serum total thyroxine (T4)andtotaltriiodothyronine(T3)levels. Plasmaglucoselevelsaremeasuredfrequently, and, if elevated, a continuous infusion of regularinsulinisgiven.
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The final option is to treatment kidney cancer symptoms order cheap benazepril line let the parents know that valid results could not be obtained and to medications and grapefruit generic benazepril 10mg with amex make arrangements for further case management that take account of this treatment hepatitis b 10 mg benazepril free shipping. A useful framework for joint working with families and schools has been described by Dowling and Osborne (1994). Prevention Early intervention programmes for children with intellectual disability, either alone or accompanied by physical disability, have been shown to have an impact on later adjustment, although the extent and durability of this effect remains a matter for debate. Such programmes focus on skills training for the child in conjunction with parent support and training (Guralnick and Bennett, 1987). Controversy remains about the value of early intervention programmes for speech and language disorders, particularly in the case of expressive language disorders and articulation problems (Snowling, 1996). With specific reading retardation and other specific learning disabilities, there is agreement that the earlier these problems are recognised and remedial tuition started the better, although there are few data to support this position (Topping, 1986; Maughan, 1995). With head injury, teaching children safety skills such as wearing helmets when riding bicycles is central to prevention, and programmes to teach such skills can be effective (Weiss, 1992). Summary In this chapter general and specific learning disabilities, communication problems, and learning difficulties that occur following traumatic brain injury were considered. Between 2 and 3 per cent of the population may be classified as having intellectual disabilities. Discrete genetic and organic factors are implicated in the aetiology of moderate and severe disability, whereas polygenetic influences and psychosocial adversity underpin mild intellectual disability. Intervention programmes include psychoeducation; organisation of appropriate supports and periodic review; offering life-skills training for the child; providing consultancy to manage challenging behaviour; counselling during family lifecycle transitions; and supporting families in dealing with the grief process. Specific language delays may be subclassified as expressive, which are the most common, and mixed receptive-expressive delays, which are the most debilitating. Language delays may involve difficulties with phonology, semantics, syntax, pragmatics and fluency. There is a hierarchy of vulnerability in the components of language that are affected in cases of specific language delay, with expressive phonology being the most vulnerable component, through expressive syntax and morphology and expressive semantics, to receptive language, which is the least vulnerable component. Specific language delays are most common among children under 5 and they are far more common among boys. They are associated with co-morbid conduct problems and later reading difficulties. Otitis media may play a role in expressive language disorders, and psychosocial disadvantage may also play an aetiological role in some cases. In differential diagnosis, specific language delay should be distinguished from the following three syndromes: autism, Landau-Kleffner syndrome and elective mutism. Multidisciplinary assessment and referral for individualised speech therapy are central to the management of specific language delays. Up to 5 per cent of children suffer from specific learning disabilities, and of these, specific reading disability is the most common. Genetic factors probably play an important role in the aetiology of these disorders, although psychosocial factors may maintain the secondary conduct and emotional problems that typically develop in youngsters with such disabilities. Psychometric evaluation followed by home-school liaison and remedial tuition is the management approach of choice. Following traumatic brain injury, children may show cognitive, attainment and behavioural difficulties. The severity of these difficulties is influenced by biological factors associated with the injury; predisposing personal and contextual factors associated with pre-morbid functioning; personal and contextual maintaining factors; and personal and contextual protective factors. Important biological factors for later adjustment include the nature of the lesion, secondary complications, seizure activity, coma duration, and the duration of traumatic amnesia. In selecting psychometric tests for use in the assessment of learning and communication problems, the availability of appropriate norms and the adequacy of their reliability, validity and user friendliness should be taken into account. Routinely using a core test battery, with supplementary tests added as required, is a particularly manageable way to deal with cohorts of cases requiring psychometric assessment of learning and communication problems. In assessing any case the impact of sensorimotor problems and medication factors should be taken into account. Testing procedures should be explained at the outset and a sensitive approach to parents and children taken in managing their adjustment to the testing situation. Early intervention programmes for children with intellectual disability, either alone or accompanied by physical disability, have been shown to have an impact on later adjustment, and these programmes focus on skills training for the child in conjunction with parent support and training. The psychologist must give the parents the information arising from the assessment the parents enter this interview with the view that Chris, their only child, is naughty just like his cousin. The Family and the School: A Joint Systems Approach to Problems with Children (second edition). The early and accurate identification, evaluation and management of children with these problems is essential. Working in partnership with parents and teachers is central to good practice in this area. As youngsters move towards adulthood, promoting skills for independent living, in so far as that is possible within the constraints entailed by the disability, becomes the primary goal. Up to 60 per cent are unable to lead an independent life and only 4 per cent reach a stage where they are indistinguishable from normal children (Gilberg, 1991). However, underestimating the potential of children with pervasive developmental disorders to develop life skills is the major pitfall to be avoided. In this chapter, after considering the classification, epidemiology and clinical features of autism and other pervasive developmental disorders, a variety of theoretical explanations concerning their aetiology will be considered along with relevant empirical evidence. The immediate concern was his persistent flicking of light switches, which was causing much disruption throughout the school. This was a particular problem because on a number of occasions fuses had blown as a result of the switch flicking. Also Tom responded to all attempts to control this behaviour with extreme aggression. In a preliminary consultation he made no eye contact and showed no emotional response to the interview situation. He showed little emotional attachment to his teacher, who accompanied him and who had known him for about three years. He was unable to recount a story at length about events that had happened in the preceding week such as the visit of a juggler to the school. His cherished possessions were a collection of four model cars, each of which had doors or bonnets that opened and clicked shut. Tom appeared to get most pleasure from opening and closing the doors and bonnets but showed little interest in using the cars for make-believe car chases or other such games involving imagination and symbolic play. At dinner time in the school he would become very upset and angry if required to sit anywhere other than in his usual place, and refused food unless it was served in an orange bowl.
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He does not ponder why it is that women can get themselves into such a state that trivial matters can become unbearable symptoms zoloft withdrawal cheap benazepril on line. It is not surprising that he has such a tiny proportion of successes treatment 4 autism purchase discount benazepril online, if this is the level of analysis to medications related to the blood order discount benazepril line which these women are subjected. The refusal to accept this as a rewarding life is not a refusal to accept reality. No amount of direct medication can be effective, unless women can also be brainwashed into deluding themselves that their monotonous and unremitting drugery in the home is for any purpose or doing any good. Bringing up children is not a real occupation, because children come up just the same, brought or not. The evidence is that the fewer masking problems there are the greater the strain on the central problem of the marital relationship itself. In western 313 culture the ultimate success-figure is the astronaut; the wife of an astronaut can bask in money and reflected glory. The cosmonaut is the American aristocrat; presidents fly to him, he prays on behalf of the nation standing on the moon: his domestic set-up must have everything money and planning can provide. Advertising of chocolate bars and biscuits in England has recently recognized the function of escapist eating. Female revolt takes curious and tortuous forms, and the greatest toll is exacted by the woman upon herself. She finds herself driving her husband away from her by destructive carping, fighting off his attempts to make love to her, because somehow they seem all wrong. Often husbands report that frigidity has developed in a wife who seemed to enjoy sex in the early days of marriage. Sexual love is not a matter of orgasm or of romanticism: approaching each other from their opposite poles husbands and wives miss each other in the dark and clutch at phantoms. It is appalling to reflect that the most popular form of contraception in England is still the sheath. One and threequarter million English women use the pill, not even an eighth of the housewife population. Every week the press features another pill horror story, of a bride dead of thrombosis within weeks of her marriage. A story in the News of the World is that the Family Planning Association warns that the 400,000 women supplied by the Association with the pill are suffering an assortment of fifty side-effects. The coil has a painful failure rate in about twenty per cent of cases and can be an oddly disquieting resident in the body. Mrs Monica Foot wrote a horrifying account of spontaneous abortion with a bow-type coil in the Sunday Times and was reviled for her candour. As long as women have to think about contraception every day, and worry about pills, sheaths, and devices of all kinds, and then worry every time a period is due, more irrationality will appear in their behaviour. There are more women who attempt suicide than men, more women in mental hospitals than men13; there are hundreds of children injured by desperate parents every year, and even cases of infants bodily put to death by deranged mothers. The tiny scandalous minority of babybashers and husband-murderers get into the press. The majority of women drag along from day to day in an apathetic twilight, hoping that they are doing the right thing, vaguely expecting a reward some day. The working wife waits for the children to grow up 316 and do well to vindicate her drudgery, and sees them do as they please, move away, get into strange habits, and reject their parents. The idle wife girds her middle-aged loins and goes to school, fools with academic disciplines, too often absorbing knowledge the wrong way for the wrong reasons. My own mother, after nagging and badgering her eldest child into running away from home (a fact which she concealed for years by talking of her as if she were present, when she knew absolutely nothing of what she was doing), took up ballet dancing, despite the obvious futility of such an undertaking, studied accountancy, and failed obdurately year after year, sampled religion, took up skiing and finally learnt Italian. In fact she had long before lost the power of concentration required to read a novel or a newspaper. Every activity was an obsession for as long as it lasted-some lasted barely a month and those are too numerous to list. Of course, single women do not escape female misery, because of the terrific pressure to marry as a measure of feminine success. They dawdle and dream in their dead-end jobs, overtly miserable, because they are publicly considered to be. The phenomenon of single women devoting their lives to aged parents, which has no counterpart in the male sex, is incompletely understood if we do not consider the element of self-cloistering which inspires these women. The mockery of spinsters and acid-faced women is not altogether the expression of prejudice, for these women do exude discontent and intolerance and self-pity. Given the difficulty of marriage as a way of life, and the greater difficulties of spinsterhood, happiness must be seen by women to be a positive achievement. Ultimately, the greatest service a woman can do her community is to be happy; the degree of revolt and 317 irresponsibility which she must manifest to acquire happiness is the only sure indication of the way things must change if there is to be any point in continuing to be a woman at all. It is commonly admitted that there is a battle waging between the sexes but like most other facts which we dare not directly contemplate it is most commonly referred to facetiously. Whether it is waged at home or abroad it is always infighting without rules or conventions and its conclusion is death. And, each time, after a decent period has elapsed, I have remarried a very rich man and become famous for the ethereal look on my beautiful pale face. Because they have the upper hand, men usually conduct themselves with more grace than women do upon the battleground. Men do not realize that they are involved in a struggle to the death until they have lost it and are facing the ruinous capitulations of the divorce court, when in chagrin at their foolishness in neglecting their defences they give vociferous vent to their conviction that the world is run for the benefit of 319 predatory and merciless women. They are usually arranged for a purpose: to introduce a new arrival to a group, to emphasize the importance of an event, to get to know each other. Men take women to parties and therefore women are at a disadvantage from the outset. The most obvious, usually practised by women who are not seriously attached, is the stimulation of male rivalry by more or less subtle flirtation. A woman may appear to operate this technique unconsciously; she is very rarely entirely in control of it, none the less it is extremely effective. In playing this game she may take advantage of tensions already existing in the masculine group and aggravate them. Her best bet is to exploit the male chauvinism which prompts her escort to display his catch for the evaluation of his peers. More irrevocably attached women only use such techniques in moderation, because they have constructed a whole battery of minor artillery, a sort of lingering death of a thousand cuts to be constantly dealt out to their chosen victim. If her husband is the life of the party she will languish and demand querulously to be taken home, or become overcome by liquor curiously fast even to the extent of making an exhibition of herself. If he is having fun she will hiss in his ear that he is drunk and making a fool of himself, or remind him that he has to drive home, or, if he remains proof against her, accuse him of gaping after every attractive woman in the room.
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This type of information may help parents and teachers minimise the exposure of the child to treatment yellow tongue purchase benazepril visa punitive criticism symptoms during pregnancy order benazepril 10 mg amex. This may be a very significant intervention in cases where the child has developed complex motor tics or coprolalia which are disruptive in school and distressing for family members at home treatment of hemorrhoids cheap benazepril 10mg with visa, and have led to the child being regularly punished, criticised or ostracised. A second goal of psychoeducation is to offer a diagnosis, with some indication of the degree of confidence with which the diagnosis may be made. The final diagnosis should be offered by a full multidisciplinary team that can offer an authoritative psychosocial and paediatric summary of the outcome of a thorough evaluation. Antecedents or consequences associated with frequent tics may be removed or modified. Arrangements may be made for children to have relatively isolated quiet time, following daily transitions from home to school or school to home, or between classes at school, during which they can relax and cease attempting to control their tics. Arrangements may be made with school staff for the child to sit exams separately from the class, particularly in cases where there are vocal tics. Time pressure should be minimised in exam situations and youngsters should be permitted to take occasional rests during exams to reduce the frequency of tics (Hagin and Kugler, 1988). Co-morbid depression, anxiety, conduct problems, attention deficit hyperactivity disorder, obsessive-compulsive disorder, and school-based learning problems may be managed following the guidelines set out for these problems elsewhere in this text. Habit reversal includes awareness training, competing-response training, relaxation training and contingency management. A mirror or video tape may be used over a number of sessions to give immediate, accurate feedback on the nature and occurrence of the tics. The psychologist may also alert the child to each occurrence of the tic during training periods. This procedure helps the child to describe the tics, increases motivation to control them, and also helps the child to develop awareness of early warning signs that the tic is about to occur. This awareness of early warning signs is used as a cue for carrying out a competing response, which will be described below. Another aspect of awareness training is coaching the child in using the tic recording forms presented in Figures 13. When using this form, the child notes the number of tics that occur in the first 10 minutes of each hour throughout the day and the associated antecedents and consequences. With this form, the child is trained to count the number of tics occurring during a set 10-minute period each day. The child is also trained to carry out a competing response for two minutes contingent upon the occurrence of the tic or contingent upon recognising an early warning sign that the tic is about to occur. Competing responses should be incompatible with the tic; be capable of being maintained for two minutes; be inconspicuous; strengthen the muscles antagonistic to the tic or habit; and produce a heightened awareness through tensing the muscle. For tics, it is recommended that the competing response should involve the isometric tensing of the muscles opposite to those involved in the tic movement. Relaxation training is included in the habit-reversal programme so that children can lower their arousal level in stressful situations and so reduce the frequency with which tics occur. Here the child is helped to list all of the embarrassing and inconvenient consequences of the tics or habits on one side of an index card and all of the advantages of reducing the frequency of the tics on the other. This card should be carried at all times and reviewed frequently by the child to remind him of the benefits of complying with the treatment programme. Parents may be trained to praise the child and to use a reward system, like that described in Chapter 4, to reinforce the child for using the competingresponse and relaxation skills in appropriate ways. In cases where there is a very high rate of tics, the reward system may be confined to a specific period each day, and the duration of this period may be gradually lengthened as the child gains more control over the tics or habits. This procedure is known as contingent negative practice and is distinct from massed practice, where the tic is practised consistently for periods of up to 30 minutes in the consulting room. There is good evidence for the effectiveness of contingent negative practice with tics, but not for massed practice, where relapses are common (Levine and Ramirez, 1989). However, both neuroleptics have troublesome short-term side effects, such as akathesia and akinesia, and irreversible long-term side effects, particularly tardive dyskinesia. Clonidine hydrochloride, while less effective than the neuroleptics, is safer and its main side effect is sedation. Collectively these conditions form part of a spectrum of psychological problems with a common genetic diathesis, and basal ganglia dysfunction has been implicated in their aetiology. These environmental stimuli come to elicit anxiety through an initial process of classical conditioning, and some people have a particular vulnerability to developing intrusive, unacceptable, obsessive thoughts. Habit reversal and contingent negative practice may also be used with more circumscribed tic disorders and trichotillomania. Then the interviewer may help Trevor construct a hierarchy of situations which elicit obsessional anxiety. Somatisation or conversion symptoms; pain; adjustment to chronic illness; and preparation for anxiety-provoking medical and dental procedures are among the more common reasons for referral. In this chapter common childhood problems in each of these areas will be addressed. Other conditions where somatic factors are involved, such as enuresis and encopresis, sensory impairment, head injury, eating disorders, drug abuse and injuries arising from physical abuse, are discussed in other chapters. The anticipatory grieving process associated with life-threatening illness such as cancer is discussed in Chapter 24. From a clinical perspective, the assessment and management of somatisation problems and the management of chronic childhood illness must take account of children, conceptions of illness and pain, which evolve as children mature, and the wider psychosocial context within which illness occurs. Prior to age 3 years, illness is defined by children in terms of a single symptom, and the cause of illness is understood to be remote. For example, a child may say that tummy aches are caused by the man on the television. Between 3 and 5 years children still conceive of illness in single-symptom terms, but use the concept of contagion to explain the aetiology of the diseases. Magical thinking may also occur during this stage, and children may wonder if something that they did caused their illness or if the illness is a punishment for wrong doing. With the transition that occurs between 5 and 7 years to concrete operational thinking, most children develop a more sophisticated idea about the symptomatology and aetiology of illness. Most illnesses are construed at this stage as entailing multiple symptoms and being caused by internal processes such as ingesting germs. So children at this stage begin to develop health-related behaviours such as washing their hands before eating to remove germs, or exercising to keep their body healthy. As children approach adolescence and the onset of formal operational thought, they can give detailed physiological explanations of illnesses. So an 11-year-old may say that lung cancer is caused by cells growing too quickly and this in turn is due to their being covered in tar from cigarette smoke. Teenagers can offer sophisticated psychophysiological explanations for the aetiology of illnesses. For example, a diabetic teenager may explain that his blood sugar level is affected by his diet, insulin intake, level of physical activity and stress level.
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However symptoms quadriceps tendonitis cheap benazepril 10mg overnight delivery, the problem with this understanding is it cannot be proven true symptoms stiff neck buy generic benazepril 10 mg on-line, and so it was never accepted treatment plant purchase benazepril online pills. Man`s emergence from the State`s religious fanaticism involved the application of his reason as a responsible individual. It is the act` of an individual and not his intent` which forms the basis for determining criminality within him. In other words, criminologists are concerned with the act` of the criminal rather than his intent`. The classical writers accepted punishment as a principal method of infliction of pain, humiliation and disgrace to create fear` in man to control his behavior. The propounders of this school, however, considered prevention of crime more important than the punishment for it. They therefore, stressed on the need for a Criminal Code in France, Germany and Italy to systematize punishment for forbidden acts. Thus the real contribution of classical school of criminology lies in the fact that it underlined the need for a well defined criminal justice system. The advocates of classical school supported the right of the State to punish the offenders in the interest of public security. Relying on the hedonistic principle of pain and pleasure, they pointed out that individualization was to be awarded keeping in view the pleasure derived by the criminal from the crime and the pain caused to the victim from it. They, however, pleaded for equalization of justice which meant equal punishment for the same offence. The exponents of classical school further believed that the criminal law primarily rests on positive sanctions. In their opinion the Judges should limit their verdicts strictly within the confines of law. Thus classical school propounded by Beccaria came into existence as a result of the influence of writings of Montesquieu, Hume, Bacon and Rousseau. His famous work,Essays on Crime and Punishment received wide acclamation all over Europe and gave a fillip to a new criminological thinking in the contemporary west. He sought to humanize the criminal law by insisting on natural rights of human beings. Beccaria`s views on crime and punishment were also supported by Voltaire as a result of which a number of European countries redrafted their penal codes mitigating the rigorous barbaric punishments and some of them even went to the extent of abolishing capital punishment from their Penal Codes. Major Shortcomings of the Classical School the contribution of classical school to the development of rationalized criminological thinking was by no means less important, but it had its own pitfalls. The classical school proceeded on an abstract presumption of free will and relied solely on the act. It erred in prescribing equal punishment for same offence thus making no distinction between first offenders and habitual criminals and varying degrees of gravity of the offence. However, the greatest achievement of this school of criminology lies in the fact that it suggested a substantial criminal policy which was easy to administer without resort to the imposition of arbitrary punishment. It goes to the credit of Beccaria who denounced the earlier concepts of crime and criminals which were based on religious fallacies and myths and shifted emphasis on the need for concentrating on the personality of an offender in order to determine his guilt and punishment. Beccaria`s views provided a background for the subsequent criminologists to come out with a rationalized theory of crime causation which eventually led the foundation of the modern criminology and penology. Neo-Classical School In criminology, the Neo-Classical School continues the traditions of the Classical School within the framework of Right Realism. Hence, the utilitarianism of Jeremy Bentham and Cesare Beccaria remains a relevant social philosophy in policy term for using punishment as a deterrent through law enforcement, the courts, and imprisonment the free will` theory of classical school did not survive for long. It was soon realized that the exponents of classical school faultered in their approach in ignoring the individual differences under certain situations and treating first offenders and the habitual alike on the basis of similarity of act or crime. The neo-classists asserted that certain categories of offenders such as minors, idiots, insane or incompetent had to be treated leniently in matters of punishment irrespective of the similarity of their criminal act because these persons were incapable of appreciating the difference between right and wrong. This tendency of neo-classists to distinguish criminals according to their mental depravity was indeed a progressive step inasmuch as it emphasized the need for modifying the classical view. Thus the contribution of neo-classical thought to the science of criminology has its own merits. Intuitively, politicians see a correlation between the certainty and severity of punishment, and the choice whether to commit crime. The practical intention has always been to deter and, if that failed, to keep society safer for the longest possible period of time by locking the habitual offenders away in prisons (see Wilson). From the earliest theorists, the arguments were based on morality and social utility, and it was not until comparatively recently that there has been empirical research to determine whether punishment is an effective deterrent. The main tenets of neo-classical school of criminology can be summarized as follows 1. Neo-classists approached the study of criminology on scientific lines by recognizing that certain extenuating situations or mental disorders deprive a person of his normal capacity to control his conduct. Thus they justified mitigation of equal punishment in cases of certain psychopathic offenders. Gillin observed that neoclassists represent a reaction against the severity of classical view of equal punishment for the same offence. Neo-classists were the first in point of time to bring out a distinction between the first offenders and the recidivists. They supported individualization of offender a treatment methods which required the punishment to suit the psychopathic circumstances of the accused. Thus although the act` or the crime` still remained the sole determining factor for adjudging criminality without any regard to the intent, yet the neo-classical school focused at least some attention on mental causation indirectly. The advocates of this school started with the basic assumption that man acting on reason and intelligence is a self-determining person and therefore, is responsible for his conduct. But those lacking normal intelligence or having some mental depravity are irresponsible to their conduct as they do not possess the capacity of distinguishing between good or bad and therefore should be treated differently from the responsible offenders. Though the neo-classists recommended lenient treatment for irresponsible or mentally depraved criminals on account of their incapacity to resist criminal tendency but they 26 certainly believed that all criminals, whether responsible or irresponsible, must be kept segregated from the society. It is significant to note that distinction between responsibility and irresponsibility, that is the sanity and insanity of the criminals as suggested by neo-classical school of criminology paved way to subsequent formulation of different correctional institutions such as parole, probation, reformatories, open-air camps etc. This is through this school that attention of criminologists was drawn for the first time towards the fact that all crimes do have a cause. It must, however be noted that though this causation was initially confined to psychopathy or psychology but was later expanded further and finally the positivists succeeded in establishing reasonable relationship between crime and environment of the criminal. Neo-classists adopted subjective approach to criminology and concentrated their attention on the conditions under which an individual commits crime. Thus it would be seen that the main contribution of neo-classical school of criminology lies in the fact that it came out with certain concessions in the free will` theory of classical school and suggested that an individual might commit criminal acts due to certain extenuating circumstances which should be duly taken into consideration at the time of awarding punishment. Therefore, besides the criminal act as such, the personality of the criminal as a whole, namely, his antecedents, motives, previous life-history, general character, etc. It may be noted that the origin of jury system in criminal jurisprudence is essentially an outcome of the reaction of neo-classical approach towards the treatment of offenders.