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Analysis of such responses should not focus on a mere "yes" or "no" answer; rather users should focus on ways that Ministries of Health can assume their stewardship role treatment of strep throat cheap biltricide 600mg without a prescription. As per leadership and governance functions medications xarelto generic biltricide 600mg on-line, users can summarize questions to symptoms melanoma order biltricide no prescription draw general conclusions: Questions 14 can be summarized to determine the vision and direction of the overall health system. Note if the right to health and gender equality are specifically mentioned or if broader principles of social justice are used. For example, the national development plan (analysis table 7) may be silent on gender equality but the health sector strategy may promote genderresponsive health policies. Users may want to note such discrepancies in coherence among the assessment levels and explore the reasons and process behind this. It could be that the health sector strategy was developed in accordance with gender mainstreaming methods and therefore reflects a commitment that the national development plan does not. Such process issues are important to note and share during the dissemination of the report towards catalysing future actions towards overall policy coherence. Ensuring that human rights and gender equality are adequately reflected in service delivery requires: attention to the establishment of specific entitlements of the population through the identification of a basic package or several basic packages tailored to specific groups; ensuring that the design of service delivery is respectful of human rights and protects the dignity of women, men, girls and boys, and that service delivery is guided by consideration of the differential needs and life circumstances of women and men of various groups. If so, are gender norms, roles and relations that may lead to different experiences and outcomes for women and men acknowledged (to be addressed under each sub-question)? Adolescents are more likely to engage in risky behaviour and be exposed to sexual violence and sexual exploitation. Programmes need to ensure the best interests of the adolescent by recognizing their evolving capacity (age and stage of development). The views of the adolescent should be given due weight in accordance with his/her age and maturity. States should enable women to have control over and decide freely and responsibly on matters related to their sexual and reproductive health free from coercion, discrimination and violence. Men and women have a right to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, and the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth. Health-related education and information, including on sexual and reproductive health, is an important element of the right to health. Another important consideration is that mental health services are integrated into general health care and, as far as possible, provided in the community. Such acts can include interpersonal, domestic and sexual violence, female genital mutilation and other harmful practices. Physical distance is often a barrier to the realization of equal access to health services. People in rural areas, and those who do not have fixed physical domiciles, often have greater indirect expenditures for health care, including loss of income when travelling to distant health facilities. In order to ensure equality and non-discrimination, it is necessary to identify which groups have least access to health services and underlying determinants of health. Without such strategies, there can be no guarantee that people with disabilities will have equal access to health services. Community health workers are often well trusted and well-informed about the health risks historically faced by the community at large, as well as those faced by particular groups. Local, simple, culturally accessible ways including for the visual and hearing impaired? In order for health information to be equally accessible to all, appropriate provisions must be made. Without such provisions, the right to information of several communities, such as linguistic minorities, people with disabilities and less educated populations will be compromised. Effective delivery of health services depends on an appreciation for cultural diversity within a population. Privacy plays an essential role in the effective delivery of health services, without which diagnoses suffer, and community illness patterns are missed, among other problems. Marginalized groups, such as women and minorities, have an even greater need to be assured of their right to privacy because of the gender-related and other stigma. States have an obligation to make quality health care available, and if that health care is to be provided by third parties, then the State has an obligation to not only keep the quality of thirdparty care up to par, but also to make sure that measures are being taken to improve upon that standard. As community health workers often play a vital role in the delivery of health services, their capacities must be increased such that they can be formally recognized as part of the health workforce with requisite recognition. Is the importance of gender norms, roles and relations reflected in plans for service design and delivery (women and men)? As men and women have different health needs, it is important for a service plan to identify them, especially needs that are particular to one sex or the other. Notes: Indicate if women and men are not specified among the various groups or if women are treated as a homogenous "vulnerable" group. Elderly Areas of attention commonly posing challenges include access to food, shelter, health care and income-generating activities. States must ensure that those in prison also have equal access to health services as the general population. People with physical, psycho-social and intellectual disabilities Areas of attention include access to devices that enable independence, medications, psychological services, linguistic support and nursing staff. Areas of attention include prenatal and postnatal care, nutrition, family planning, protection from harmful traditional practices, as well as child abuse and neglect. Areas of attention include access to preventive curative health information which is accessible to services as well. Internally displaced groups Areas of attention include essential services, emergency care, life-cycle services, psychological services, and sanitary quarters. Nomadic groups Points of access to health-care facilities, nutrition, and sanitation Every country has specific population groups which face an undue burden of discrimination, marginalization and exclusion. As local health authorities and communities are often better apt to identify community health needs and prioritize them, accordingly they should have a clearly stated role. As men and women have different health needs, it is important that these needs be represented equally on all levels of service delivery. Are any mechanisms for complaints and redress from rights-holders (patients, family members, etc) such as, for example, client satisfaction surveys, patient charters or suggestion boxes addressed? Issues for follow up via either interview, additional document review or otherwise Such mechanisms help to ensure that rightsholders (patients, family members, etc) are capable of expressing their opinions and of holding duty-bearers to account. However, you may need to consult additional documents and staff members of the planning or delivery units of the MoH for clarifications on activities and processes not explicitly addressed in the strategy. Analysis of such responses should not focus on a mere "yes" or "no" answer; rather users should focus on ways that Ministries of Health can improve service delivery. Note if and how these entitlements appear to be different for specific population groups. For example, look at when and how women and men are referred to in descriptions of basic packages of health services; note if they are discussed separately for all entitlements, or only those related to specific health areas. Users may draw upon other existing health data that may indicate that gender or sex differences exist in other health areas that require attention. If no sex-disaggregated data exist in the plan, nor are there any plans to incorporate such data, users can raise the issue as a gap for future research and enquiry.
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It is convenient and fairly comfortable for the patient medicine lodge kansas biltricide 600 mg on-line, although it can be somewhat easily moved out of position symptoms 5 days post embryo transfer buy generic biltricide pills, during sleep in treatment 1-3 order biltricide overnight, for example. Communication is difficult, the mask is easily displaced, and it must be removed at mealtime. The partial rebreathing mask (low flow) and nonrebreathing mask (low flow) deliver more precise concentrations of oxygen to the patient. Mechanical ventilators (high flow) are most frequently encountered in a hospital critical care unit. Patients on ventilators have an artificial airway in place, while the ventilator controls the respiratory rate and volume. Although oxygen is not a flammable substance, it does support combustion, so care must be taken to avoid spark or flame where oxygen is in use. Suction is available from a wall outlet, similar to oxygen, or as a mobile apparatus. It is unlikely that the radiographer would be required to suction a patient, but he or she might be needed to assist with the procedure. Suction tubing must have a disposable catheter attached to its end for collection of airway secretions. The radiographer should be familiar with the location of suction equipment and replacement disposable catheters. Medications administered intravenously result in rapid patient response; medications are delivered in this fashion in emergency and critical situations. Patients who are dehydrated and require fluid and electrolyte replacement will have these (normal saline or D5W) administered intravenously. A heparin lock consists of a venous catheter established for a certain length of time to make a vein available for medications that have to be administered at frequent intervals. This helps prevent the formation of scarred, sclerotic veins as a result of frequent injections at the same site. This is a two-part device consisting of a solid (without a bore) needle and a flexible plastic catheter. After the needle is introduced into the vein, the catheter is advanced over the needle, secured with tape, and the needle removed. If placed lower than the vein, the solution will stop flowing and blood will return into the tubing. Occasionally, the position of the needle or catheter in the vein will affect the flow rate. If the bevel is adjacent to the vessel wall, flow may decrease or stop altogether. Extravasation occurs when medication or contrast medium is introduced into the tissues surrounding a vein rather than into the vein itself. The needle should be removed, pressure applied to prevent formation of a hematoma, and warm moist heat applied to relieve pain. The antecubital vein is the most commonly used venipuncture site for contrast medium administration. It is not used for infusions that take longer than 1 hour because of its location at the bend of the elbow. The basilic vein, located on the dorsal surface of the hand, is used when the antecubital vein is inaccessible. A warm compress can be applied to the area of intended injection to increase area blood circulation and improve access to the intended vein. The needle is inserted into the vein at a 15-degree angle; blood will flow back into the tubing when the needle is correctly positioned. The chest drainage system usually has three compartments: one is the suction control chamber, another is the collection chamber, and the third is the water seal chamber, which prevents atmospheric air from entering the chest cavity. Radiographers might encounter chest drainage systems when performing mobile radiographic examinations on postsurgical patients. The radiographer must be careful not to disturb chest tubes during patient or equipment manipulation, and to immediately report any sudden change in patient condition and/or patient complaint of chest pain or discomfort. Urinary catheterization may be employed postsurgically to assist in the healing of tissues or to assist the incontinent patient in the elimination of urine. The type selected is dependent on how long it is expected to remain in the bladder. The urine collection bag must be kept below the level of the bladder; backflow of urine into the bladder can lead to infection. When transporting or transferring the catheterized patient, care must be taken that the catheter does not become entangled or dislodged. Examples of such responses include hay fever, urticaria, allergic rhinitis, eczema, and bronchial asthma. Allergic reactions of particular importance to the radiographer involve the use of latex products and contrast media. Medical Equipment That Could Contain Latex Disposable gloves Tourniquets Blood pressure cuffs Stethoscopes Intravenous tubing Oral and nasal airways Enema tips Endotracheal tubes Syringes Electrode pads Catheters Wound drains Injection ports B. Also, when gloves are changed, latex protein/powder particles get into the air, where they can be inhaled and come in contact with body membranes. Studies have indicated that when unpowdered gloves are worn, there are extremely low levels of the allergy-producing proteins present. A wide variety of products contain latex: medical supplies, personal protective equipment, and many household items. Also at risk are other workers with frequent glove use (hairdressers, housekeepers, food service workers, etc. Types of Reactions to Latex Irritant contact dermatitis Allergic contact dermatitis (delayed hypersensitivity) Latex allergy (immediate hypersensitivity) 1. It is characterized by development of irritated dry, itchy areas on the skin, usually the hands. Irritant contact dermatitis is a skin irritation resulting from the use of gloves and/or from exposure to other workplace products and chemicals. Irritant contact dermatitis can also be caused by repeated handwashing, incomplete drying, use of sanitizers, and exposure to glove powder. Allergic contact dermatitis (delayed hypersensitivity) results from exposure to the chemicals added to latex during its manufacture. These chemicals can cause skin reactions like those produced by poison ivy, that is, the rash usually begins 24 to 48 hours following contact and can lead to oozing skin blisters and/or spread to areas away from the area of initial contact. Wearing latex gloves during episodes of hand dermatitis may increase skin exposure and the risk of developing latex allergy. Latex allergy (immediate hypersensitivity) can be a much more serious reaction to latex. Certain proteins in latex can cause sensitization and, although the amount of exposure needed to cause this sensitization is unknown, even very low-level exposure can trigger allergic reaction in some sensitized individuals. Reactions usually begin within minutes of exposure to the latex, but can occur hours later. More severe reactions are respiratory, for example, itchy eyes, runny nose, sneezing, difficulty breathing, and wheezing. A lifethreatening reaction such as shock is rarely the first sign of latex allergy.
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The following factors taken from Robert Plonsey and Barr treatment urinary incontinence buy biltricide 600mg visa, are the key criteria for electrode selection : Passive compatibility of the material with tissue 7 medications that can cause incontinence purchase 600 mg biltricide with mastercard. The electrochemical effect at the metal-electrolyte interface is responsible to medicine 035 generic 600 mg biltricide with visa convert the conduction current of the electrodes to ionic current in the tissues. Though idealized, the following model is used to represent the electrode-tissue interface [5, 8]. Through a push button on the control interface, the user is expected to initiate a hand movement stimulation sequence that will be picked up and addressed by the control system. The second available surface system, the Bionic Glove, is developed at the University of Alberta and consists of "a fingerless glove with a forearm sleeve that is worn over three or four self-adhesive electrodes previously placed on the hand and forearm" (P. The displacement transducers that covers the wrist joint detects movement and initiates an of/on automatic ramping up and down stimulation in such a way that wrist extension beyond a certain angle triggers of grasp while the flexion triggers hand opening. Being a stepping stone for further development, the earlier models utilizes either surface, cuff or epineural electrode that stimulated the peroneal nerve directly and an external heel switch for control with the following shortcomings : Properly placing the surface electrodes, False triggering of the stimulation Inadvertent elicitation of reflex spasms in the plantarflexor muscles Pain or discomfort from the stimulation, mechanical failure of the switch and other components Difficulty in achieving balanced dorsiflexion with a single electrode Difficulty in achieving balanced dorsiflexion with a single electrode Used by more than 3500 Danish patients, the single channel surface system, Foot-lifter is one of the commercially available products. The second groups of lower limb assists are the standing/transfer systems intended to enable persons with paraplegia to stand from a seated position and transfer to another surface. Even if the bladder and bowl implants effectively restores micturition and bowl function and avoids the prevalence of catheter related infections, the rhizotomy requirements has unfavorable impact on both patients and clinicians preference towards the systems and hence different scholars are working hard to make the implants more comfortable . Commonly known as phrenic pacing systems, which restore lung function by stimulating the diaphragm via phrenic nerve. The external antenna is responsible to link the implanted receiver and the external control unit [6, 7]. Though not commercially available, the MedImplant, which is developed in Austria, uses four electrodes sutured to the epineurium of each phrenic nerve from a single 8-channel receiver/stimulator to restore lost lung function. Apart from the surgical related complications, the major shortcoming for phrenic pacing systems is that individuals with either complete phrenic nerve can only use them though individuals with partial phrenic nerve can use the system if assisted by the inspiratory intercostal muscles . Hunter Peckham and Knutson, "future systems will be designed around a platform technology, where numerous neuromuscular deficits will be treated using the same basic neuro-prosthetic system or a subset of the possible components of an entire system". Hence further refinement of system configuration as well as introduction of more reliable stimulating and recording electrodes are inevitable. Neuromodulation: Technology at the Neural Interface, 1998 [Peer Reviewed Journal] [Online], Vol. Functional electrical stimulation for the upper extremity: Information for Patients and Families [Online], n. Reed, 2006, Electrotherapy explained: Principles and practices Butterworth: Heinemann Elsevier Watson, T. The aim of this study is to find out causes of puberty menorrhagia and role of medical and operative management in a rural medical college of South Bengal. Materials and methods: After ethical committee approval and informed patient consent 200 young girls either attending outpatient department or admitted in the indoor with history of excessive bleeding per vagina between menarche and 19 yrs of age were included in the present study. After proper history, physical examination and investigations as appropriate the cause of excessive bleeding was diagnosed and treated accordingly. Results and Observations: Most (67%) of the patients had puberty menorrhagia for 6 months to 1 year and 63. Conclusion: Commonest cause of puberty menorrhagia is immaturity of the hypothalamic - pituitary ovarian axis resulting in anovulation. Proper evaluation by history, clinical examination and investigations are important to diagnose the etiology of puberty menorrhagia. Puberty menorrhagia is defined as excessive 81 International Journal of Health Sciences & Research ( Without ovulation unopposed estrogen results in endometrial proliferation, with eventual excessive menstrual bleeding. There are very few studies on puberty menorrhagia in this subcontinent and all the studies have very few numbers of subject. The study was carried out from 1st January 2010 to 31st December 2014 in the department of Gynecology at a rural medical college of South Bengal. Blood loss during menstruation was considered excessive if the patient had prolonged cycle >7 days and/or there was history of passage of clots and were included in the study. Those patients with history of trauma or pregnancy test positive were excluded from the study. A detail history regarding age, socioeconomic status, milestones of growth and onset of puberty were taken. The present complaint with onset, duration and amount of blood loss were also noted. Enquiries were made about menstrual interval, duration of bleeding, passage of clots and number of pads required daily. The medical history included history of recent weight gain or loss, any voice changes, tuberculosis, endocrine disease like diabetes, thyroid disorder, history of any drug intake and any cardiac, renal or haematological disorders. History of any blood or component transfusion and surgical intervention were also recorded, Personal history included history of sexual behaviour, trauma or abortions. Family history was taken in detail regarding presence of any disease like tuberculosis, thyroid disease and bleeding diathesis. Neck vein, neck glands, gum bleeding along with pulse, blood pressure and temperature were also recorded. Abdominal palpation was done to exclude any hepatosplenomegaly, ascites or any other abdominal-pelvic mass in the lower abdomen. Tenderness over the sternum and other bony areas were examined along with presence of any joint swelling. Obese patients were observed for any signs of acne, hirsutism and features of hyperandrogenism. Secondary sex characters, like breast development, axillary and pubic hairs were inspected. Gynaecological examination included inspection of the vulva and if the hymen appeared intact, vaginal examination was avoided. Speculum and per vaginal International Journal of Health Sciences & Research ( Bone marrow examination, serum ferritin and Hbelectrophoresis were done in patients having suspected hematological problem. Some investigations (VonWillebrand factor activity, Ristocetin cofactor assay, 21 day serum progesterone level) were done selectively to establish diagnosis in suspected cases. The management protocol was decided upon the condition of the patient and the underlying cause of menorrhagia. In anovulatory bleeding with a hemodynamically stable patient, antifibrinolytic drugs like tranexamic acid were used as first line therapy during the days of menstruation for control of blood loss. Anaemia was corrected by oral haematinics or blood transfusion / component therapy. Treatment of tubercular, haematological and thyroid diseases was done after consulting with respective specialists. Importance was given to provide full nutritional, physical and psychological support to the young girls. Regular check-up of these patients were done by maintaining menstrual calendar, clinical examination and monitoring therapeutic response.
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The analgesic activity above extract was evaluated by using tail immersion method and formalin induced pain method in albino mice medicine go down order 600 mg biltricide mastercard. Analgesic activity of petroleum ether 4d medications best purchase biltricide, chloroform symptoms 3 months pregnant order 600mg biltricide with amex, methanol and water extracts create dose dependent analgesic activity, formalin test is one of the principle analgesic models to compare with clinical pain. In the early phase of formalin test pain arise due to the direct stimulation of the sensory nerve fibers by 4 National Journal of Advanced Research formalin while in the late phase pain was due to inflammatory maditors like histamine, prostaglandins, serotorin and bradykinins . Antiulcer activity the aqueous suspension of Saraca indica flowers are used against gastric ulcer in albino rats. The major constituent of Saraca indica flowers contains saracasin, saracadin, waxy substance, fatty acids and flavonoids etc. So the flowers of Saraca indica suspension exhibit an antiulcer potential activity through at least one or more possible mechanism including inhibition of basal gastric secretion, stimulation of mucus secretion and endogenous gastric mucosal prostaglandin synthesis . Antidiabetic activity Hypoglycemic effect of the methanolic bark extracts of Saraca indica Linn in normal and streptozotocin induced diabetic rats was evaluated. At dose of 400mg/kg through oral route the extract has shown a significant hypoglycemic activity . Phenobarbitone induced sleeping time by using actophotometer method was used to determine this activity. Immunomodulatory Activity Saraca indica seed integument induces apoptosis in human Tlymphocytes. Saracin found to be an interesting immunomodulator for the mammalian immune system . Both the dose levels of the research drug and standard drug aspirin (100 mg/kg) showed significant (P<0. Cardioprotective activity Cardioprotective activity of alcoholic extract of Saraca indica bark was investigated against cyclophosphamide induced cardiotoxicity. Anthelmintic activity: Saraca indica leaves extract has been used for anthelmintic activity, for this we used both maceration and Soxhlet method of extraction by using solvent like ethanol and methanol. Found that the ethanolic as well as methanolic extract were tougher than the positive control as much as anthelmintic activity. Glycosides, alkaloids, tannin, flavonoids and terpenoids seem to be accountable phytochemical constituent for signifying anthelmintic activities of ethanolic and methanolic extract [21-22]. Antioxidant activity Many herbs and spices have been shown to impart antioxidant effects in food. There are several reports that the extracts (ethanolic, hydroalcoholic and acetone) of Saraca indica bark showed the antioxidant activity. Panchawat and Sisodia studied in vitro antioxidant activity of Saraca indica roxb. They concluded that the oral administration of the extract caused a significant reduction in blood glucose level in diabetic mice and showed significant antioxidant activity . They determined that the processed Saraca indica and pterospermum acerifolium exhibited potential antioxidant properties . Cardioprotective effect of Saraca indica against cyclophosphamide induced cardiotoxicity in rats and determined that the free radical generated during treatment with cardioprotective cause membrane injury. Larvicidal activity Ether extract of the Saraca indica leaf and the chloroform extracts of the bark were evaluated for larvicidal activity. The pet ether extracts of leaves and chloroform extract of the bark of Saraca indica showed significant larvicidal activity . Antifungal activity Traditionally fungal infections have been attributed to compromised immune response of an individual and not posing a very serious danger to the population at large; 5 National Journal of Advanced Research however, there have been increasing incidences of fungal disease outbreaks in the past. Finding new antifungal agents is therefore a priority of the clinical microbiology community. The antifungal activity of methanolic and hot aqueous extracts of Saraca indica leaves, flowers and bark against Alternaria alternata, Colletotrichum gloeosporioides, Drechlera specifera, Dermato protective the root, bark and seed extracts of Saraca indica find several uses in the treatment of skin complications such as eczema, psoriasis, acne, dermatitis, herpes-kushta/ visarpa, pruritis, scabies, tinea pedis and skin cancer [31-32]. The flower extracts of Saraca indica which contains flavonoids, has been shown to reduce skin tumours induced by 7, 12-dimethyl benzanthracene40. It is also known to rejuvenate skin complexion, induce quick healing of skin injuries, and reduce freckles and external inflammations of the skin14. Seed extracts have been reported to be effective against dermatophytic fungi . Conclusions the medicinal importance of the tree as discussed above evidently prove that Saraca indica is one of the most important medicinal plant which possess a lot of therapeutic values specially for female disorders. The stem bark is chiefly used in medicines and it has been reported to contain chemicals such as glycoside, flavanoids, tannins, saponins, esters and primary alcohols. Saraca indica has been greatly used as traditional medicine for women related problems, such as menorrhagia, leucorrhoea, bleeding hemorrhoids, dysfunctional uterine bleeding etc. Saraca indica (Ashoka): A review, Journal of chemical and pharmaceutical research. Saraca indica (Ashoka): A Review: Journal of chemical and pharmaceutical research. These could be subjected to further detailed investigations for uncovering the bio-active principles. Pharmacognostical, phytochemical and pharmacological evaluation for the antipyretic effect of the seeds of Saraca indica Roxb. Cardioprotective effect of Saraca indica against cyclophosphamide induced cardiotoxicity in rats: A biochemical, electrocardiographic and histopathological study, Indian J Pharmacol. Panchawat and Sisodia, In vitro antioxidant activity of Saraca indica Roxb De wilds stem bark extracts from various extraction processes, Asian journal of pharmaceutical and clinical research. Evaluation of antihyperglycemic and antioxidant activities of Saraca indica (Roxb) de wild leaves in streptozotocin induced diabetic mice, Asian pacific journal of tropical disease. Comparative study upon the antioxidant potential of Saraca indica and pterospermum 6 National Journal of Advanced Research 26. Quantitative analysis of catechins in Saraca indica and correlation with antimicrobial activity. Nerve related diseases stroke and spinal cord lesions result loss of the peripheral nerves system, which stimulate the muscular system. Dictating the current technologies and associated future works, it finally draws a succinct conclusion. They exhibit a steady resting membrane potential in the range of -50 and -100mV and conduct action potential when sufficiently stimulated resulting an all-or-none response . It is also defined as a treatment that improves mobility by utilizing a small electrical charge . The invention of Faradic simulator in the 1800s marked utilization of electric current for stimulation of nerve fibers. In the clinical world, wide varieties,low-frequency currents are used to stimulate muscle, nerve or both . Biphasic pulse in turn,can be either balanced (symmetrical) or unbalanced (asymmetrical) [12, 13]. Effective utilization of electric current for neuromuscular innervation requires understanding of the basics of how action potential is used to stimulate muscles ; hence electrical neuromuscular excitation hinges on the basic understanding of the nerve fibers to be excited, the electrodes and electrode-tissue interactions .
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Transgender Law Center: 10 Tips for Working with Transgender Individuals: A Guide for Health Care Providers treatment quadratus lumborum purchase 600mg biltricide amex. In addition medications and pregnancy buy 600 mg biltricide with visa, a robust nondiscrimination policy promotes general workforce effectiveness by signaling that bias is not tolerated (see Sidebar 3-1 treatment kidney infection generic biltricide 600mg with mastercard, below). Hospitals that offer health care coverage to the spouses of employees sometimes do not extend these same coverage options to employees who have a same-sex partner (in states where they cannot marry). Hospitals should review all employee benefits and policies, beyond health care coverage, to ensure that same-sex-partnered employees (in states where they cannot marry) are treated identically to employees with spouses. Same-sex partners should be able to access benefits as easily as spouses; for example, same-sex partners should not be asked to provide proof of their relationship beyond what is required of spouses. In addition, hospitals should ensure that references to spouses also allude to domestic partners and that references to family are inclusive of same-sex partners, to the extent permitted by law. Affordable Health Care Coverage for Same-Sex Partners More employers around the country are offering health care coverage to employees that have a same-sex partner (in states where they cannot marry). For example, 293 of the Fortune 500 companies offer same-sex partner health care benefits. See Chapter 5, "Patient, Family, and Community Engagement," for additional examples of outreach activities. Increasing awareness of these issues can pave the way for better working relationships among employees and to better-functioning workplace teams. I had no idea how much they worried about other people being uncomfortable, or losing out on opportunities and raises. Many transgender people in the workplace have experienced extremely high levels of bias and discrimination, and hospitals should be proactive in addressing the challenges typically faced by transgender employees, which can place employers at high risk. A growing number of employers are updating their employee health plans to provide coverage for medically necessary transitions from one sex to another. The American Medical Association4 and a host of other health care organizations have called on employers to offer coverage for these transitions, for which there are established standards of care5 and clinical guidelines. Identify a "point person," generally in human resources, to provide expertise and support around transitions and other transgender workplace needs. Create or have readily available guidelines to ensure smooth workplace transitions. The Endocrine Society: Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline. National Center for Transgender Equality: Transgender Equality and the Federal Government: A Resource from the National Center for Transgender Equality. For health care organizations to improve the care they provide to all patients, they must collect and use accurate data. Data are helpful for informing policies and program development; evaluating the effectiveness of policies and programs; developing marketing, research, quality improvement, and community outreach initiatives; and responding to the changing needs of patient populations. Understanding the characteristics of patients and patient populations can help hospitals identify and ultimately address disparities in health and health care and plan for services that meet unique patient needs (see Sidebar 4-1, below). There are numerous opportunities to collect these data during the health care encounter. These aspects include relationship status, sexual orientation, sexual behaviors, sex, and gender identity. Registration and admitting processes should allow for the designation of relationship status (such as identification of a same-sex spouse or domestic partner) and gender identity. Registration and admitting forms and processes may also allow for designation of patient support persons, visitors, emergency contacts, and representatives; and disclosure of the existence of relevant legal arrangements (including advance health care directives and marital and other legally recognized relationships, such as registered domestic partnerships). Sidebar 4-2, page 27, provides an example of adding gender identification to electronic health records. Information regarding sexual orientation is usually provided in interactions between patients and providers, through physician or interview notes, or during a health history. This may involve adding new fill-in fields or drop-down menus to capture data elements. Note: Gathering patient-level data about sexual orientation and gender identity has been the subject of considerable interest and debate, and work is rapidly evolving on these issues. The growing concern about health care disparities and barriers to equitable care has demonstrated the need to collect such data, but the best ways to do so have not yet been established. Therefore, comprehensive recommendations on data collection methods are beyond the scope of this document. As advances are made in health information systems and in electronic health records, consideration should be given to the integration and alignment of sexual orientation and gender identity information data into all hospital information systems. If a patient requests that this information not be recorded, this request should be respected. Staff training is a crucial component of successful efforts to appropriately collect and use sexual orientation and gender identity data. In addition to training on the methods and procedures that the health care organization uses to collect these data, the health care organization must ensure that staff can explain to patients why these data are important and how data will be used. Training should also emphasize that information collected about sexual orientation and gender identity will not be used to facilitate discrimination against the patient in any way (see Chapter 1, "Leadership"). This toolkit offers online resources that can help the hospital identify and address staff concerns. The privacy of patient data, including demographic data, is protected from inappropriate disclosure by the privacy rule of the Health Insurance Portability and Accountability Act (see Appendix C, "Laws, Regulations, and Executive Materials," page 51). Any privacy protocols, particularly those involving electronic health records, must ensure that patient data are shared only with those who need access to these data in order to plan, coordinate, or assess the effectiveness of appropriate medical services. Example of Adding Gender Identification to Electronic Health Records One hospital added transgender self-identification options when it adopted a new system for electronic health records. In this system, the admitting/registration screen displays the options "M" and "F" in the field labeled "Sex," in order to match the options currently offered by private and government insurers. Patient surveys offer an opportunity for the hospital to begin building a confidential database of patient experiences and perceptions in order to learn more about the quality of care provided by the hospital from the perspective of different patient populations. Asking patients to voluntarily share their sexual orientation and gender identity on patient surveys helps ensure that patient satisfaction data can be stratified by these populations and can help identify and track trends in patient experiences (see Sidebar 4-3, below). Examples of Closed-Format Sexual Orientation and Gender Identity Questions Sexual Orientation Do you consider yourself to be: Straight (heterosexual) Gay or lesbian Bisexual Sexual Behavior In the past (time period, such as one year), with whom have you had sex? Men only Women only Both men and women I have not had sex over the past (time period, such as one year). No Yes, transgender male to female Yes, transgender female to male Yes, transgender, do not identify as male or female Some data collection instruments provide a brief definition of transgender as part of the gender identity question. The following is a question with a definition that has been successfully used on general population surveys: "Some people describe themselves as transgender when they experience a different gender identity from their sex at birth: for example, a person born with a male body but who feels female or lives as a woman. An awareness of the demographic composition of the community allows hospitals to plan for the services necessary to meet patient needs. Community needs assessments can help the hospital learn which groups are represented in its patient population and to ensure that the services and education it offers reflect the diversity of its patients and the broader community. One of the provisions of the Affordable Care Act requires charitable hospitals to conduct regular community needs assessments that take into account input from persons who represent the broad interests of the community served by the hospital. The health care organization can identify the need for new or modified services by being involved and engaged with patients, families, and the community. Health care organizations have a responsibility to serve all segments of the population and, therefore, must strive to understand the ever-changing health care needs of the patient populations within the communities they serve.
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Fitzgerald symptoms kidney failure discount 600 mg biltricide with visa, "Rape Myth Acceptance: Exploration of Its Structure and Its Measurement Using the Illinois Rape Myth Acceptance Scale treatment 6th february buy discount biltricide 600mg line," Journal of Research in Personality natural pet medicine 600 mg biltricide amex, Vol. Polusny, and Maureen Murdoch, "Prevalence and Consequences of Adult Sexual Assault of Men: Review of Empirical Findings and State of the Literature," Clinical Psychology Review, Vol. Porter, Louise, "Leadership and Role-Taking in Multiple Perpetrator Rape," in Miranda A. Alison, "A Partially Ordered Scale of Influence in Violent Group Behavior: An Example from Gang Rape," Small Group Research, Vol. Rand, Michael, and Shannan Catalano, National Crime Victimization Survey, Washington, D. 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Brewer, PhD Rates of anal cancer among men have nearly doubled over the past 3 decades in the United States, making it an increasingly important public health concern. Thus, anal cancer screening could play a role in anal cancer prevention for gay and bisexual men, Objectives. We assessed the willingness of gay and bisexual men, who have high rates of anal cancer that might be prevented through regular screening, to receive anal Papanicolaou tests. We surveyed a national sample of men aged 18 to 59 years who selfidentified as gay (n = 236) or bisexual (n = 70). Anal cancer screening was highly acceptable to gay and bisexual men, although cost was a major barrier. Efforts to reduce anal cancer disparities should target beliefs about anal cancer and barriers to anal Papanicolaou testing in this population. Statistical models suggest that regularly screening gay and bisexual men for anal cancer through anal Papanicolaou (Pap) testing (also called anal cytology) would increase life expectancy similarly to other accepted prevention measures, such as cervical cancer screening, and would be cost effective. We examined beliefs of gay and bisexual men about anal cancer and anal cancer screening, as well as correlates of willingness to receive anal Pap tests. Knowledge Networks identified panel members through list-assisted, random-digit dialing. Panel members received free Internet access or small cash payments for completing multiple Internetbased surveys each month. Of 874 men invited to participate in our study, 609 (70%) completed the online survey. We excluded 12 men whose sexual orientation we could not definitively categorize as either gay or bisexual. Most were non-Hispanic White (81%), had college degrees (56%), reported annual household incomes of $60 000 or higher (60%), had health insurance (86%), and lived in urban areas (93%). Approximately one half were living with a partner or were married (48%); similar percentages of gay (47%) and bisexual (50%) men reported this type of relationship. We cognitively tested the survey with 28 gay and bisexual men and further refined it with 8 additional men prior to beginning the study. The survey first presented basic information about anal cancer, because pilot testing showed that men had low familiarity with the disease: ``Anal cancer forms in the tissues of the anus. The anus is the opening of the rectum (last part of the large intestine) to the outside of the body. We measured awareness of anal Pap tests and then presented basic information about this test, because pilot testing showed that most men were unfamiliar with the procedure. The survey then assessed history of anal Pap testing by asking men when their most recent test occurred, whether they had ever tried unsuccessfully to get an anal Pap test (including the main reason they were unsuccessful), where they would go to get an anal Pap test if they decided to get one, barriers that they believed would prevent them from getting an anal Pap test, perceived effectiveness of anal Pap testing, whether anal Pap testing is only needed for people who have anal intercourse, how often men who have sex with men should get an anal Pap test, and whether they thought doctors recommend anal Pap tests for men who have sex with men. We assessed how willing men would be to get an anal Pap test (1) if it were free, and (2) if it cost $150 out of pocket.
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The lack of research and documentation compounds the stereotypes that bisexuals lead more privileged medications hair loss purchase generic biltricide pills, safer lives than their gay and lesbian contemporaries medications narcolepsy discount biltricide 600mg fast delivery. Department of Justice treatment myasthenia gravis buy biltricide amex, which tracks the race, gender (male or female), and age of victims of all crimes, does not ask about sexual orientation unless the crime is bias-motivated. So we have no large scale government studies of how many bisexuals face domestic violence, sexual assault, murder, police misconduct, and other types of crime. Other cases involving bisexual victims were likely categorized as being anti-homosexual based on the bias language used or on quick assumptions made by the responding officers. In 2004 agencies reporting to the national coalition worked with 59 openly bisexual survivors of hate violence. This number does not include survivors who sought services at mainstream domestic violence agencies. Even when shelters record sexual identity, clients may not be asked directly but rather have staff assume sexual identity based on the gender relationship between the survivor and the batterer. The sparse reporting of violence against bisexuals may lead bisexuals to internalize a sense of safety leading and to a deprioritization of bisexual-related violence prevention, education, and documentation efforts. We as a bisexual community must come together to have a frank conversation about our lived experience of violence before we can expect the broader world to find us in the shadows. Much of it lumps bisexuals into either "lesbian" or "gay male" categories, making it difficult to draw any conclusions about bisexual health. It is important to recognize that many, if not most, bisexual people do not come out to their health care providers or to researchers due to judgments that silence, stereotypes that shame, and assumptions that erase bisexual identity. When a woman is partnered and says she is using birth control, there may be an automatic assumption that she is monogamous and heterosexual. A man in a same-sex relationship is assumed to be gay and therefore not in need of information about sex with women. When a man says he is married or partnered, there are often no subsequent questions asked about other sexual partners. A study published in the American Journal of Public Health 1998 is a perfect illustration. However, the researchers identified all women as simply "women," with no sexual orientation descriptors. In contrast, the men in the study were categorized as either gay men, bisexual men, or heterosexual men. For example, the use of the phrase "heterosexual men as well as men who have sex with men" does not account for men who identify as heterosexual but also have sex with men. Discordance between Sexual Behavior and Self-Reported Sexual Identity: A Population-Based Survey of New York City Men. The researchers concluded that health care providers should pay attention to the interaction effect of these variables. Sexual Health Issues for Bisexual Youth "Everyone thought I was a freak I tried to show off, always had a boyfriend to prove I was okay. Not giving birth may put bisexual women at greater risk for ovarian and endometrial cancers, and teenage pregnancy also has health implications. Bisexual Invisibility: Impacts and Recommendations 23 San Francisco Human Rights Commission communities. The researchers found that, while the overall majority of women do not use barrier protection during oral sex with women, those participants who do use barriers during oral sex with women are most likely to identify as bisexual. Despite that finding, Cochran and Mays reported that "high-risk sexual experimentation. Researchers should be aware of unintentional implications that bisexually-identified clients are not "yet" gay or lesbian and/or are necessarily engaging in high-risk behavior. An article published in 1996 in Family Planning Perspectives reported that female bisexual teens were more likely than their heterosexual counterparts to have a history of physical and sexual abuse. Health care providers working with female teens should be aware of the implications of these findings and should be prepared to give referrals for counseling, birth control, and pregnancy planning advice. In San Francisco and Berkeley, 33 percent of sexual minority young men surveyed had engaged in unprotected sex in the previous six months, and in New York, 28 percent of the sample reported having unprotected sex in the previous year. Youth who explore their sexuality and live with homophobic parents or in abusive foster homes wind up on the streets where they experience substance abuse, greater risk for mental health problems, and may be forced to resort to survival sex in exchange for food, shelter, or money. Older bisexual individuals are at risk for feeling isolated from their community, which may eventually lead depression and social isolation. Sexual intercourse, abuse and pregnancy among adolescent women: does sexual orientation make a difference? For young gays on the streets, survival comes before pride, few beds for a growing class of homeless. Many members of the bisexual community have negative experiences with health care providers, with problems ranging from disclosure of sexual orientation to distribution of improper or incomplete sexual health information. Cheryl Dobinson and colleagues explain that disclosure is important for bisexual clients for many reasons, including. This kind of misinformation has especially devastating effects on youth who are just beginning to explore their sexuality. Bisexual youth are becoming sexually active without being provided with the information they need to responsibly and safely engage in sexual activity. However, in order to receive proper information, youth have to inform even the most sensitive health care providers of their sexual activity and identity. Bisexual Invisibility: Impacts and Recommendations 25 San Francisco Human Rights Commission minority young people in the health care setting. According to the National Association of Pediatric Nurse Practitioners: Most nonheterosexual youths will not disclose their sexual orientation to their primary health care provider without being asked. Therefore, providers should raise issues of sexual orientation and sexual behavior with all adolescent patients in a sensitive clinical environment. Health risks and needs of gay, lesbian, bisexual, transgender, and questioning adolescents. One study of California data was striking, though: it found that while gay men earned 2-3% less than straight men and lesbians 2. While the full pictures of income disparities and poverty contain many subtleties, the data certainly undermine the oftrepeated stereotype that bisexuals hide within straight privilege. Bias in the Workplace: Consistent Evidence of Sexual Orientation and Gender Identity Discrimination. Bisexual Invisibility: Impacts and Recommendations 27 San Francisco Human Rights Commission It is also instructive to look at the most recent report, which tracks grants made in 2009. I felt a little bit ashamed about my bisexuality, but I also figured it was a pretty cool dealthe old saying about it "doubling your chances on Saturday Night" (Woody Allen? In a sense, I have chosen to be invisible in one stigmatized category by wearing the mark of another. One reason may be that bisexuality presents its problems at the intersections with other sexual identities. Approximately 150 organizations were contacted about participating in the survey, of which 30 responded (20% response rate).
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This type of error is referred to treatment xerostomia cheap biltricide 600 mg without prescription as lateral decentering and characterized by a uniform density loss across the radiographic image medications during pregnancy purchase biltricide toronto. If the x-ray beam is both off-center and off-focus below the focusing distance symptoms retinal detachment purchase discount biltricide, the portion of the image below the focus will show increased density; if the x-ray beam is off-center and off-focus above the focusing distance, the image below the focus will show decreased density. So, except for the central area where the lead strips and x-ray beam are vertical, grid cutoff will be severe. A uniform density loss across the radiographic image will occur if the xray beam is off-center laterally. As the lead strips are made taller, or the distance between them decreases, scattered radiation is more likely to be trapped before reaching the image receptor. This results in severe grid cutoff everywhere except in the central portion of the radiographic image. As the number of lead foil strips per inch increases, the lead foil strips must become thinner, and therefore less visible. If the lead strips get thinner, more energetic scattered radiation can pass through them and reach the image receptor. So, to maintain the efficiency of a grid having many lead strips per inch, its grid ratio is often increased as well; that is, the lead strips are made taller to increase the likelihood of their trapping scattered radiation before it reaches the image receptor. The radiolucent interspace material is most frequently made of plastic or fiber particularly in pediatric imaging and mamography; some grids use aluminum as the interspace material. Aluminum is sturdier, it gives the image a smoother appearance free of objectionable grid lines, and can perhaps have an additional filtering effect on scattered radiation. However, a greater increase in patient dose is required with aluminum interspaced grids. Fiber interspace material, on the other hand, can be affected by moisture and result in warping of the grid. Other ways of expressing and measuring grid efficiency include the following: Grid factor-The Grid factor (G) of a particular grid is the ratio of the total amount of radiation (primary and scattered) incident upon the surface of the grid compared to the amount of radiation transmitted Interspace material Lead strips D H W Grid ratio = H:D Figure 1136. Grid ratio is defined as the height of the lead strips (H) to width of the interspace material (W). S= Scattered photon transmission An undesirable but unavoidable characteristic of grids is that they do absorb some primary/useful photons as well as scattered photons. The higher the primary to scattered photon transmission ratio, the more desirable the grid. The definitions of grid ratio and grid frequency do not take into account the thickness of the lead strip; lead content does consider it. Lead content is measured in g/cm2 and expresses the amount of lead contained within a particular grid. How must exposure factors be adjusted to maintain appropriate density when changing from nongrid to grid? How can exposure factors be changed to preserve the density level when changing from one ratio grid to another? In actual practice, the grid conversion factor varies slightly according to kV range used. The conversion factors listed in the chart to the left can be used to calculate grid conversions in exposure factor problems. To reduce the amount of imagedegrading scattered radiation, another image will be made using a 12:1 ratio grid. What new mAs factor will be required in order to maintain the original level of radiographic/image density? Transmitted/ useful radiation Grid factor = Primary total Transmitted total Figure 1137. The grid factor (G) is the grid conversion factor and expresses the total amount of radiation striking the grid surface compared to the amount of radiation transmitted through the grid. To improve scattered radiation cleanup, another image will be made using a 12:1 grid. What new mAs factor will be required to maintain the original level of radiographic/ image density? Using the grid conversion formula shown above and substituting known quantities, 40 4 = x 5 4x = 200 x = 50 mAs required with 12:1 grid. The use of high-ratio grids at low kV levels is discouraged because of the unnecessary patient exposure required. Lower ratio grids (5:1, 6:1) are often used in mobile imaging because they often more (grid) positioning latitude. Remember, to avoid detrimental changes in radiographic density, mAs adjustments are essential when changing grid ratios. A word of caution regarding the use of an inverted (filmscreen) cassette in place of a grid: the results are unpredictable and this practice is discouraged. Appropriate selection and careful use of a grid provides a far more predictable outcome and a diagnostically superior radiographic image. As energetic scattered radiation emerges from the body, it continues to travel in its divergent fashion and, much of the time, will bypass the image recorder. A 6-inch air gap produces an effect similar to an 8:1 grid, while a 10-inch air gap is equivalent to a 16:1 grid. As scattered radiation emerges from the part, it continues to travel in its divergent fashion, bypassing the image receptor. Scattered radiation adds image-degrading densities to the radiographic image (increased density and lower contrast; poor contrast resolution). The production of scattered radiation increases with increases in field size, kV, and thickness and volume of tissue. The single most important way to decrease the production of scattered radiation is to collimate. The amount of scattered radiation reaching the image receptor is decreased through the combined use of collimators and grids. If focused grid requirements are not met, the resulting image will demonstrate a loss of density as a consequence of grid cutoff. The most common way of expressing grid efficiency is by grid ratio and number of lead strips per inch. Because grids remove many x-ray photons that would have contributed to image density, the addition of a grid requires a significant increase in mAs. When implementing a grid or changing grid ratio, a gridconversion factor must be used to determine required mAs change in order to avoid undesirable changes in radiographic/image density. In general-purpose radiographic tubes, the glass envelope usually accounts for approximately 0. This type of filter serves to remove the diagnostically useless xray photons that contribute only to patient (skin) dose.