Student Study Guide symptoms 10 weeks pregnant discount requip 1 mg without a prescription, by Joe Etherton treatment viral pneumonia purchase requip online now, Texas State University (1-4292-3470-9) this helpful student resource offers chapter-by-chapter help for studying and exam preparation medicine keri hilson lyrics purchase requip mastercard. Eileen Achorn medicine woman dr quinn purchase requip, University of Texas at San Antonio Tsippa Ackerman medicine 230 buy cheap requip 0.25mg on line, Queens College Paula Alderette treatment qt prolongation generic 2 mg requip visa, University of Hartford Richard Alexander symptoms nausea fatigue purchase requip 2mg with mastercard, Muskegon Community College Leatrice Allen symptoms 6dp5dt order generic requip canada, Prairie State College Liana Apostolova, University of California, Los Angeles Hal Arkowitz, University of Arizona Randolph Arnau, University of Southern Mississippi Tim Atchison, West Texas A&M University Linda Bacheller, Barry University Yvonne Barry, John Tyler Community College David J. Jacquin, Mississippi State University Annette Jankiewicz, Iowa Western Community College Paul Jenkins, National University Cynthia Kalodner, Towson University Richard Kandus, Mt. San Jacinto College Jason Kaufman, Inver Hills Community College Jonathan Keigher, Brooklyn College Mark Kirschner, Quinnipiac University Cynthia Kreutzer, Georgia Perimeter College, Clarkston Thomas Kwapil, University of North Carolina at Greensboro Kristin Larson, Monmouth College Dean Lauterbach, Eastern Michigan University Robert Lichtman, John Jay College of Criminal Justice Michael Loftin, Belmont University Jacquelyn Loupis, Rowan-Cabarrus Community College Donald Lucas, Northwest Vista College Mikhail Lyubansky, University of Illinois, Urbana-Champaign Eric J. Rodgers, Hawkeye Community College David Romano, Barry University xxxvi Preface Sandra Rouce, Texas Southern University David Rowland, Valparaiso University Lawrence Rubin, St. Thomas University Stephen Rudin, Nova Southeastern University Michael Rutter, Canisius College Thomas Schoeneman, Lewis and Clark College Stefan E. Schulenberg, University of Mississippi Christopher Scribner, Lindenwood University Russell Searight, Lake Superior State University Daniel Segal, University of Colorado at Colorado Springs Frances Sessa, the Pennsylvania State University, Abington Fredric Shaffer, Truman State University Eric Shiraev, George Mason University Susan J. Simonian, College of Charleston Melissa Snarski, University of Alabama Jason Spiegelman, Community College of Beaver County Michael Spiegler, Providence College Barry Stennett, Gainesville State College Carla Strassle, York College of Pennsylvania Nicole Taylor, Drake University Paige Telan, Florida International University Carolyn Turner, Texas Lutheran University MaryEllen Vandenberg, Potomac State College of West Virginia Elaine Walker, Emory University David Watson, MacEwan University Karen Wolford, State University of New York at Oswego Shirley Yen, Brown University Valerie Zurawski, St. Slattery, Clarion University Although our names are on the title page, this book has been a group effort. To the people at Worth Publishers who have helped us bring this book from conception through gestation and birth, many thanks for your wise counsel, creativity, and patience. We also thank our fantastic supplements team: Sharon Prevost, media and supplements editor, for recruiting a talented team of academic authors and helping them bring the supplements to life: Joe Etherton, Texas State University and Judy Levine, Farmingdale State College (we give both of them an extra special shout out of thanks); Meera Rastogi, University of Cincinnati; Joy Crawford, University of Washington; J. Their home was a 28Context and Culture room mansion, called Grey Gardens, in the chic town of East Hampton, New York. But the Beales were not rich soViews of Psychological Disorders Before Science ciety women, entertaining in grand style. They had few visiAncient Views of Psychopathology tors, other than people who delivered food to them daily, Forces of Evil in the Middle Ages and the and they lived in impoverished circumstances. For the most Renaissance part, they inhabited only two of the second-floor rooms Rationality and Reason in the 18th and an upstairs porch. The house, a wood-shingled seaside and 19th Centuries home, was falling apart, the paint on the shingles long since the Transition to Scientific Accounts having been worn away by the elements. These intelligent of Psychological Disorders women were not simply poor recluses, though. They were Freud and the Importance of Unconscious Forces unconventional, eccentric women who fiaunted the rules of the Humanist Response their time and social class. Scientific Accounts of the room had two twin beds, one for Little Edie to use when in the Psychological Disorders room, the other for Big Edie. Big Edie made her bed into an unusual Behaviorism nest of blankets (no sheets), and the mattress was so soiled that the the Cognitive Contribution grime and the cat droppings were indistinguishable. Cats constantly Social Forces walked across the bed or rested on it (or on Big Edie), but there was Biological Explanations no litter box for them. When Big Edie fell off a chair and broke her leg at the age of 80, she refused to leave the house to see a doctor, and refused to allow a doctor to come to the house to examine her leg. As a result, she developed bedsores that became infected and she died at Grey Gardens 7 months later (Wright, 2007). Little Edie althe subfield of psychology that addresses ways covered her head, usually with a sweater that she kept in place with a piece of the causes and progression of psychological jewelry. She professed not to like women in skirts, but invariably wore skirts herself, disorders; also referred to as psychopathology. Although they were odd, could their behavior be chalked up to eccentricity, or did one or both of them have a psychological disorderfi The sort of psychologist who would evaluate Big Edie and Little Edie would specialize in abnormal psychology (or psychopathology), the subfield of psychology that addresses the causes and progression of psychological disorders (also referred to as psychiatric disorders, mental disorders, or mental illness). The Three Criteria for Determining Psychological Disorders Big Edie and Little Edie came to public attention in 1971 when their unusual living situation was described in the national press. Health Department inspectors had raided their house and found the structure to be in violation of virtually every regulation. At the time of the filming, Big Edie was 79 and her daughter 57, and the film captures their unusual lifestyle. To determine whether Big Edie or Little Edie had a psychological disorder we must first define a psychological disorder: A pattern of thoughts, feelings, or behaviors that causes significant personal distress, significant impairment in daily life, and/or significant risk of harm, any of which Big Edie and Little Edie Beale were clearly unconis unusual for the context and culture in which it arises (American Psychiatric ventional and eccentric. As we shall see shortly, the History of Abnormal Psychology all three elements (distress, impairment, and risk of harm) do not need Figure 1. However, when a person with a psychological disorder experiences distress, it is often out of proportion to a situation. Some people with psychological disorders exhibit their distress: They may cry in front of others, share their anxieties, or vent their anger on those around them. But other people with psychological disorders contain their distress, leaving family and friends unaware of their emotional suffering. For example, a person may worry excessively but not talk about the worries, or a depressed person may cry only when alone, putting on a mask to convince others that everything is all right. A person can have a psychological disorder without experiencing distress, although it is uncommon. For instance, someone who chronically abuses stimulant medication, such as amphet1. People who knew them describe daily life, and/or risk of harm determine whether he or she is said to have a the Beale women as free spirits, making the best of life. Little Edie did show significant dislevel: When one or two elements are tress in other ways, though. Although Little Edie appears to be significantly distressed, her distress is reasonable given the situation. Being the full-time caretaker to an eccentric and demanding mother for decades would undoubtedly distress most people. Because her distress makes sense in its context, it is not an element of a psychological disorder. Big Edie, in contrast, appears to become significantly distressed when she is alone for more than a few minutes, and this response is unusual for the context. A person with a psychological disorder may be impaired in functioning at school, at work, or in relationships. But where do mental health clinicians draw the line between normal functioning and impaired functioningfi For instance, after a relationship breakup, every 100 workers, an average of 37 work days per month are lost because most people go through a difficult week or two, though of reduced productivity or absences they still go to school or to work. They may not accomdue to psychological disorders plish much, but they soon begin to bounce back. One type of impairment directly refiects a particular pattern of thoughts: a psychosis is an impaired ability to perceive reality to the extent that normal functioning is not possible. Hallucinations are sensations that are so vivid that the perceived objects or events seem real, although they are not. Hallucinations can occur in any of the five senses, but the most common type is auditory hallucinations, in particular, hearing voices. Rather, this form of psychotic symptom must arise in a context that renders it unusual and indicates impaired functioning. The fact that they lived in such squalor implies an inability to function normally in daily life. Whether the Beales were impaired is complicated, however, by the fact that they viewed themselves as bohemians, set their own standards, and did not want to conform to mainstream values (Sheehy, personal communication, December 29, 2006). Their withdrawal from the world can be seen as clear evidence that they were impaired, though. An impaired ability to perceive reality to the the women also appear to have been somewhat paranoid: In the heat of extent that normal functioning is not possible. The History of Abnormal Psychology Risk of Harm Some people take more risks than others. They may diet too strenuously, exercise to an extreme, gamble away too much money, or have unprotected sex with multiple partners. For such behavior to indicate a psychological disorder, it must be outside the normal range. The criterion of danger, then, refers to symptoms of a psychological disorder that lead to life or property being put at risk, either accidentally or intentionally. They had a handyman come in regularly to her situation; both women appeared to have an impaired ability to function. The risk of harm to to repair fallen ceilings and walls and to fill holes that rats might use to enter the women, however, is less clear-cut. On at least one occasion in her early 30s, Little Edie appears to have been a danger to herself. From then on, her head was at least partially bald, explaining her ever-present head covering. The only aspect of their lives that suggests a risk of harm was the poor hygienic standards they maintained. Context and Culture As we noted earlier, what counts as a significant level of distress, impairment, or risk of harm depends on the context in which it arises. That human waste was found in an empty room at Grey Gardens might indicate abnormal behavior, but the fact that the plumbing was out of order for a period of time might provide a reasonable explanation. Their house was broken into in 1968, and, as relatives of Jackie Kennedy, they had cars with Secret Service agents posted outside their house while John F. To psychologists, culture is the shared norms and valpsychological disorder than those born earlier (Kessler, Berglund, et al. For example, in some cultures, distress may be conveyed by complaints of fatigue or tiredness rather than by sadness or depressed mood. Some sets of symptoms that are recognized as disorders in other parts of the world are not familiar to most Westerners. This disorder may break out in clusters of people, like an epidemic (Bartholomew, 1998; Sachdev, 1985).
Vitamin B12 is synthesized by microorganisms and is obtained by ingesting animal or vegetable products contaminated by bacteria medications 3 times a day purchase requip 0.25mg overnight delivery. After ingestion medications that cause high blood pressure order requip 0.5mg mastercard, it is bound by intrinsic factor medicine overdose purchase requip master card, synthesized by gastric parietal cells treatment neuroleptic malignant syndrome order requip 0.25 mg with visa, and this complex is then absorbed in the terminal ileum medicine assistance programs cheap requip 0.5mg without prescription. Vegans who omit all animal products from their diet often have subclinical vitamin B12 deficiency symptoms after embryo transfer discount 2 mg requip with mastercard. Serum vitamin B12 and folate levels should be measured and antibodies to intrinsic factor and parietal cells should be assayed symptoms by dpo order 0.25mg requip with amex. Intrinsic factor antibodies are virtually specific for pernicious anaemia but are only present in about 50 per cent of cases symptoms 6 week pregnancy requip 1mg low cost. A radioactive B12 absorption test (Schilling test) distinguishes gastric from intestinal causes of deficiency. Rapid correction of vitamin B12 is essential using intramuscular hydroxycobalamin to prevent cardiac failure and further neurological damage. On the first day he felt a little shaky but by the third day he felt very unwell with the fever and had a feeling of intense cold with generalized shaking at the same time. There is a previous history of hepatitis 4 years earlier and he had glandular fever at the age of 18 years. He has had a number of heterosexual contacts each year but says that all had been with protected intercourse. He had returned from Nigeria 3 weeks earlier and was finishing off his prophylactic malaria regime. He had been in Nigeria for 6 weeks as part of his job working for an oil company and had no illnesses while he was there. In the abdomen there is some tenderness in the left upper quadrant of the abdomen. The diagnosis should be confirmed by appropriate expert examination of a blood film. The most important feature in this 24-year-old man is the fever with what sound like rigors. He looks unwell with a tachycardia and some tenderness in the left upper quadrant which could be related to splenic enlargement. Even when it is, it does not provide complete protection against malaria which should always be suspected in circumstances such as those described here. The risk might be assessed further by finding which parts of Nigeria he spent his time in and whether he remembered mosquito bites. Measures to avoid mosquito bites such as nets, insect repellants and suitable clothing are an important part of prevention. Other acute viral or bacterial infections are possible but are less likely to explain the abnormal results of some investigations. The diagnostic test for malaria is staining of a peripheral blood film with a Wright or Giemsa stain. Treatment depends on the likely resistance pattern in the area visited and up-to-date advice can be obtained by telephone from microbiology departments or tropical disease hospitals. Falciparum malaria is usually treated with quinine sulphate because of widespread resistance to chloroquine. A single dose of Fansidar (pyrimethamine and sulfadoxine) is given at the end of the quinine course for final eradication of parasites. However there is increasing resistance to quinine, and artemesinin derivatives are increasingly becoming the first-line treatment for falciparum malaria. In severe cases hyponatraemia and hypoglycaemia may occur and the sodium here is marginally low. Most of the severe complications are associated with Plasmodium falciparum malaria. They include cerebral malaria, lung involvement, severe haemolysis and acute renal failure. Over the past few weeks she has felt as if she was feverish and has developed night sweats. She and her two children, aged 4 and 6 years, have come from Nigeria to visit her husband who has been in this country for 2 years. She has had occasional fevers over the last 10 years and these have been treated presumptively as malaria with a good response. She has been otherwise well, although her periods have been irregular over the last 3 months. There are no abnormalities in the cardiovascular or respiratory systems and there are no lymph nodes palpable. The length of the symptoms makes infections such as malaria unlikely, although this should be checked since she arrived from Nigeria and combined infections are possible. A very important finding is that immature red and white cells are seen in the peripheral blood. This leucoerythroblastic anaemia indicates bone-marrow replacement by tumour or infection forcing immature cells out into the blood. Miliary tuberculosis is characterized by tuberculous granulomata throughout the body due to widespread dissemination of tubercle bacilli. It is now usually seen in elderly persons and the diagnosis is often only made at autopsy. There may be choroidal tubercles in the eyes on funduscopy and hepatosplenomegaly. Biopsy of her liver and bone marrow may show tubercle bacilli or caseating granulomas. The tuberculin test may be negative because of immunoincompetence induced by the disease. Antituberculous treatment with four agents must be started immediately once biopsy material has been obtained. In a woman of child-bearing age a pregnancy test should be done, particularly in the face of menstrual irregularities. Tuberculosis is a notifiable disease and the diagnosis should be notified and arrangements made to screen her children and any other close contacts. Although eligibility for treatment needs to be assessed by appropriate managers, this woman has an acute life-threatening illness and is a potential infective risk to others. He works as a solicitor and describes episodes where he has fallen asleep in his office. He finds it difficult to concentrate at work, and has stopped playing his weekly game of tennis. He had an episode of depression 10 years ago related to the break-up of his first marriage. On direct questioning, he has noticed that he has become more constipated but denies any abdominal pain or rectal bleeding. Examination of his cardiovascular, respiratory and abdominal systems is unremarkable. The differential diagnosis is extensive and includes cancer, depression, anaemia, renal failure and endocrine diseases. He has a past history of depression, but currently has no obvious triggers for a further episode of depression. He is not waking early in the morning or having difficulty getting to sleep, which are common biological symptoms of severe depression. Insidious onset of fatigue, difficulty concentrating, increased somnolence, constipation and weight gain are features of hypothyroidism. Hypothyroidism typically presents in the fifth or sixth decade, and is about five times more common in women than men. Obstructive sleep apnoea is associated with hypothyroidism and may contribute to daytime sleepiness and fatigue. On examination the facial appearances and bradycardia are consistent with the diagnosis. Characteristically patients with overt hypothyroidism have dry, scaly, cold and thickened skin. Scalp hair is usually brittle and sparse, and there may be thinning of the lateral third of the eyebrows. Bradycardia may occur and the apex beat may be difficult to locate because of the presence of a pericardial effusion. A classic sign of hypothyroidism is the delayed relaxation phase of the ankle jerk. Other neurological syndromes which may occur in association with hypothyroidism include carpal tunnel syndrome, a cerebellar sydrome or polyneuritis. Clues to the diagnosis in the investigations are the normochromic, normocytic anaemia, marginally raised creatinine, and hypercholesterolaemia. The anaemia of hypothyroidism is typically normochromic, normocytic or macrocytic; microcytic anaemia may occur if there is menorrhagia. Renal blood flow is reduced in hypothyroidism, and this can cause the creatinine to be slightly above the normal range. The most severe cases of hypothyroidism present with myxoedema coma, with bradycardia, reduced respiratory rate and severe hypothermia. The most common cause of hypothyroidism is autoimmune thyroiditis and the patient should have thyroid autoantibodies assayed. Elderly patients or those with coronary heart disease should be started cautiously on T4 because of the risk of precipitating myocardial ischaemia. The swelling started at the ankles but now his legs, thighs and genitals are swollen. He had hypertension diagnosed 13 years ago, and a myocardial infarction 4 years previously. He continues to smoke 30 cigarettes a day, and drinks about 30 units of alcohol a week. Examination On examination there is pitting oedema of the legs which is present to the level of the sacrum. His apex beat is not displaced, and auscultation reveals normal heart sounds and no murmurs. The liver, spleen and kidneys are not palpable, but ascites is demonstrated by shifting dullness and fluid thrill. Unilateral oedema is most likely to be due to a local problem, whereas bilateral leg oedema is usually due to one of the medical conditions listed above. Pitting oedema needs to be distinguished from lymphoedema which is characteristically non-pitting. If the oedema is pitting, an indentation will be present after pressure is removed. The major differential diagnoses are cardiac failure, renal failure, nephrotic syndrome, right heart failure (cor pulmonale) secondary to chronic obstructive airways disease or decompensated chronic liver disease. The frothy urine is a clue to the diagnosis of nephrotic syndrome and is commonly noted by patients with heavy proteinuria. The patient has signs of bilateral pleural effusions which may occur in nephrotic syndrome, if there is sufficient fluid retention. The bruising and peri-orbital purpura is classically seen in patients with nephrotic syndrome secondary to amyloidosis. The normochromic, normocytic anaemia is typical of chronic disease and is a clue to the underlying diagnosis of amyloidosis. Patients with amyloidosis may have raised serum transaminase levels due to liver infiltration by amyloid. The patient should have a renal biopsy to delineate the cause of the nephrotic syndrome. The exception is the patient with long-standing diabetes mellitus, with concomitant retinopathy and neuropathy, who almost certainly has diabetic nephropathy. A bone marrow aspirate showed the presence of an excessive number of plasma cells, consistent with an underlying plasma cell dyscrasia. Patients with amyloidosis should have an echocardiogram to screen for cardiac infiltration, and if the facilities are available a serum amyloid P scan should be arranged which assesses the distribution and total body burden of amyloid. The initial treatment of this patient involves fluid and salt restriction, and diuretics to reduce the oedema. He should be anticoagulated to reduce the risk of deep vein thrombosis or pulmonary embolus. Definitive treatment is by chemotherapy supervised by the haematologists to suppress the amyloidogenic plasma cell clone. Patients with nephrotic syndrome secondary to amyloidosis usually progress to end-stage renal failure relatively quickly. The man has recently retired, and returned 2 weeks ago from a coach trip to Eastern Europe and Russia. Staphylococcal food poisoning occurs within a few hours and typically presents abruptly and may be severe but short-lived. Campylobacter, Salmonella and Shigella cause more severe symptoms than viral gastroenteritis. The incubation period for giardiasis is typically about 2 weeks, but varies from 3 days to 6 weeks. Giardia lamblia infects the small intestine and causes a watery, yellow, foul-smelling diarrhoea. The history should try to distinguish between the smalland large-bowel origin of the diarrhoea. Large-bowel diarrhoea tends to be maximal in the morning, pain is relieved by defaecation, and blood and mucus may be present. By contrast diarrhoea of small-bowel origin does not occur at any particular time, and pain is not helped by defaecation. Typically a pale fatty stool without blood or mucus occurs in small-bowel disease. Other pathogens which cause small-bowel diarrhoea include Campylobacter, rotavirus, Cryptosporidia and Strongyloides. If small-bowel-type diarrhoea persists, other non-infective causes of malabsorption should be considered such as tropical sprue, coeliac disease, and chronic pancreatitis. Giardia lamblia occurs worldwide especially in the tropics but also is endemic in Russia, and infection occurs commonly in visitors to St Petersburg. Poor sanitation and untreated water supplies are important factors in transmission. Outbreaks can occur in residents of nursing homes, and giardiasis is a common cause of diarrhoea in homosexuals. If stool samples are negative, cysts can be found on jejunal biopsy or by sampling duodenal fluid by asking the patient to swallow the Enterotest capsule. Ideally a stool sample should be examined 6 weeks after treatment to ensure the parasite has been eradicated. This has developed over the past 10 days, and she is now breathless after walking 50 yards. About 2 weeks ago she had a flu-like illness with generalized muscle aches and fever. She feels extremely tired and has noticed palpitations in association with her breathlessness. In addition she has some discomfort in her anterior chest which is worse on inspiration. Profound hypocalcaemia, hypophosphataemia, and hypomagnaesaemia can all cause myocardial depression. The clinical picture of myocarditis is non-specific, but common symptoms include myalgia, fatigue, shortness of breath, pericardial pain and palpitations. Patients usually have a marked sinus tachycardia disproportionate to the slight fever. There may be atrial or, more commonly, ventricular arrhythmias or signs of conducting system defects. Chest X-ray may be normal if the myocarditis is mild, but if there is cardiac failure there will be cardiomegaly and pulmonary congestion.
The dates when these schools and other private communities would be agreed between the respective health management team and the management of such an institution medicine to stop contractions buy requip visa. Health Facility based delivery is the most convenient and cost effective way of delivering the vaccine treatment broken toe generic requip 0.5 mg with mastercard. However medications after stroke requip 1 mg overnight delivery, should pockets of unvaccinated girls be identified medicinebg buy discount requip on-line, locations outside the health facilities would be considered for use to access missed girls symptoms of strep requip 1mg with visa. Please provide details of demand generation activities to encourage girls to come to the health facilityfi If the country does not plan to link with schools please provide a justification for this decision medications blood donation buy requip 0.5mg otc. School registers will not only serve as primary sources of verifying numbers during both microplanning and implementation but also means of verifying the age of the eligible school going girls as well treatment 7th march cheap 2 mg requip. Post implementation treatment xanax withdrawal buy generic requip 1 mg on line, school records such as the registers would be key in verifying the numbers of girls who would have been missed per school so that where possible in the two week period, appropriate follow up actions can be undertaken. Describe what follow-up mechanism will be used to ensure girls receive their second dose. The MoE and the teachers will be actively engaged throughout the process of both vaccine delivery and also follow-up action. Community sensitisation and awareness raising will be critical to the successful roll-out of the vaccine. No community venues have been deliberately planned outside those that are routinely used as designated vaccination points. New community venues as suggested by community members through their leaders would be considered also bearing in mind the potential population to be reached otherwise schools and health facilities would remain the primary points of vaccination Will this approach be used for every yearfi This is already part of the routine immunisation system of structures as well as the child health week. During the vaccinations, they would support crowd control and oversight on safety and waste boxes and waste movement to the point of storage before disposal by the environmental health officers in collaboration with the Zambia Environment Management Agency. Will additional personnel need to be hired in order to vaccinate the introduction year multi-age cohortsfi Where the district may not have enough staff, nearby districts would be able to provide the required staff. Microplanning would inform this to the best detail enough to determine how many health workers would be require in each area and therefore how many more to add to the already existing would be required. What interventions will be established to increase community based acceptance and increase community supportfi Early and timely engagement of the communities at several fronts would be the mainstay but direct contact through the community based volunteer would be expected to strengthen that task. Uniformity of the message would also imply the moderately educated community volunteers would have one message to carry to the community. This strategy also provides designated outreach points as closest points for the out-of-school girls to receive the service within their communities as most of these pre-determined outreach points follow clusters of settlements. These meetings will allow the registers to be fully updated and reconciled after the year one activities. In the second year the registers will be utilised to track girls for the second dose and missing girls will be identified. Lists of missing girls will be shared with teachers to ascertain whether they have transferred from the school or they were just absent on the day of vaccination. Social mobilisation will be an on-going activity during preparation, vaccine roll-out and in the follow-up period. Zambia recently introduced rubella vaccine in routine immunisation through a very successful one off campaign. These have increasingly not been required with recent expansions of the Zambian health work force. Health facilities Schools Designated outreach points Will this delivery strategy be used for every yearfi Experiences from the demonstration showed us that direct engagement with the community, however far or otherwise hard to reach, supplemented by generic means like radio announcements and radio station messages 6. Government supplies these facilities with the necessary commodities for the Child Health Week. The Social mobilisation committee will be responsible for supporting the Ministry of Health Spokesperson to deliver prepared communication messages, manage the media conferences and press releases. Guidelines will be prepared on how to communicate during and after rumors and misconceptions. Past experience has shown that if any media reports about introduction of new vaccines and potential side effects, many media channels pick it up and disseminate the news through print media or radio stations, the consequence can be disastrous and parents will not take their children for vaccination, which will affect coverage. This committee will meet to plan before, monitor progress during the crisis and review and map way forward after a crisis. The Ministry of Health with the Ministry of Education are partnering on an initiative to introduce schools to the Youth Friendly corners in health facilities in the area. The goal is to have a focal point person in each public school (both primary and secondary) who will refer pupils to health centres when a problem that is beyond the school counseling unit. Another MoH initiative is training out of school adolescents within communities to be peer-educators and provide education on health-related issues through drama and interpersonal interactions in communities and schools. Every public school (both primary and secondary) has a school health programme, providing services such as personal hygiene, sanitary hygiene and disposal, washing hands after using the toilet, feeding programme for disadvantaged children, eyes, throat, ear, nose and dental checks, etc. This programme is not yet operating an optimal level and there have been concerns with consistency and quality of the interventions. Inadequate funding has been identified as the biggest barrier to the successful roll-out of a comprehensive school health programme focused on adolescents. There will be on-going discussions with key partners in the country to seek supplemental support to reinvigorate the school health programme. Has there been an evaluation and if so, how was it evaluated and what were the findingsfi For girls in the communities, there are several non-governmental, community and faith-based organisations that conduct health educations sessions with adolescents. Another initiative for in and out of school youth, implemented by Family Health Trust in 5 Provinces is called Dance for Life, it builds life skills such as self-esteem, leadership, and assertiveness. This programme started in 2015 and is currently training adolescents, peerleaders, and health workers who will be serving as community linkages between the health facilities and the youth for programme implementation. Between 2012 and 2016, this application has reached 64,313 males and 40,646 females. Of those, 533 are between 10 and 14 years of age, and 16,903 are between 15 and 19 years. The country has health education targeting 9 13 years providing guidance and counselling life skills. School health programs are mandatory, and are provided regularly at both primary and secondary levels. The content is examinable in the final primary examinations (grade seven examinations). Agreed health topics are included in school curriculum on health, taught by teachers and school nurses where available or by clinic staff if there no school nurse. For improving adolescent immunization platform (this can include integration with: other vaccines provided to adolescents. This achievement provides critical evidence that combined efforts between government and civil society lead to improved health service uptake. June 2018 Please note that, due to a variety of factors, the launch date may vary compared to the date stipulated in the application. Please summarise the cold chain capacity (at central and other levels) and readiness to accommodate new vaccines, taking into consideration training, cold chain equipment and other logistical requirements. If cold chain expansion is required, state how it will be financed, and when it will be in place. For example in Lusaka District will pick up twice in a month verses one in a month if necessary. This will create the capacity for the central level to hold stock pending distribution to the provinces and districts. The country also has an ongoing cold chain expansion strategy at lower levels to accommodate new vaccines and to address the increased number of health facilities and health posts being constructed. At National level 40m3 x 5 cold rooms were installed to expand vaccine storage capacity. At provincial level, all provinces have one cold room each installed with varying capacities ranging from 30-40m3. District and health facility levels cold chain expansion has also been conducted across the country with 1680 vaccine refrigerators installed. About 660 cold boxes and vaccine carriers were procured and distributed across the country. A few kerosene and gas fridges exist but are on the verge of being decommissioned. To respond to some of the challenges the country experienced with cold chain, the ministry is implementing a replacement plan for all kerosene and gas refrigerators and shifting to the solar direct drive, which have larger capacity with less maintenance costs. The ministry through the fixed Government budget and with support from partners will continue to procure of cold chain to cater for anticipated or newly opened health facilities and to replace broken down and obsolete equipment. The vaccine supply chain of the country is made up of four levels which are the Central, provincial, district and service delivery. Districts collect vaccines from the Provinces monthly and in turn districts to service delivery facilities collect from district stores monthly as well. Vaccine and dry supplies delivery between levels is mainly provided through government funding to all the four levels with partner support coming in on a few occasions especially between district to health facility level. Co-financing information the co-financing requirement applies to vaccines for the routine cohort. However, Gavi will fully finance vaccines for the additional multi-age cohort during the introduction year. If you would like to co-finance an amount higher than the minimum, please provide information in Your co-financing row. Country group Preparatory transition phase 2018 2019 2020 minimum co-financing per dose 0. Specifications of vaccinations with new vaccine for routine cohort Source 2018 2019 2020 2021 Number of girls in routine cohort to Table 5. Specifications of vaccinations with new vaccine for additional multi-age cohort Source 2018 2019 2020 2021 Number of girls in the additional multi-age cohort to be vaccinated Table 5. Information on these extra costs and fees will be provided by the relevant Procurement Agency as part of the cost estimate to be requested by the Country. The total co-financing amount does not contain the costs and fees of the relevant Procurement Agency, such as contingency buffer and handling fees. Planning and training at district level for health workers and planning and training for community volunteers. Where Gavi support is not enough to cover the full needs, please describe other sources of funding and the expected amounts to be contributed, if available, to cover your full needs. It is also anticipated that the government will fund new vaccine introduction over and above the existing expenditure toward health delivery in the country. Note: these funds can be used over a longer period than the introduction year in order to strengthen routine immunisation. For example to reinforce routine outreach activities in difficult to access districts. In the first year, this grant will target ages 9-14 throughout all targeted schools. For instance, during introduction trainings, we also reinforce skills for routine immunisations. Additional demand generation activities will take place during the introduction campaign, these activities will also include traditional vaccines. During the catch up phase, in the third year, there will be additional teams that will require to be trained, mobilised for vaccinations services in the schools, outreach posts, additional requirement to distribute vaccines, monitoring activities for the additional teams during the catch-up. In addition activities will include community mobilisation, and printing of additional monitoring tools. The government of the republic of Zambia will foot most of the budget that would not be captured under Gavi, the Vaccine Alliance. This immunisation allocation includes funds for co-financing obligations, procurement of traditional vaccine, procurement of under five cards and cold chain equipment and general programme management. It is expected that the actual breakdown will be clearer once parliament approves the budget. The aforemntioned increases clearly shows that the amounts being allocated to the Government are well within what has been set aside in the budget. It is therefore anticipated that the government will fund new vaccine introduction over and above the existing expenditure toward health delivery in the country. Distribution down the ladder is by pull system, done quarterly at provincial and monthly at district levels. The Government of the Republic of Zambia Public Finance Act and related financial regulations, as well as generally accepted accounting principles, will be used to account for the resources which will be received under the grant. While the Zambia Public Procurement Act will apply to all Procurements under the grant. Monitoring of performance will be conducted through data review of administrative reports including number of girls vaccinated, fully vaccinated and drop out rate. Tally sheets will be used to capture daily vaccinations and reported at the end of each day to the district, province, and national command centres. Note that the necessary time for licensure should be factored into the introduction timeline and reflected in the Vaccine Introduction Plan or Plan of Action. For each of the vaccine(s) requested, please provide the actual licensure status of the preferred presentation and of any alternative presentations, if required. Please describe local customs regulations, requirements for pre-delivery inspection, special documentation requirements that may potentially cause delays in receiving the vaccine. This should include details on sufficient availability of waste management supplies (including safety boxes), the safe handling, storage, transportation and disposal of immunisation waste, as part of a healthcare waste management strategy. An official immunization record from your doctor or another school will be accepted. Due dates for undergraduate students: July 8, 2020 for Fall 2020 semester start and December 13, 2020 for Spring 2021 start. Disclosure documents are reviewed for potential conflicts of interest and, if identified, they are resolved prior to confirmation of participation. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People. Moscicki et al (2012) Updating the Natural History of Human Papillomavirus and Anogenital Cancers. Peitzmeier et al (Forthcoming) Pap Test Use Lower among Female-to-Male Patients than Non-Transgender Women. Identify strategies that providers can use to address these systems, interpersonal, and technical barriers, including specific techniques for adjusting the Pap exam 4. Saslow et al (2012) American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology Screening Guidelines for the Prevention and Early Detection of Cervical Cancer. This article focuses on Malawi, but the issues are relevant to other lowincome settings. Our studies of a most common female cancer, with approximately 528,000 screening population in Nkhoma in rural Malawi suggest a cancers in 2012 (1, 2). Persistence of infection and progression to cancer Expanded vaccination of adult women 3 doses regimen may therefore be linked to a failure of the immune response, Secondary prevention: Papanicolaou. Cervical cancer has become a screening approach used in any particular context (country, rare disease in high-income countries, and there is widespread or healthcare facility) dependent on factors that include the consensus that these very substantial benefts would not balance of benefts and harms, the potential for women to be lost have come about in the absence of substantial investments to follow-up, cost and availability of the necessary equipment in screening (24). Organized screening thermo-ablation) programmes seek to ensure that the steps of call and recall Different approaches are needed in poor regions of the world. In recent years there has been renewed these barriers constitute an enormous challenge if we are interest in use of thermo-coagulation (also known as cold to improve cervical cancer prevention in poor countries such coagulation or increasingly, thermal ablation) to treat cervical as Malawi. Both screening test (Qiagen), concluded further developments were vaccines have been in use in different countries since 2006. Tanzania is now in the second year of a trained healthcare professional, it would be quicker to provide demonstration project, delivered in schools by campaign weeks. There is therefore considerable Malaysia was the frst Muslim country to introduce a national interest in self-collected specimens. She is currently Chair of the Screening Cervical cancer impacts family, community and national life. Recent and ongoing projects span the cancer journey from are beyond the scope of this article. Nonetheless, it is important screening through symptomatic diagnosis and survivorship, but with to recognise that such evidence is available. Non-communicable an emphasis on cancer screening both within the United Kingdom diseases, including cervical cancer, have been shown to adversely and in sub-Saharan Africa. She leads a programme of research in the interface of and international research and government committees on cancer, cancer and primary care. Comparison treat approach for the treatment of cervical precancerous lesions in sub-Saharan Africa. Reproductive health carcinoma and 1,374 women with adenocarcinoma from 12 epidemiological studies. Barriers to utilisation of cervical cancer screening in Sub Sahara Africa: 368-83. Integrated Review of Barriers to Cervical 27 Cancer Screening in Sub-Saharan Africa. Bruni L, Diaz M, Barrionuevo-Rosas L, Herrero R, Bray F, Bosch X, de Sanjose S, 18. Global estimates of human papillomavirus vaccination coverage by papillomavirus, human immunodefciency virus and immunosuppression. The cervical cancer epidemic that screening of invasive cervical cancer: follow-up of four European randomised controlled trials. Breast and cervical cancer screening programme implementation in 16 testing for the detection of cervical cancer.
Under stress medicine quotes generic requip 0.25mg fast delivery, a person with a fixation might regress to the thoughts medications safe in pregnancy buy requip 0.25mg low price, feelings medicine 66 296 white round pill cheap requip 1 mg free shipping, and behaviors of the earlier stage brazilian keratin treatment purchase generic requip pills. For example medications prescribed for ptsd generic 1mg requip visa, according to Freud (1905/1955) medicine 751 m discount requip amex, people with a fixation at the oral stage use food or alcohol to alleviate anxiety treatment diabetes purchase requip no prescription. Mental Illness symptoms flu buy 0.25 mg requip fast delivery, According to Freud Freud proposed two general categories of mental illness: neuroses and psychoses. A neurosis is a pattern of thoughts, feelings, or behaviors that expresses an unresolved confiict between the ego and the id or between the ego and the superego. For instance, parents who are too strict about toilet training their toddler may inadvertently cause their child to become fixated at the anal stage. He revolutionized treatmarked by persistent and repetitive thoughts and behaviors (American Psychiatment of psychological disorders by listening to ric Association, 2000). Conflicts and threats do not necessarily cause psychological disorders, but they may do so when a particular defense mechanism is relied on too heavily. Psychoan unresolved confiict between the ego and the dynamic theorists have focused on areas that Freud did not develop fully: id or between the ego and the superego. Rationalization Justifying the confiict-inducing After a father hits his thoughts, feelings, or daughter, he justifies his behaviors with explanations behavior to himself by saying she deserved it. Reaction Formation Transforming the confiictYour feelings of attraction to inducing thoughts or feelings your colleague at work are into their opposite transformed into distaste and disgust, and you begin to feel repulsed by the colleague. Treatment based on psychodynamic theory is generally referred to as psychodynamic therapy and will be discussed in Chapter 4. Another challenge is that the theory is not generally amenable to scientific testing. For instance, a fear of eating dust could be due to a sublimation of sexual impulses (a fixation at the oral stage) or a reaction formation to an unconscious desire to play with fecal matter (a fixation at the anal stage). The problem the History of Abnormal Psychology 21 is not that there can be more than one hypothesis based on psychodynamic theory, but rather that there is no evidence and no clear means for obtaining evidence that either hypothesis (or both) is correct. These psychologists proposed a different view of human nature and mental illness that came to be called humanistic psychology, which focuses on free will, innate goodness, creativity, and the self (Maslow, 1968). For example, suppose a woman believes she should always be energetic (ideal self), but her real self is someone who is often energetic, but not always. The incongruence between the two selves can lead her to feel bad about herself, which in turn creates feelings of apathy and guilt. However, although the emphasis on self-empowerment has proven useful, the humanist approach falls shorts as a general method for conceptualizing and treating mental illness. Building on the humanist nomenclature, other clinicians have recognized that clients are consumers of mental health services who often choose from a variety of possible treatments. Nevertheless, it is also acceptable to use the term patient, and in this book we use the term patient and patients to emphasize the suffering and distress experienced by people with psychological disorders. Lasting Contributions of Psychodynamic and Humanist Approaches As the humanist response made clear, psychodynamic theory was not solidly rooted in science. Nevertheless, despite its limitations, psychodynamic theory rested on a fundamental insight that was crucial for the development of later theories and treatments: Mental processes are the internal operations that underlie cognitive and emotional functions (such as perception, memory, and guilt feelings) and most human behavior. Furthermore, the notion that cognitive and emotional functions (such as some mental processes and mental contents are hidden away from consciousness perception, memory, and guilt feelings) and has proven invaluable to understanding psychopathology. Moreover, psychodynamic approaches cleared the way for more scientific the specific material that is stored in the approaches to understand psychological disorders, which we consider next. Mental agnosis and treatment; he also proposed an extensive theory of illness can take the form of neurosis or psychosis. Moreover, he proposed that the mind moment-to-moment interactions between child and parent can is structured so as to function across three levels of consciouscontribute to psychological disorders. Various forms of psychoness: the conscious, the preconscious, and the unconscious. A drawback awareness but nonetheless infiuence thoughts, feelings, and of psychodynamic theory is that it has proven difficult to test behaviors. The ego frequently employs defense mechanisms to transcan occur when there is incongruence between the ideal and form confiict in a way that prevents unacceptable thoughts and real selves. Rogers developed client-centered therapy to defeelings from reaching consciousness. For healthy psychological such processes and contents can be hidden from awareness. Scientific Accounts of Psychological Disorders In the early 20th century, advances in science led to an interest in theories of psychological disorders that could be tested rigorously. Several different scientific approaches (and accompanying theories) that emerged at that time are still with us today; they focus on different aspects of psychopathology, including behavior, cognition, social forces, and biology. These scientific accounts and theories have thrived because studies have shown that they explain some aspects of mental illness. Behaviorism All of the views discussed so far focus on forces that affect mental processes and mental contents. However, some psychologists in the early 20th century took a radically different perspective and focused on directly observable behaviors. For instance, to the extent that using a drug has pleasurable consequences, an individual is more likely to use the drug again. After investigating why this latter salivation might occur, he determined that the dogs began salivating when they heard the approachBehaviorism focuses on observable behaviors ing footsteps of the person feeding them. Big Edie appears to have developed maladaptive behaviors related to a fear of being alone. This may have been a result of past negative experiences with (and the resulting associations to) being alone. The behaviorist approach has also accounted for some aspects of substance abuse, including alcoholism, which can arise because of the association between drinking and feeling more relaxed soon after drinking: Based on past experiences with alcohol, someone who wants to become less tense may reach for a bottle. Behaviorists have discovered different ways that associations can be learned, and each sort of learning can affect psychological disorders (we will discuss forms of learning in Chapter 2 and treatments based on these forms of learning in Chapter 4). Rather, mental processes and mental contents are clearly involved in the development and maintenance of many psychological disorders. The Cognitive Contribution Psychodynamic and behaviorist explanations of psychological disorders seemed incompatible. Psychodynamic theory emphasized private mental processes and mental contents; behaviorist theories emphasized directly observable behavior. Then, the late 1950s and early 1960s saw the rise of cognitive psychology, the area of psychology that studies mental processes starting from the analogy of information processing by a computer. Researchers developed new, behaviorally based methods to track the course of hidden mental processes, and these mental processes began to be demystified. If a mental process is like a computer program, direct connections can be made between observable events (such as changes in the time it takes to respond to different stimuli) and mental processes. For instance, a man who is very anxious in social situations may pay excessive attention to whether other people seem to be looking at him; when people glance in his general direction, he will then notice the direction of their gaze and infer that they are looking at him. For example, people who are depressed often think very negatively and inaccurately about themselves, the future, and the world. They think that they are inept, ugly, or unlovable or they have other equally unhappy thoughts. They often believe that they will always be so, and that no one will care about them; or, if someone does care, this person will leave as soon as he or she sees how really inept, ugly, or unlovable the depressed person is. Cognitive therapy might have been appropriate for the Beale women, who had unusual beliefs. Consider the fact that Little Edie worried about leaving her mother alone in her room for more than a few minutes because she might come back and find her mother dead, or that a stranger might break in, despite the fact that the windows were nailed shut (Graham, 1976). One time, a big kite was hovering over Grey Gardens and she called the police, concerned that the kite was a listening device or a bomb (Wright, 2007). The focus on particular mental processes and mental contents illuminates some aspects of psychological disorders. Social Forces We can view behavioral and cognitive explanations as psychological: Both refer to thoughts, feelings, or behaviors of individuals. In addition to these sorts of factors, we must also consider social factors, or factors that involve more than a single person. There is no unified social explanation for psychological disorders, but various researchers and theorists in the last half of the 20th century recognized that social forces affect the emergence and maintenance of mental illness. Many of these social forces, such as the loss of a relationship, abuse, trauma, neglect, poverty, and discrimination, produce high levels of stress. Looking at the earliest years of life, Freud had a valuable insight when he recognized that the way parents treat their children can make them more vulnerable to mental illness. Two researchers who focused on the interactions between the infant and the primary caretaker were John Bowlby (1969) and Mary Ainsworth (1989; Ainsworth & Bell, 1970). They examined attachment style, which characterizes the particular way a person relates to intimate others. These children became upset when their mother left, but quickly calmed down upon her return (Ainsworth & Bell, 1970). These children became angry when their mother left and remained angry upon her return, sometimes even hitting her (Ainsworth & Bell, 1970). These children exhibited a combination of resistant style have a higher likelihood of subsequently and avoidant styles, and also appeared confused or fearful with their mother developing symptoms of psychological disorders (Main & Solomon, 1986). Children who did not have a secure attachment style (those with a resistant/anxious, avoidant, or disorganized style) were more likely to develop symptoms of psychological disorders (Main & Solomon, 1986; Minde, 2003). However, attachment styles can be different in different cultures; these four attachment styles and their association with psychological disorders are not necessarily accurate descriptions of attachment styles for all cultures or countries (Rothbaum et al. For example, researchers have found that healthy relationships can mitigate the effects of a variety of negative events, such as abuse (during childhood or adulthood), trauma, discrimination, and financial hardship. Their extended family and their community ostracized them, at least in part because they were independent-minded and artistic women. In addition, Little Edie endured her own unique social stresses: Both her parents were excessively controlling, though in different ways. Like the other factors, social factors do not fully account for how and why psychological disorders arise. Biological Explanations As some researchers explored the behavioral, cognitive, and social factors that contribute to psychological disorders and their treatment, other researchers continued to focus on biological causes of psychological disorders and their medical treatments. The final stage of this disease damages the brain and leads to abrupt changes in mental processes, including psychotic symptoms (Hayden, 2003). The discovery of a causal link between syphilis and general paresis heralded a resurgence of the medical model, the view that psychological disorders have underlying biological causes. In fact, antibiotics that treat syphilis also prevent the related mental illness, which was dramatic support for applying the medical model to at least some psychological disorders. Since that discovery, scientists have examined genes, neurotransmitters (chemicals that allow brain cells to communicate with each other), and abnormalities in brain structure and function associated with mental illness. As we shall see throughout this book, multiple factors usually contribute to a psychological disorder, and treatments targeting only the bacterium Treponema pallidum is responsible biological factors are not necessarily the most effective. Unfortunately, the documentaries and biographies about the two women changes in mental processes, including psychotic have not addressed this issue, so there is no way to know. We might be tempted to infer that such tendencies in this family refiect an underlying genetic predisposition, but we must be careful: Families share more than their genes, and common components of the environment can also contribute to psychological disorders. The Modern Synthesis of Explanations of Psychopathology In the last several decades, researchers and clinicians increasingly recognize that psychological disorders cannot be fully explained by any single type of factor or theory.
