While many of these practices are not harmful mental disorders caused by genetics generic lyrica 150mg overnight delivery, the widespread beliefs that menstrual blood is polluting and dangerous disorders of brain journal of neurology order lyrica 75 mg with visa, and that the menstruating body is weak and shameful mental health kalispell mt buy lyrica 75 mg otc, lead to behaviours that expose women to health risks mental illness quiz schizophrenia buy cheap lyrica 150mg. Amina meets regularly with Shopna mental health outcome measures generic lyrica 75 mg with mastercard, Monira and girls in local schools to speak to them about hygiene mental health board best 150 mg lyrica, especially menstrual hygiene. Some of these links are highlighted below: Article 11 of the International covenant on economic, social and cultural rights affirming that it is derived from the right to an adequate standard of living and the right to the highest attainable standard of physical and mental health, as well as a right to life and human dignity. Article 14(2)(h) of the Convention on the elimination of all forms of discrimination against women, which obliges states to eliminate discrimination against women in rural areas and ensure they have adequate living conditions, especially housing, sanitation, electricity and water supply, transport and communication. The Convention on the right of persons with disabilities establishes that the right to social protection requires states parties to ensure access by persons with disabilities to clean water services. The Convention on the rights of the child obliges states parties to take appropriate measures to combat disease and malnutrition through the provision of clean drinking water (Article 24(2)(c)) and to promote basic education and support the use of basic knowledge regarding hygiene and environmental sanitation (Article 24(2)(e)). It is also clear that several of the Millennium Development Goals will not be met unless menstrual hygiene needs have been responded to (see Table 9. This should be a key message when advocating menstrual hygiene to decision-makers. Women and girls have to manage their menstruation during school, at work and at home. Poor menstrual hygiene situations in any of these contexts can prevent them engaging fully. The education level of a mother has been shown to be directly linked to child survival. If girls are missing school because of menstrual hygiene, this could potentially contribute to reduced child survival. Post-natal women need particular care in relation to the loss of blood following childbirth, especially in the first few days after the birth. Accessible, affordable and sustainable water, sanitation and hygiene facilities are needed by menstruating women and girls. Without these basics, managing menstruation hygienically is very challenging and can lead to absence from school or work. Target 7d By 2020, to have achieved a significant improvement in the lives of at least 100 million slum dwellers. A hygiene working group is developing a proposal for how hygiene (including handwashing, food hygiene and menstrual hygiene) could be included in the post-2015 sustainable development targets. This provides an opportunity for raising the profile of menstrual hygiene and influencing development priorities for the coming years. The four dimensions of advocacy13 the following diagram shows how policies and their associated instruments have a direct impact on knowledge, attitudes, commitment to act, and decisions. This is because menstrual hygiene has often been overlooked; it is associated with a wide range of taboos and expected behaviours; and many of the people in decision-making and leadership positions are male and have no experience of menstruation-related challenges. Advocacy is needed at national and international levels as well as at local level. It offers opportunities for rooted advocacy15 in empowering women and girls to improve their own menstrual hygiene situations, and for men and boys to support them in this task. Communication framework An outline of a possible communication framework for menstrual hygiene has been included in Toolkit 9. It identifies target groups, key information and communication channels and methodologies. The media is a useful channel for advocating menstrual hygiene because it can: · · · · · · · Get menstrual hygiene onto the political public agenda. Notes on good practice when working with the media have been included in Toolkit 9. The following examples show how the media has been used in Nepal and Zimbabwe by engaging famous artists or celebrities. Ten artists produced work to make the viewer consider menstrual hygiene, aiming to break the silence surrounding the issue. Engaging a famous artist - bringing menstrual hygiene into the open (WaterAid in Nepal) In Nepal, artist Ashmina Ranjitin designed and wore a dress made out of sanitary pads and tubes of red liquid to raise awareness of the practice of separating women and girls from the household during menstruation. Unfortunately, for the women of Zimbabwe, this is not a situation they are left to imagine. The example below shows ZanaAfrica in Kenya, an organisation tackling the issue of menstruation practically as well as through its advocacy efforts nationally, and also wider context through the use of the web. Advocating menstrual hygiene on the web (ZanaAfrica, Kenya)19 Through its website, ZanaAfrica raises issues relating to vulnerable children in the poorest communities in Kenya. Issues discussed include menstrual hygiene, education, violence and the rights of women and girls in the sex industry. Dialogue events Dialogue events on menstrual hygiene also open up opportunities for sharing good practice and identifying gaps and ways forward. The following example is an event facilitated by the Water Research Commission in South Africa. Managing Menstruation Inter-agency dialogue on menstrual hygiene (Water Research Commission, South Africa) Dialogue was established between 60 delegates representing national and provincial departments in South Africa, donor and development agencies, academic institutions, trade unions, civil society organisations and the private sector. Recommendations were made on research and development, monitoring and compliance, awareness-raising and partnerships. Our goal is nothing short of becoming the leading expert in all issues relating to sanitary pad manufacturing, distribution in Africa, and research. This can only be attained through a group effort, and in this interconnected world, we invite you to add to the knowledge base. The lessons learned from the research will need to be targeted to different groups and communicated through appropriately selected channels and media for the greatest advocacy benefit. The following are four examples of presenting learning from research: through the use of posters at conferences; the publishing of an advocacy report; and the publishing of a paper on practical experiences of implementing menstrual hygiene. Toilets are not enough: school menstrual hygiene management in Malawi Sally Piper Pillitteri Supervisor: Sue White 1. For example, their usual coping mechanisms for obtaining sanitary protection materials, bathing with dignity and privacy, and washing or disposing of their menstrual materials are disturbed in emergency situations, where they may be forced to live in close proximity with male relatives or strangers. Dealing with menstrual hygiene when it is already difficult to access hygienic water, sanitation and hygiene facilities poses a double challenge. Sidra, 28, "The hygiene class was really beneficial for all of us, especially the lessons on menstrual hygiene. They gave us napkins and taught us to use a new one for each cycle and then to burn them. Before, we were using pieces of old cut clothes, which we would wash and use until they were too dirty to be of use anymore. The division of responsibility for who takes action on menstrual hygiene management is unclear. Because a number of sectors have some level of responsibility, there is a risk that the issue is overlooked or there is a confusing multiplication of responses. A young woman in Bangladesh makes cotton sanitary pads which are considered by many women to be affordable, comfortable and hygienic. Photo: WaterAid/Caroline Irby Researchers: Thйrиse Mahon Sarah House Sue Cavill Contact: theresemahon@wateraid. Reports such as this are useful for building up a body of evidence that can be used to influence governments, donors and other actors to support positive change. However, this can be a challenge as menstrual hygiene is a cross-sector issue and many conferences and workshops are sector-specific. The following example from Tanzania shows how menstrual hygiene challenges faced by girls at school were integrated into an advocacy document for a national water sector review meeting. The aim of the document was to highlight the issue of poor water, sanitation and hygiene facilities in schools and call for increased effort and resources. The target groups for the leaflet included the Government of the United Republic of Tanzania and large donors funding the water sector. Menstrual hygiene issues were included as part of the information provided in the leaflet. A recent report estimates that in SubSaharan Africa half of all girls who drop out of school say that a lack of adequate water and sanitation facilities are a contributing factor. A further 10 per cent of schoolage girls who have reached the age of puberty do not attend school during menstruation (Tearfund, 2008). More children than ever before are attending school in Tanzania as a result of a number of successful policy initiatives, most notably the abolition of school fees in 2002. Whilst the number of latrines has been increasing over this time, the resources required to keep pace with this enrolment are significant as it has led to a need for more than 240,000 additional drop holes in schools across Tanzania. There is an urgent need to focus on providing quality education and retaining pupils, especially girls. National or regional conferences or forums also offer an opportunity to reach target audiences. These included: · To raise the profile of water, sanitation and hygiene in schools, with the objective of ensuring that every new and existing school at every educational level has functioning, child-friendly toilets, separate for girls and boys, with facilities for menstrual hygiene management. Rotary International and Lions International have partnered together, with a goal to supply enough sanitary pads to keep 160,000 girls in school per year. Other organiations have taken upon themselves the burden to source sanitary pads for schools they support; yet it was noted that some are delivering them without proper authorisation and permission from the Ministry of Education. Develop and implement policies on institutional support to sexual maturation, including infrastructure and capacity building of shareholders; 2 Coordinate partnerships and facilitate stakeholder participation in the management of sexual maturation; and 3 Develop modalities for provision of sanitation materials as part of learning materials. Drawn by a girl from northern Tanzania as part of participatory research by Dr Marni Sommer. Oster E and Thornton R (2010) Menstruation, sanitary products and school attendance: Evidence from a randomised evaluation, American Economic Journal: Applied Economics, 27 April 2010. Water Research Commission (2011) Dialogue: Menstrual hygiene; Supporting the sanitary dignity campaign for women and girls. House S, Mahon T and Cavill S (2011) Menstrual hygiene matters: Guidelines for practitioners. Fernandes M (2010) Breaking the silence: Menstrual hygiene management in rural India. Approaches have been identified for responding to problematic myths and practices. Trusted female adults have been identified and are available to discuss menstrual hygiene with adolescent girls and answer their questions. Module 1 Toolkit 1 2 Module 1 Toolkit 1 3 Toolkit 1 4 Toolkit 1 5 Module 4 Module 5 p. Similar books are available or being developed in a number of other countries (eg Pakistan, Uganda, Ethiopia, Cambodia and Ghana). Good practice for developing booklets on menstrual hygiene for girls · · · · · · · · · · · · · Research what is already available. Align the content with the approved Ministry of Education or Ministry of Health guidance. Include case studies from girls How did they feel when they had their first period? Include a section on how to stay healthy during menstruation what protection to wear, what to eat, what exercise to take, how to keep clean, how to deal with cramps, how to clean or dispose of sanitary protection materials, etc. Encourage girls to speak to their mothers, grandmothers or other trusted adults to discuss the issues further. Pilot all aspects of the document through discussions with schoolgirls, parents, teachers and educational advisers. Obtain government permission to distribute and use the booklets in schools this will open up opportunities for dissemination. Once the girl feels confident about the first part of managing that is managing the menstrual flow, then the latter part is no problem at all. One sees that girls often cease to perform their regular activities due to the embarrassment associated with managing the menstrual flow. During your period, you can do everything you normally do, including daily bath or shower, exercising, dancing and playing sports are all fine. In fact, you will feel better by continuing your normal routine, and find that warm bath is a great way to help with any cramping you may have. These were public places and when they took a bath in them there could be causes for embarrassment. However, now times have changed and we have the privacy of a bathroom or a seperate place to bathe. It is advisable to take bath at least once a day in luke warm water to keep the body clean and avoid bad odour. The vast majority of girls use cloth pads usually torn from old saris, instead of sanitary towels/napkin. There is no private place to change and clean them and often no safe water and soap to wash them properly. A culture of shame and embarrassment forces them to seek for well hidden places even in their homes to dry these clothes. This practice is responsible for a significant proportion of illness and infection associated with female reproductive health. Clean cloth: these are cut to fit in the panty area by sewing several layers of cotton rags on top of each other. Menstrual blood is healthy and clean unless the girl is suffering from reproductive tract infection. However, girls should ensure that used sanitary materials are disposed of in a proper and hygienic manner. Disposal of used sanitary materials by burning or burying is a safe and hygienic method. Menstruating girls need to eat Iron contains food such as vegetables fruits; yogurt etc to replace iron loses due to bleeding. Improper disposal of used sanitary materials like pads make a girl menstruate continuously for life. Read and understand the facts about period from guidebooks to help other children.
Children with pre-pubertal onset of obsessive-compulsive disorder are more likely to have a comorbid diagnosis of tic disorder mental health worksheets cheap lyrica 75 mg free shipping. Body Dysmorphic Disorder Several disorders are often comorbid with body dysmorphic disorder mental treatment 3 cm cheap lyrica 75mg visa. Individuals with hoarding disorder may also present with schizophrenia mental disorder test pdf order lyrica 75mg amex, dementia disorders of brain and nervous system generic lyrica 75mg on-line, eating disorders mental illness on college campuses lyrica 150mg on-line, autism mental health nursing cheap 150mg lyrica, and intellectual disability (Saxena, 2007). It may also present with non-clinical levels of symptoms for some or all of these disorders (Saxena). Trichotillomania and Excoriation Youth with trichotillomania and excoriation often experience other psychological problems (Woods et al. Research suggests that 60 to 70 percent of youth with trichotillomania meet the criteria for at least one additional psychiatric disorder, with anxiety and affective disorders being the most frequently diagnosed (Tolin et al. If such obsessions or compulsions are related to external or developmental stressors, psychotherapy or other psychosocial interventions targeted to these stressors may be useful. Treatments for obsessive-compulsive disorder are discussed are outlined in Table 3. Psychosocial Treatments Effectively treating obsessive-compulsive disorder in youth is crucial to aiding in their lifelong functioning. The affected youth visits the clinician twice in the first two weeks, and then once weekly, with a telephone call visit between in person visits. Most studies directly used or modified the manual by March and Mulle (1998) (Benazon, Ager, & Rosenberg, 2002; DeHaan et al. These medications have been shown to be significantly more effective compared to placebo treatments. It should be noted that the distinction of family focused here is meant to imply a format for treatment delivery. Fluoxetine (Prozac): Approved for children aged eight and older Sertraline (Zoloft): Approved for children aged six and older Fluvoxamine (Luvox): Approved for children aged eight and older Studies show promising results but there have only been a small number of studies. However, each study addresses complex comorbidity and issues impacting community-based clinic treatment. Although these results are encouraging, caution must be taken due to the small sample sizes and lack of active control groups. Antibiotic treatments are only indicated when the presence of an autoimmune or strep-infection has been confirmed and coincided with onset or increased severity of obsessive-compulsive disorder symptoms. In some instances, herbal remedies may make symptoms worse or interfere with pharmacological treatment. Antibiotic treatments Herbal therapies While these medications may be helpful, they are not without risks and side-effects. These risks must be weighed against the potential benefit from the medication when making treatment decisions. Youth taking these medications should be monitored for potential medical or psychological side-effects throughout treatment, particularly if other medications are also prescribed. Likewise, insight-oriented therapies have not been shown to be effective in treating youth with obsessivecompulsive disorder. As discussed in the Causes and Risk Factors section of this review, there is a subset of children who develop obsessive-compulsive disorder following a strep-infection. However, antibiotic treatment does not prevent obsessivecompulsive disorder without a strep infection being present (Gilbert, 2008). Herbal remedies have not been sufficiently tested as a treatment for obsessive-compulsive disorder. In addition, a small study of adults with obsessive-compulsive disorder showed a positive response to intravenous ketamine infusion (Stetka & Correll; Rodriguez et al. Trichotillomania (Hair-Pulling Disorder) and Excoriation (Skin-Picking Disorder) Research exploring treatments for childhood trichotillomania and excoriation is promising, but the treatments have not been researched sufficiently enough to warrant the designation of evidence-based treatment. These and other treatments are summarized in Table 4 and discussed more fully in the paragraphs that follow. Psychoeducation entails teaching youth and parents about hair pulling and how to monitor behavior. Cognitive restructuring helps youth identify and change maladaptive beliefs associated with stressful situations and to distinguish between minor setbacks and full-blown relapses. In the treatment of trichotillomania and excoriation, therapists may employ either emotion-regulation techniques, which help youth learn more adaptive ways of coping with emotion, or cognitive restructuring, which helps youth recognize and change the thoughts or emotions that occur before or after pulling or picking (Woods, Flessner, & Conelea, 2008). There are still no clear evidence-based pharmacological interventions to treat trichotillomania in children (Flessner, 2011). Table 4 Summary of Treatments for Trichotillomania and Excoriation by Level of Support What Works There are no evidence-based practices at this time. Treatment involves exposing children to the stimuli associated with the urge, while challenging thoughts associated with high-risk situations. Some demonstrated improvement on certain measures of picking behavior has been demonstrated in some pharmacological studies. Body Dysmorphic Disorder Unfortunately, there are no evidence-based treatments yet available for youth with body dysmorphic disorder. Evidence suggests obsessive-compulsive disorder, major depressive disorder and social phobia are effectively treated with pharmacotherapy. However, there are currently no studies that meet evidence-based standards to support this idea (Phillips & Hollander). Hoarding Disorder Unfortunately, no treatments that meet the level of evidence-based standards are available for youth with hoarding disorder. Although no treatment path has yet been developed, a combination of (1) discarding excess possessions; (2) organizing remaining possessions; (3) planning to prevent new 213 Obsessive-Compulsive and Related Disorders acquisitions; and (4) introducing alternative behaviors have shown some success (Saxena & Maidment). Treatment may include education about hoarding, setting goals, enhancing motivation, training decision making skills, and practice sorting and organizing. This can be coupled with discarding old possessions and preventing acquisition of new possessions (Steketee, 2014). Obsessive-Compulsive Disorder Research is extremely limited on the role of culture and ethnicity in obsessive-compulsive disorder. Although the physiological symptoms are universal, the way in which the experience is interpreted and expressed varies as a function of culture (Washington, Norton, & Temple, 2008). Culture also influences help-seeking behaviors and treatment preferences (Sue, Zane, & Young, 1994). Clinicians should consider, but not assume, cultural influences to ensure proper identification and treatment. Clinicians should be familiar with the ways in which youth and families conceptualize symptoms. Cultural practices and norms shape the way in which emotions are understood and expressed. This can lead to differences in attributions of emotions and behaviors, expressions of symptoms, and the language used to describe the symptoms. Clinicians and researchers who are unaware of culture-specific idioms of distress may fail to notice important symptoms, dismiss symptoms as irrelevant, or misattribute the symptoms to a different diagnosis. Normative cultural practices should also be considered to avoid characterizing certain behaviors as psychologically abnormal (March & Mulle, 1998). For example, research on standardized measures has demonstrated that African American individuals report higher levels of cleaning and checking symptoms, but do not report anxiety and/or impairment surrounding these symptoms. Thus, they do not always meet diagnostic criteria for obsessive-compulsive disorder during structured interviews (Thomas, Turkheimer, & Oltmanns, 2000; Williams et al. Similarly, South Asian/East Indian and Southeast Asian individuals are more likely to report obsessive-compulsive symptoms compared to Caucasian, African American, and Latino individuals (Washington, Norton, & Temple, 2008). However, these elevated reports of obsessive-compulsive symptoms were only associated with obsessive-compulsive disorder distress and impairment in South Asian/East Indian individuals. Elevated reports of obsessive-compulsive symptoms in Southeast Asian individuals were not associated with increased incidence of obsessive-compulsive disorder (Washington, Norton, & Temple). Lau and colleagues (2004) found that, while African American youth reported slightly higher levels of their own internalizing symptoms compared to Caucasian youth, teachers rated Caucasian students as having higher anxiety and African American students with higher externalizing symptoms. Teachers may interpret anxious refusal as oppositional-defiance based on racial stereotypes (Lau et al. Only seven studies reported racial/ethnic demographics; four of these were entirely Caucasian, while the others still underrepresented minorities. Some researchers posit that, along with institutional mistrust, ethnic minorities may not participate in randomized clinical trials because of financial barriers, language barriers, proximity to specialty clinics, and cultural beliefs about the best approaches to mental illness. This limits the ability to generalize results of these studies for use in community-based clinics that serve minority and economically disadvantaged patients. In a recent review of evidence-based treatments and modifications for ethnic minority youth, treatments discussed were the selective use of culturally responsive adaptations based on actual client need and avoidance of overgeneralizations based on race/ethnicity/culture (Huey & Polo, 2008). Symptoms may present differently, as Caucasians may be more concerned with body issues where Asian Americans may be more concerned with hair and skin (Marques et al. Trichotillomania and Excoriation Disorder Research suggests rates of trichotillomania are similar between Caucasians and African Americans, and German and American samples demonstrate equivalent rates of excoriation (Woods, Flessner & Conelea, 2008). However, one study of trichotillomania in African American women showed that trichotillomania rates positively correlated with anxiety levels in college students in the sample (Neal-Barnett, Statom, & Stadulis, 2011). While excoriation is significantly more frequent in females than males, it appears to be consistent across cultures. Often, the obsessive thoughts (also called obsessions) are irrational and/or unrealistic. The actions or behaviors (called compulsions) are a temporary escape from stress and anxiety. Therefore, proper assessment by a licensed clinician is imperative to make an accurate diagnosis. While this risk does not solely affect children and adolescents, families should be aware of this risk and monitor their children for signs of suicidal ideation (thinking about suicide). For additional information on this topic, families should consult the "Youth Suicide" section of this Collection. Journal of the American Academy of Child and Adolescent Psychiatry, 37 (10: Suppl), 27-45. Practice parameters for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 51(1), 98-113. Evidence-based psychosocial treatments for child and adolescent obsessive-compulsive disorder. Do parent and child behaviours differentiate families whose children have obsessive-compulsive disorder from other clinic and non-clinic families? Cognitive behavior therapy in treatment-naпve children and adolescents with obsessive-compulsive disorder: An open trial. The survey form of the Leyton Obsessional Inventory-Child Version: Norms from an epidemiology study. Behavior therapy versus clomipramine for the treatment of obsessive-compulsive disorder in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 37(10), 1022-1029. Ritual, habit, and perfectionism: the prevalence and development of compulsive-like behavior in normal young children. Abnormalities of visual processing and frontostriatal systems in body dysmorphic disorder. Cognitive behavior therapy for childhood repetitive behavior disorders: Tic disorders and trichotillomania. The obsessive-compulsive scale of the child behavior checklist predicts obsessive-compulsive disorder: A receiver operating characteristic curve analysis. Parental involvement in the treatment of childhood obsessive-compulsive disorder: A multiple-baseline examination incorporating parents. Race/ethnicity and inter-informant agreement in assessing adolescent psychopathology. Behavioral psychotherapy for children and adolescents with obsessivecompulsive disorder: An open trial of a new protocol-driven treatment package. Journal of the American Academy of Child and Adolescent Psychiatry, 35(3), 333-342. Functional disturbances within frontostriatal circuits across multiple childhood psychopathologies. Evidencebased assessment of compulsive skin picking, chronic tic disorders and trichotillomania in children. Trichotillomania symptoms in African American women: Are they related to anxiety and culture? Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder. Psychometric evaluation of the Brown Assessment of Beliefs Scale in body dysmorphic disorder. Treating body dysmorphic disorder with medication: Evidence, misconceptions, and a suggested approach. Cognitive behavioral therapy for youth with body dysmorphic disorder: Current status and future directions. Randomized controlled crossover trial of ketamine in obsessive-compulsive disorder: Proof-of-concept. Metacognitive therapy versus exposure and response prevention for pediatric obsessive-compulsive disorder. Clinical features of children and adolescents with obsessive-compulsive disorder and hoarding symptoms.
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Syndromes
You have aortic insufficiency and symptoms worsen or new symptoms develop, especially chest pain, difficulty breathing, or edema (swelling)
Duralith
Tuberculin skin test (also called PPD)
Calcitonin -- This hormone is involved in bone metabolism. It may be given as a nasal spray (Miacalcin), or as an injection under the skin (Calcimar or Mithracin)
Nausea and vomiting
Pancreatitis (inflammation of the pancreas)
Mediastinoscopy with biopsy
Blood culture
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