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Does not find out what protocols each institution/health care setting the institution requires in which work is performed B celexa 10mg discount medicine norco. Does not follow the documentation procedures/ guidelines of each policies/ procedures/ guidelines of institution’s interpreter office purchase cheap celexa symptoms viral infection, the institution order celexa 40 mg without a prescription symptoms intestinal blockage, resulting in the which may include: following possible situations: Keeping phone log Errors in follow-up activities Documenting all follow-up Mishandled priorities activities, such as follow-up Not getting paid appointments Interpreter’s office not being Completing weekly invoice of able to locate interpreter hours worked Incomplete or inaccurate Submitting documentation to the statistics at the end of the year appropriate person or filing documentation in the appropriate place and in a timely manner Keeping interpreter’s office informed of exact location (i. Does not notify patients of follow- canceled, or rescheduled up, canceled, or rescheduled appointments when requested appointments when requested B. Does not reschedule appointments patients when requested for patients when requested C. Does not observe the rules of etiquette and/or institutional norms cultural etiquette and/or (e. Ignores verbal/nonverbal cues that nonverbal cues that may indicate indicate implicit cultural content or implicit cultural content or culturally based culturally based miscommunication miscommunication (e. Does not assess the the issue, at that point in time in urgency/centrality of the issue and that particular exchange, to the becomes a barrier to goals and outcomes of the communication by: encounter: Interjecting disruptively (e. Does not assist the speaker in terms are used, assists the speaker developing explanations for in developing an explanation that ‘untranslatable’ words, instead can be understood by the listener providing explanations for the words or omitting concepts *Untranslatable words are words that represent concepts for which a referent does not exist in the society using the target language. Cannot explain the boundaries and meaning of confidentiality, and its the meaning of confidentiality, nor implications and consequences its implications and consequences B. Intentionally or unintentionally parameters of information sharing, reveals confidential information in keeping with the policies and outside the clinical parameters procedures of the institution and/or team, for example: Supervision Patient conference/continuity of care meetings Professional meetings, workshops, conferences, [taking responsibility for maintaining the anonymity of the parties by ensuring that any information shared at professional meetings does not contain identifying characteristics (e. Does not know how to deflect dealing with confidential matters inappropriate requests for that may be brought up in the information and violates community or health care setting confidentiality D. Cannot explain the concept of accuracy and completeness, and accuracy and completeness, nor their implications and consequences their implications and consequences B. Is not committed to transmitting accurately and completely the accurately and completely the content and spirit of the original content and spirit of the original message into the other language message without omitting, modifying, condensing, or adding C. Does not monitor her or his own his own interpreting performance interpreting performance D. Is unaware of and unable to personal biases and beliefs that may identify personal biases and beliefs interfere with the ability to be that may interfere with the ability impartial, and has the moral to be impartial, and does not have fortitude to withdraw if unable to the moral fortitude to withdraw if be impartial unable to be impartial B. Accepts assignments where close accepting any assignment where personal or professional ties or close personal or professional ties or strong personal beliefs may affect strong personal beliefs may affect impartiality, even when other impartiality (including conflicts of alternatives are available interest), unless an emergency renders the service necessary C. Interjects personal issues, beliefs, between provider and patient and opinions, or biases into the refrains from interjecting personal interview issues, beliefs, opinions, or biases into the interview D. Does not respect patient’s physical and maintains spatial/visual privacy privacy nor maintain spatial/visual of patient, as necessary privacy of patient B. Does not respect patient’s personal/emotional privacy: personal/emotional privacy: Refrains from asking personal Asks personal, probing probing questions outside the questions on own initiative scope of interpreting tasks Uses the role of interpreter to Does not use the role of influence a social relationship interpreter to influence a social with the patient outside the relationship with the patient interpreting encounter outside the interpreting Becomes personally involved encounter Refrains from becoming personally involved in the patient’s life** ** In small, close-knit communities, it is often not possible for an interpreter to remain personally and socially uninvolved with patients. However, interpreters should always strive to maintain the ethical and professional standards of confidentiality and impartiality while in their role. Cannot explain the meaning of professional distance, and its professional distance, and its implications and consequences implications and consequences B. Is not able to balance empathy boundaries of the interpreter role with the boundaries of the interpreter role C. Ignores patient needs or tries to needs by facilitating the use of resolve everything for the patient appropriate resources D. Becomes personally involved to involved the extent of sabotaging or compromising the provider-patient therapeutic relationship, thereby misleading the patient as to who the provider is and effectively disempowering the provider E. Creates expectations in either party either party that the interpreter role that the interpreter role cannot cannot fulfill fulfill F. Encourages and/or creates patient taking into account the social dependency on the interpreter. Initiates contact with the patient patient outside the scope of outside the scope of employment employment, avoiding personal for personal benefit benefit B. Takes on functions or provides functions or services that are not services that are not part of the part of the interpreter role interpreter role C. Is not aware of competency limits; refrains from interpreting beyond becomes involved in situations that her or his training, level of are beyond her or his level of experience, and skills, unless these training, skill, and/or experience; limitations are fully understood by and on occasions where no other the patient and provider and no source of interpreting is available, other source of interpreting is does not inform patient or available provider of these limitations D. Persists in functioning as an situations where there may be a interpreter in situations where conflict of interest there may be a conflict of interest E. Does nothing or addresses the feels strongly that either party’s situation in an ineffective, behavior is affecting access to or disruptive manner quality of service, or compromising either party’s dignity, uses effective strategies to address the situation B. Dietary flavonoids, abundant in plant-based foods, cause the population of a country is substantially have been shown to improve cognitive function. Data on per present in cocoa, green tea, red wine, and some capita yearly chocolate consumption in 22 fruits, seems to be effective in slowing down or countries was obtained from Chocosuisse even reversing the reductions in cognitive per- (www. To laureates per 10 million persons in a total of 23 my knowledge, no data on overall national cog- countries (Fig. Conceiv- exclusion of Sweden, the correlation coefficient ably, however, the total number of Nobel laure- increased to 0. Switzerland was the top per- ates per capita could serve as a surrogate end former in terms of both the number of Nobel point reflecting the proportion with superior laureates and chocolate consumption. The slope cognitive function and thereby give us some of the regression line allows us to estimate that measure of the overall cognitive function of a it would take about 0. The minimally effective chocolate dose seems to A list of countries ranked in terms of Nobel hover around 2 kg per year, and the dose–response laureates per capita was downloaded from curve reveals no apparent ceiling on the number Wikipedia (http://en. Correlation between Countries’ Annual Per Capita Chocolate Consumption and the Number of Nobel Laureates per 10 Million Population. Considering that in this instance the observed The principal finding of this study is a surpris- number exceeds the expected number by a fac- ingly powerful correlation between chocolate tor of more than 2, one cannot quite escape the intake per capita and the number of Nobel laure- notion that either the Nobel Committee in ates in various countries. Of course, a correla- Stockholm has some inherent patriotic bias tion between X and Y does not prove causation when assessing the candidates for these awards but indicates that either X influences Y, Y influ- or, perhaps, that the Swedes are particularly ences X, or X and Y are influenced by a common sensitive to chocolate, and even minuscule underlying mechanism. Obviously, ceivable that persons with superior cognitive these findings are hypothesis-generating only function (i. Given its per capita chocolate con- Prize would in itself increase chocolate intake sumption of 6. It Finally, as to a third hypothesis, it is diffi- remains to be determined whether the consump- cult to identify a plausible common denomina- tion of chocolate is the underlying mechanism tor that could possibly drive both chocolate con- for the observed association with improved cog- sumption and the number of Nobel laureates nitive function. Messerli reports regular daily chocolate consumption, status from country to country and geographic mostly but not exclusively in the form of Lindt’s dark varieties. Intake of flavonoid-rich and the specific chocolate intake of individual wine, tea, and chocolate by elderly men and women is associated with better cognitive test performance. The cumulative dose of chocolate that tive function, blood pressure, and insulin resistance through is needed to sufficiently increase the odds of be- cocoa flavanol consumption in elderly subjects with mild cogni- tive impairment: the Cocoa, Cognition, and Aging (CoCoA) ing asked to travel to Stockholm is uncertain. Cerebral are time-dependent variables and change from blood flow response to flavanol-rich cocoa in healthy elderly year to year.
Outbreak control measures These guidelines present a brief buy generic celexa 20 mg on line treatment chlamydia, somewhat generic celexa 40 mg sale medicine for runny nose, summary of outbreak control measures buy celexa 10mg free shipping symptoms 5dpiui. It is beyond the scope of this document to provide detailed information about control measures for specific diseases and situations. These relate to the duties of Medical Officers of Health, Health Protection Officers and Food Act Officers. This list should not be considered as a substitute for the text of the actual statutes and regulations. General considerations Although definitive measures usually require knowledge of the source and reasons for the outbreak, control activities should be considered at all stages of the investigation. Initial control measures will be based on knowledge of the pathogen, and probable sources and modes of transmission. The sources of an outbreak can usually be considered as a continuum from ‘upstream’ determinants to ‘downstream’ factors. For example, an outbreak of meningococcal disease in a community could be simultaneously due to social and economic conditions predisposing people to over-crowding and poor housing, a lack of availability of accessible primary health care services for early diagnosis, and to close physical contact with an individual carrying nasopharyngeal Neisseria meningitidis. Points of potential outbreak control can also occur at several places on this continuum. In general, however, upstream determinants can only be addressed over a long time scale and with substantial political and community support. For this reason, most outbreak control measures focus on the immediate sources of the outbreak, but it is important to bear in mind that the causes of outbreaks occur in a much broader context. To use the example of an outbreak of meningococcal disease, immediate outbreak control measures will involve tracing and administering prophylaxis to close contacts of the index case, but it is important to remember that improved living conditions and improved access to affordable and appropriate health services (along with development of an effective vaccine) could have greater impact on meningococcal disease outbreaks in the long term. Control measures may be considered under three areas aimed at: the outbreak source contaminated vehicles of infection transmission susceptible humans. The choice of control measure within these three areas is dictated by factors such as whether the outbreak source is known, whether a suspected vehicle has been identified and whether a vaccine or prophylactic treatment is available for susceptible humans. Outbreaks associated with food, water or environmental sources Closure of premises or site of outbreak (e. Outbreaks associated with animal contact Removal from contact, treatment, isolation, immunisation or destruction of animal reservoirs (e. Outbreaks associated with contaminated food or water Removal or recall of contaminated product (e. Outbreaks associated with vectors Application of insecticides, setting traps, eliminating breeding habitats, improving management of solid waste (e. Outbreaks associated with food, water or environmental sources Education to change behaviour associated with food preparation or hygiene (e. Communication during outbreak investigation A coordinated approach to communication is an essential part of outbreak investigation activities. By their very nature, disease outbreaks occur at unexpected times, can grow rapidly in scale and attract considerable attention from the media, public and government agencies. A planned approach to communication will help the outbreak team to remain focused on the investigation, safe in the knowledge that information circulating about the outbreak is accurate and that relationships with other agencies are being maintained. A proposed framework for addressing communication during these scenarios is discussed in Appendix 1. Appendix 10 describes general media principles to consider in all significant foodborne outbreak situations. Communication expertise It has become increasingly important that staff involved in outbreak control have risk communication training. In major outbreak situations and emergencies local leaders are called upon to master both the news conference and the social media to build public cooperation and support for preparedness, response, and recovery measures. The art of communicating risk to the public does not always come naturally, with many having to master it by following precise instructions to get the desired outcome. Risk communication is a tool for closing the gap between laypeople and experts, and helping stakeholders make more informed choices. Risk communicators must learn to function under nearly impossible time constraints, while accepting the imperfect nature of their decisions. Using available information and the necessary expertise, action must be taken usually with some urgency while making the community understand and accept the inherent lack of certainty. In some instances, a high level of public concern can be a greater danger than the hazard itself (e. The opposite is true for situations such as indoor air pollution, food poisoning and obesity where a low level of public concern can present significant health risks. Wrongly perceived risk can create hazards by generating opposition to the adoption of risk management regulations and procedures e. Communication plans Development of a standard and an agreed communication plan should be part of the overall process for planning outbreak management (see Chapter 2). Communication within the outbreak team Processes for communicating within the team may also be covered by the overall outbreak plan. These processes may be straightforward if the team is small and shares the same workplace, but will need to be considered more explicitly if the outbreak investigation involves multiple health districts or involves multiple levels (e. Use the following principles: designate a single individual or agency as the outbreak co-ordinator. This individual/agency should organise and chair team meetings and should receive copies of all communications ensure that each ‘subgroup’ of the outbreak team (if large) has a key communication representative who can attend each meeting. There should also be someone tasked with interagency liaison schedule regular meetings of the outbreak team. Each meeting should include a summary of the outbreak as it initially presented, an update on overall progress, and then invite contributions from each arm of the investigation. Make sure that problems and barriers to the investigation are presented and discussed. Circulate the minutes and action points promptly after the meeting, including to those who were unable to attend consider how communication outside of meetings should occur, whether by email, phone or fax. Communication with the public and media Public and media communication skills are often synonymous, so are considered together in this guide. The communication plan should identify a single individual, team, or agency responsible for responding to media enquiries and for managing public communication. It may be appropriate to have multiple key spokespeople, for example, a spokesperson for local issues and another spokesperson for national enquiries. Media communication during an outbreak is made considerably easier if the organisation has built a positive and co-operative long-term relationship with the media, often with a specific contact person. The credibility of the organisation combined with trained personnel is the strongest combination for success in this area. Positive and negative aspects of media/public communication Communicating with the public and media may assist with the immediate outbreak investigation and control, and also with longer-term health goals. It gives the capacity for providing essential advice on initial control measures to large numbers of people quickly, while at the same time providing an opportunity to deliver important health promotion messages relevant to the outbreak (e. Another important function is that communicating with the public and media provides early, accurate and on-going information about the situation, even if uncertainty exists, and about the progress of the investigation. A vacuum of no information will invariably be filled by less accurate sources and can damage trust in, and the credibility of, the lead agency responsible for managing the outbreak.
In contrast purchase discount celexa online treatment resistant schizophrenia, urban sprawl has been The usual position of the food industry is that it simply 840 | Disease Control Priorities in Developing Countries | Walter C purchase celexa 20 mg otc symptoms melanoma. These communities are expressways are being removed to create parks 40 mg celexa symptoms quad strain, sidewalks, intended to become new job-creation centers and to shift and bikeways (http://www. The program was launched in 1996 to heard about Agita, 37 percent knew its purpose, and those increase the public’s knowledge of the benefits of exercise who knew of the program’s purpose were more likely to be and expand participation in physical fitness activities by active. Agita appears to have played a role in increasing encouraging people to do 30 minutes of moderate activity activity in the region (Matsudo and others 2002). As elsewhere, program designers closely linked to a national program to promote healthy perceived a lack of time as the major factor preventing diets and active lifestyles by nutritional content labeling, daily exercise. They chose three settings as places to pro- promotion of healthy diets in schools, communication of mote activity: home (gardening, chores, avoidance of tele- guidelines for healthy eating, and encouragement of inno- vision watching); transportation (walking, taking the vative community-based initiatives (Coitinho, Monteiro, stairs); and leisure time (dancing). Much of companies said that they would reduce or eliminate trans fats, this sum goes to promote foods with adverse health effects, and and many more are planning to do so (U. In Mauritius, the government required a change in the commonly used cooking oil from mostly palm Improving Processing and Manufacturing. Altering the oil to soybean oil, which changed people’s fatty acid intake and manufacturing process can rapidly and effectively improve reduced their serum cholesterol levels (Uusitalo and others diets because such action does not require the slow process of 1996). Omega-3 fatty acid intakes can be increased by hydrogenation of vegetable oils, which destroys essential incorporating oils from rapeseed, mustard, or soybean into omega-3 fatty acids and creates trans fatty acids. Food and tion in salt consumption will usually require changes at the Prevention of Chronic Disease by Means of Diet and Lifestyle Changes | 841 manufacturing level, because processed food is a major salt Another strategy is to protect consumers from aggressive source. If the salt content of foods is reduced gradually, the marketing of unhealthy foods. Coordination among lars a year encouraging children to consume foods that are manufacturers or government regulation is needed; otherwise detrimental to their health. Manufacturers and fast-food chains producers whose foods are lower in salt may be placed at a dis- personify food products with cartoon characters; display food advantage. Food fortification has eliminated iodine supported restrictions on advertising to children (Blendon deficiency, pellagra, and beriberi in much of the world. Restrictions can range from banning advertising to regions where iodine deficiency remains a serious problem, children to limiting the types of products that advertisers may fortification should be a high priority. Fortifying foods with folic acid is extremely inex- pensive and could substantially reduce the rates of several Initiatives at the Community Level chronic diseases. Grain products—such as flour, rice, and Nations and regions can promote a variety of initiatives to pasta—are usually the best foods to fortify, and in many coun- encourage greater physical activity and better nutrition. Where Many countries are undertaking efforts to educate their intakes of vitamins B12 and B6 are also low and contribute to populations about healthy lifestyles. Physical activity is promoted by creating safe routes for walking and bicycle riding and Increasing the Availability and Reducing the Cost of Healthy by organizing recreational walking that involves entire families Foods. Policies may be directed at the focus of agricultur- gramme, a partnership between an insurance company and an al research and the types of production promoted by extension academic institution, has created programs targeted to specific services. Policies often promote grains, dairy products, sugar, age groups, including children and older adults. The program’s and beef, whereas those that encourage the production and twice-weekly classes have reduced blood pressure and increased consumption of fruits, vegetables, nuts, legumes, whole grains, strength and balance (Lambert, Bohlmann, and Kolbe- and healthy oils would tend to enhance rather than reduce Alexander 2001) (box 44. Singapore’s Fit and Trim Program uses a multidisciplinary approach to increase physical activity and healthy diets among schoolchildren. Between 1992 and 2000, the rate of obesity Promoting Healthy Food Choices and Limiting Aggressive declined by 13. Ideally, such efforts are coordinated among government groups, retailers, professional groups, and nonprofit organizations, and invest- Economic Policies ment in such efforts should include the careful testing and Economic policies can have important effects on behavior and refining of social-marketing strategies. Interventions included direct media cam- personal intervention for high-risk individuals beyond that paigns,publichealthmessagesdeliveredinavarietyof ways, already offered by the mass media program. This coordinated, multisectoral approach involved from 14 to 17 percent, and the prevalence of obesity was government ministries, health professionals, employers, stable. From 1991 to 1999, the age- aimed at improving the social and physical environment so standardized incidence of myocardial infarction declined as to promote healthy living. Legislation can make this that could influence diet and physical activity deserve careful distinction, providing a modest economic incentive for consideration because they are rarely neutral and often support healthier choices and at the same time conveying important unhealthy behaviors. Increasing taxes on petroleum products and subsidiz- how changes in subsidies can affect health (box 44. Changes in smoking and in 1999 the consumption of fruits and vegetables probably 0. Circles are for deciles of polyunsaturated fat to saturated fat and for risk of coronary heart disease in the Nurses’ Health Study (Hu 1999), which closely predict the observed changes in Poland. The interven- tion’s effectiveness could be increased by replacing part of the Only a few studies have described interventions for lifestyle saturated fat with polyunsaturated fat, which has additional diseases in developing countries. Modeling Likely Interventions Primary targets for reducing lifestyle diseases include changing Replacing Dietary Trans Fat from Partial Hydrogenation the fat composition of the diet, limiting sodium intake, and with Polyunsaturated Fat. Trans fats also adversely affect high-density lipoprotein trans fat with polyunsaturated fat, and reducing salt intake. Food and Drug Administration’s analysis of the costs of the intervention in the United States. With the lower cost, the smaller effect esti- to 8 percent (Grundy 1992; Willett and Ascherio 1994). Another likely benefit is a reduction Reducing the Salt Content of Manufactured Foods through in the incidence of type 2 diabetes: estimates indicate that the Legislation and an Accompanying Education Campaign. Denmark) can eliminate partially hydrogenated fat from the Those regional variations are attributable to differing risk pro- diet, this initiative does not require consumer education, and files across regions as well as to price differentials for the costs the costs can be extremely low. Food and Drug The actual blood pressure reduction from lower salt con- Administration (2003) estimated that trans fat labeling would sumption could vary from the base-case assumption, as could be highly cost-effective. The full costs of achieving changes in behavior and policy are often complex and difficult to estimate. For would have to be greater than 5 millimeters of mercury for the intervention to be cost saving. These results may argue for initial efforts to focus on reductions in the A number of research and development priorities have been use of salt during the manufacturing process with no public identified: education campaign. The cost-effectiveness of such a change is high and could be augmented with a public education cam- • Conduct randomized trials of the use of folic acid and paign only if needed to support the legislated change. Even though factors in developing and transition countries to refine the health experts believe that physical activity interventions are understanding of risk factors in those contexts. To date, effective in reducing the risk of lifestyle diseases, no studies of almost all such studies have taken place in Europe and their cost-effectiveness are available from developing countries. If people walk voluntarily (the model assumes no opportunity • Develop surveillance systems for chronic diseases and for cost), a net economic benefit would accrue to all segments of major risk factors, such as obesity, in developing countries. If we project the economic benefits to the • Develop additional multifaceted, community-based entire U. Colditz An overall objective is to develop comprehensive national and (1999) estimates that obesity is responsible for 7 percent of all local plans that take advantage of every opportunity to encour- U. Indirect costs would involve health care providers; worksites; schools; media; associated with obesity and inactivity account for another urban planners; all levels of food production, processing, and 5 percent of health care costs.