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In Dallas County prostate cancer 9 out of 10 gleason order casodex no prescription, only 374 Hispanic adolescents are overweight percent of adolescents participate or obese, compared to just 25. Moreover, 16 percent of Dallas County For the year 2010, federal analysis adolescents do not participate in 60 suggests that children consume minutes of physical activity on any fewer calories than they did a decade day in a typical week. Texas Department of State Health Services, Center for Health Statistics, Austin, Texas. Numbers for the frst half of staying physically active and eating and teens can prevent the onset of 2012 were on track for similar results. Patients with Type I diabetes resistance, are probably the main rea 4 National Institutes of Health. Type 2 must take insulin daily, as there is son for the accelerated progression of Diabetes Progresses Faster in Kids. Cancer is the noses of children age 19 and younger second-leading cause of death among in Dallas County. For the nine-year the Texas Cancer Registry estimates period, that is a rate of about 177 that about 1,300 Texans age 19 and diagnoses per one million children younger were diagnosed with cancer age 19 and younger. An estimated 198 Texas chil dren and adolescents died of cancer the most common types of cancers in 2012, and in 2009 there were an among Dallas County children since estimated 13,700 pediatric cancer 2002 are leukemias, lymphomas and survivors diagnosed between 1995 cancers of the central nervous system, and 2009. Combined, these 1 Texas Department of State Health Services, Cancer types of cancer account for about 62 Epidemiology and Surveillance Branch, Texas Cancer Registry, Incidence Texas, 1995-2010. Smog forms its highest the right direction to improve air research during the past decade than concentrations on sunny days quality in Texas, the American Lung any other state in the U. Ozone: South, one in Central, and one in Scientifc research has been used the Facts. From one-hour average of 125 ppb) is the 2000 to 2010, ozone levels across Dallas County is among the 25 most ozone-polluted counties in the U S 40 HealtH Pediatric Asthma Estimated number of children who have had asthma during their lifetimes 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 53,346 55,708 55,484 58,455 62,248 60,680 64,127 56,403 49,489 53,577 Data Source: American Lung Association: State of the Air Reports 2002, 2004 2013. Many of these symptoms Association estimates 53,577 children are exacerbated by the presence of in Dallas County have had asthma in ozone pollution. This is up from 49,489 in 2012, but it is down from the 2008 Asthma can be caused by a number high of 62,248. Asthma may start at2 home to an estimated 140,000 chil any age, but it is most common in dren suffering from pediatric asthma, school-aged children. It is com In the United States, approximately mon for children with asthma to have 20 million people have asthma, and siblings or parents who also suffered nine million of them are children. Retrieved from Kids Health from Nemours: kid especially early in the morning and shealth. Retrieved from North Texas Asthma Consortium Website: the creation in 2008 of the National to promote indoor physical activity on northtexasasthma. Upon discharge, the asthma Children ages 6 and older can be care team prepares a management tested in a similar manner as adults, plan for the patient to maintain after but children younger than 6 present returning home. Among students, parents, nurses and other by the National Health Interview food-allergic children, peanut is the school staff to coordinate prevention Survey, conducted by the Centers most common allergen, followed by and response efforts in the event of for Disease Control and Prevention, milk and shellfsh. Nutrition tree nuts, milk, eggs, wheat, soy, food allergies have had a reaction in Edition fsh and shellfsh. Furthermore, in 25 percent of allergic reaction include hives, of reactions that occur at school the eczema, nausea and stomach pain. In 2011, a survey low for individuals under 20 years of of chlamydia, 30,493 cases of among U. Youth under2 and secondary syphilis (6,142 total sexual intercourse, with nearly 40 per the age of 14 comprised less than 1 cases of syphilis). Suicide is the third leading cause of the overwhelming majority of youth death for youth between the ages of who die from suicide are male, at 10 and 24, resulting in approximately four times the rate of females, with 4,600 lives lost annually, with another Native-American/Alaskan-Native youth 157,000 youth receiving medical care having the highest rates of suicide for self-inficted injuries and suicide related death when considering attempts. A nationwide survey of youth understand there are alterna 9-12th graders in the U. An estimated 65,015 Dallas County More specifcally, about 13 percent symptoms that may occur in-person children ages 9 to 17 suffer from a of children ages 9 to 17 suffer from or over the phone. The division diagnosable emotional disturbance or some type of anxiety disorder, such provides for a crisis hotline, as well addictive disorder, and approximately as panic disorder or any number as crisis intervention, transportation 15,554 of those are a serious distur of phobias. The term ?serious emotional distur percent suffer from a mood disorder 1 InCrisis. The Prevalence of Mental Health bance refers to children younger such as depression or bipolar and Addictive Disorders. Psychiatry (3rd health problem that severely disrupts 2 percent of children ages 9 to 17 ed. Disruptive their ability to function socially, suffer from a substance-use disorder Behavior Disorders. The Prevalence of Mental Health Services offers mental health services and Addictive Disorders. Retrieved from InCrisis Website: the prevalence of emotional dis to children and adolescents through. State Mental costing about $247 billion per year in A few specifc behavior health issues Health Cuts: A National Crisis. Retrieved from disorder, anxiety and depression, Washington Post Website. Eligibility requirements services to eligible residents of specify that applicants must apply Dallas and surrounding counties. For 2012, an estimated 196,252 area, the number of poor people well as physical and social harms Dallas County children lived in living in the suburbs has doubled. For example, Dallas County is far greater than for the health, safety, education and children who experience poverty the U. Retrieved from For 2013, the federal poverty guide completion than other students, National Center for Children in Poverty Website: Research suggests Assistant Secretary for Planning and Evaluation Website: two adults and two children as that early childhood interventions aspe. Around the country, poverty is the Effects of Poverty on Child Health and Development. Retrieved from Feeding America grams such as the National School Website: feedingamerica. Feeding America is estimated to serve A large percent of food pantries, nearly 14 million children, more than kitchens, and shelters in the Feeding three million of whom are under the America network reported serv age of 5. Participation in food assis ing many more children during the tance programs is a good option for summer. In 59 percent of Dallas County fami from $7,850 for an infant to $6,600 parents with children in child care lies with children, all parents present for a 4-year-old. The Child Care3 say that their children missed at least in the household are employed. Commission helps eligible parents 6 report that they fear losing wages pay for the cost of child care. Now a Majority: Families and registered providers or even With 2 Parents Who Work. Retrieved from ChildCare Aware Having two working parents can of America: naccrrapps. Retrieved from Texas Workforce Commission but it also results in the need for Website. An additional stress on working fami Retrieved from Center for American Progress Website. Census Bureau: Decennial Census (2000); American Community Survey 1-year estimates (2001-2011). Children in Single An estimated 251,813 children in Approximately 40 percent of U. Retrieved from Kids Count Data Dallas County, or nearly 40 percent, children have divorced parents, and Center: datacenter. This most single-parent families result 7,133,38,35,18/10,168,9,12,1,13,185/432,431 3 2 Matthews, R. Retrieved from the United States were to unmarried Building Blocks for a Healthy Future: bblocks. Non-marital birth rates are 4 families, compared to 42 percent for Centers for Disease Control and Prevention.

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This may mean that scores may fluctuate during the course of the dementia as support ‘catches up’ with the person’s changing needs man health 8 news order casodex canada. For each domain that is scored at less than the maximum, the support team is asked to specify what needs to be put in place to improve the person’s quality outcome for that domain. In addition, by looking at the descriptions for the next stage of dementia, the professional can begin to help the person and their supporters to think about what needs to be put in place to maintain the person’s quality outcome. The clinical psychologist and occupational therapist met with the staff team and care manager. The results were used to create a dementia care plan based on the interventions described in this guidance. This provided a clear overview of who was doing what in relation to Brian’s support needs. The home manager reported the reviews as helpful as they often did not notice deterioration until they had space to reflect, as they were with the person daily. It also meant better quality care for Brian as all those involved in his care were accountable for certain outcomes. The home manager felt that they were better supported by the community intellectual disabilities team whereas previously they felt that they had been left to struggle until a crisis occurred. Key points I Each area should use the Self-Assessment Checklist to measure the Outcome of their services for people with intellectual disabilities and dementia, and to assist in the development of a local strategy document. Guidance on their Assessment, Diagnosis, Interventions and Support 93 Section 19 – Future directions and research 19. Within this context, the development of new treatments for dementia, and trials to assess such treatments, have a high priority. Clinical trials are not just about pharmaceutical developments but also about psychological treatments and other approaches, the aim of which might be to maintain function and the dignity of those affected by dementia. This section has therefore been added to the revised guidance largely because we recognise that new treatments for dementia are being, and will be, developed and it is imperative that people with intellectual disabilities, in general, and people with Down’s syndrome, specifically, have the opportunity to partake in trials and subsequently benefit from the treatments that are found to be safe and effective. Similarly, people with intellectual disabilities (not due to Down’s syndrome) have a slightly earlier age-related prevalence profile of dementia than the typically developing population. Particularly in people with Down’s syndrome, the longer term objective of research is the development of a preventative treatment. These proposed new treatments will need to be 94 Dementia and People with Intellectual Disabilities tested in formal double blind placebo controlled trials. At present treatment developments aimed at preventing dementia in people with Down’s syndrome are focused on the modification of beta amyloid production in the brain. For people with intellectual disabilities not due to Down’s syndrome advances in treatment are likely to emerge from research in the typically developing population, however, these may need more formal testing (particularly with respect to side effect profiles) in the intellectual disabilities population. Research, whether of a pharmaceutical agent or of some support strategy requires the identification and involvement of people with intellectual disabilities and those who support them. This is particularly the case for people with Down’s syndrome where the risk of developing Alzheimer’s disease relatively early in life is high and treatment aimed at prevention is therefore a priority. Such research requires collaboration between people with dementia and their families, clinicians, social care providers and clinical academics and basic scientists. Research of this type has particular challenges if the right balance is to be achieved between enabling research that will lead to new treatments, on the one hand, and, on the other, ensuring the people with intellectual disabilities and dementia are not exposed to excessively intrusive research or to exploitation. It will be clinicians and support workers who are at the forefront when it comes to recruitment to such trials. Clinicians and those who support people with intellectual disabilities are the gateway to recruitment and the attitude taken to research by these two groups of people has a powerful impact on whether the potential participant is willing to meet those doing the research. Ultimately it must be for the person with intellectual disabilities to decide or, where he/she lacks the capacity to consent, the protocols and safeguards in the appropriate European and national legislations then apply. European Clinical Trials Regulation 536 (2014), Mental Capacity Act (2005), Adults with Incapacity [Scotland] Act (2000). Guidance on their Assessment, Diagnosis, Interventions and Support 95 With the advent of electronic health records searches are now possible according to particular diagnostic categories. The identification of potential participants for research has therefore become more feasible. Specialist services for adults with intellectual disabilities should ensure that all people with intellectual disabilities seen and who have received a diagnosis of dementia are identifiable by the service and at the time of diagnosis those concerned and those supporting them are informed about the importance of research, including any trials that are taking place. Specialist services have a responsibility for the identification of people with intellectual disabilities and dementia and to be willing to approach those meeting the necessary criteria for inclusion in a study on behalf of the research group undertaking the study. In clinical practice different clinicians and services may have their own approaches but for research it is usually necessary to have more formal and time-consuming assessments so that findings can be compared across studies – see section 6 for examples of diagnostic instruments and cognitive and functional assessments. Whilst it is through additional research funding that these more extensive assessments can be undertaken than is possible in clinical practice the use of agreed diagnostic assessments and of standard cognitive assessments would enhance recruitment on a larger scale for studies of, for example, risk and protective factors or for treatment trials. Clinicians working in local specialist services should establish diagnostic and assessment protocols that are agreed and in general use. There are no specific funding streams for dementia research in intellectual disabilities, and it may be seen as a ‘niche” area for mainstream funders. Funders may therefore benefit from being made aware of the importance of research in this area. Staff in services seeing adults with intellectual disabilities and, specifically adults with Down’s syndrome, where the diagnosis of dementia is being considered, should ensure that when a diagnosis of dementia is made the person concerned and those who support them are made aware of research projects being undertaken and permission requested to pass on their details to any approved and relevant research project. Services have the means to retrospectively identify any person with intellectual disabilities diagnosed as having dementia and specifically people with Down’s syndrome either in the age at risk for dementia or with a diagnosis of dementia and be willing to be a point of contact with them if approved and appropriate research is being undertaken that is looking for potential participants. In specialist memory clinics and in services for adults with intellectual disabilities the use of standardised diagnostic and neuropsychological assessments for the diagnosis and monitoring of dementia, as it affects people with intellectual disabilities, is encouraged. This will ensure that comparison can be made across services and over time thereby providing consistent and reliable data on prevalence and incidence of dementia in this population and also enabling recruitment into future trials of any new intervention or treatment. Guidance on their Assessment, Diagnosis, Interventions and Support 97 References Abbey, J. The Abbey pain scale: a 1-minute numerical indicator for people with end stage dementia. The relationship between acquired impairments of executive function and behavior change in adults with Down syndrome. The Test for Severe Impairment: an instrument for the assessment of people with severe cognitive dysfunction. Personality and behaviour changes mark the early stages of Alzheimer’s disease in adults with Down’s syndrome: findings from a prospective population-based study. Executive dysfunction and its association with personality and behaviour changes in the development of Alzheimer’s disease in adults with Down syndrome and mild to moderate learning disabilities. Theoretical exploration of the neural bases of behavioural disinhibition, apathy and executive dysfunction in preclinical Alzheimer’s disease in people with Down’s syndrome: potential involvement of multiple frontal-subcortical neuronal circuits. Aging and developmental disabilities: demographic and policy issues affecting American families. Challenging behaviours: Psychological interventions for severely challenging behaviours shown by people with learning disabilities. Dementia and people with learning disabilities: Guidance on the assessment, diagnosis, treatment and support of people with learning disabilities who develop dementia. Risk factors for dementia in people with Down syndrome: Issues in assessment and diagnosis. Reflections upon the development of a dementia screening service for individuals with Down’s syndrome across the Hyndburn and Ribble Valley area. Intellectual and daily living skills of 30-year-olds with Down’s syndrome: continuation of a longitudinal study. Environmental design to maximize autonomy for older adults with cognitive impairments. See me, Not the dementia: understanding people’s experiences of living in a care home. Epidemiology of psychiatric disorders in elderly compared with younger adults with learning disabilities. The outpatient clinic for adults with Down syndrome; a model to diagnose dementia. The neuropsychological assessment of age-related cognitive deficits in adults with Down’s syndrome. Development and psychometric properties of the Glasgow Depression Scale for people with a learning disability. Using medication to manage behaviour problems among adults with a learning disability: Quick reference guide.

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Tese sources information if it is relevant to the health and safety con might include: cerns in the child care setting prostate cancer hormone shot cheap casodex online master card. Tax incentives (credits and deductions are available under federal law to most for-proft child care programs). If the parents/guardians choose to involve them, or has a signifcant change in therapy. Nevertheless, the facility may Each objective should include persons responsible for its assume both roles if the parents/guardians so request and monitoring. The changing needs of children with disabilities and/or special health care needs do not always follow a pre The individualized service or treatment plan for a child dictable course. Ad hoc reevaluations may be necessitated with disabilities or a child with special health care needs by changes in circumstances. Other colleges and universities with expertise in training (such as speech and language therapy). Tese are the contact Tese sources might include: persons within the local education agency or lead agency. Community resources (such as volunteers, lending libraries, and free equipment available from communi 8. Tax incentives (credit and deductions are available under federal law to most for proft child care 8. A periodic, thorough process of reevaluation is and educational particulars of a range of special health care essential to identify appropriate goals and services for the needs and disabilities. Center, Large Family Child Care Home SpeciaLink: The National Centre for Child Care Inclusion, at the University of Winnipeg. Problem-solving approaches that are efective in The facility should have an identifable governing body or other settings also work in early childhood programs. This person with the responsibility for and authority over the standard describes accepted personnel management prac operation of the center or program. For any organization to function efectively, lines of should appoint one person at the facility, or two in the case responsibility must be clearly delineated with an individual of co-directors, who is responsible for day-to-day manage who is designated to have ultimate responsibility (1). A comprehensive site observation checklist is avail the facility should include, but should not be limited to , able in the print version of Model Child Care Health Policies, the following: available online at. Developing and implementing policies that promote the Child Care Pennsylvania Website for download at achievement of quality child care;. When problems are identifed, planning for corrective Family Child Care Homes action, and assigning and verifying that a specifc 1. Chil daily sign-in/sign-out policies, including authorized dren should not be placed in the care of unauthorized individuals for pick-up and allowing parent/guardian family members or other individuals (1-8). A written comprehensive and coordinated planned References program based on a statement of principles; 1. Methods and schedules for conferences or other site/DocServer/Jan 07 Child Care Fact Sheet. Supporting growth and development of babies in child care: What does the research say? Department of Health and Human Services, routine child health care, health consultation, health Ofce of the Assistant Secretary for Planning and Evaluation. Physical activity (both outdoors and when children are kept indoors), play areas, screen time, and outdoor play policy; w. Sleeping, safe sleep policy, areas used for sleeping/ napping, sleep equipment, and bed linen; x. Food and nutrition including food handling, human Review and Communication of milk, feeding and food brought from home, as well Written Policies as a daily schedule of meals and snacks; All written policies should be reviewed and updated at aa. Smoking, tobacco use, alcohol, prohibited substances, which include pertinent plans and procedures, to all staf and and frearms; parents/guardians at least annually, and two weeks before ac. Human resource management; new policies or changes to existing policies go into efect. Maintenance of the facility and equipment; and when changes to existing policies have been made, af. Parents/guardians who are not able to read should have The facility should have specifc strategies for implement the policies presented orally to them. Facility policies should vary according to the barrier should have the policies presented to ages and abilities of the children enrolled to accommodate them in a language with which they are familiar (1). Policies, plans, and procedures ages child care administrators to keep information and poli should generally be reviewed annually or when any changes cies current. A child care health consultant can be very helpful practices that is shared and developed cooperatively among in developing and implementing model policies. Hours and days of operation; 374 Caring for Our Children: National Health and Safety Performance Standards d. The text methods of communication between parents/ of the policies can be edited to match individual program guardians and staf. Inclusion of children with special health care needs; recommended and should be added to the ?Parent Handbook. If the state termination; ment is provided orally, parents/guardians should sign a state. Care of children and caregivers/teachers who are ill; Health Policies can be adapted to these smaller settings. Sleeping, safe sleep policy, areas used for sleeping/ napping, sleep equipment, and bed linen; 2. Infants and Toddlers Parents/guardians and caregivers/teachers should sign that 2. Commonly asked questions about child care centers and the Other Limitations in Services Americans with Disabilities Act. A policy explicitly written informed consent from the parent/guardian prior stating the consequence for staf who do not follow the to sharing information at a transition meeting, in a written discipline policies should be reviewed and signed by summary, or in some other verbal or written format. Primary factors supporting the prohibition of certain methods of punishment include In the case of a child who may be eligible for preschool ser current child development theory and practice, legal aspects vices, with approval of the family of the child, a conference (namely that a caregiver/teacher is not acting in place of should be convened among the lead agency, the family, parents/guardians with regard to the child), and increasing and the local educational agency not less than ninety days liability suits. In the case of a child who may not be eligible for ment and only one state does not prohibit corporal such preschool services, with the approval of the family, punishment in large family child care homes (4). A plan also requires description of Format for the Transition Plan eforts to promote collaboration among Early Head Start Each service agency or primary care provider should have programs under section 645A of the Head Start Act, early a format and timeline for the process of developing a tran education and child care programs. The plan The facility should determine in what form and for how should include the following components: long archival records of transitioned children should be maintained by the facility. Identifcation of potential child care, educational, or All children and their families will experience one or programmatic arrangements; more program transitions during early childhood. Summary of any special health care needs and successful the most common transitions is from preschool to kinder strategies that were employed in child care. Tough coordinating and evaluating months prior to the child turning three and an anticipated health and therapeutic services for children with special transition, since fnding the proper facility for a child can health care needs is primarily the responsibility of the be a complex and time consuming process in some com school district or regional center, staf from the child care munities. Each state is required to develop transition guide facility (one of many service providers) should participate, lines that implement the federal guidelines in respect to as staf members have had a unique opportunity to observe timelines, procedural due process expectations, and the the child. It is important for all providers ful to both caregivers/teachers and families in both localities of care to coordinate their activities and referrals; other when children with special health care needs are involved. If records are The use of outside consultants for small and large family shared electronically, providers should ensure that the child care homes is especially important in meeting this records are encrypted for security and confdentiality. Clothing: Clothing should protect children from sun Exchange of Information at Transitions exposure and permit easy movement (not too loose and not too tight) that enables full participation in active A written communication policy should be in place play; footwear should provide support for running and to describe needed communication between parents/ climbing. Hats and sunglasses should be worn to protect guardians and caregivers/teachers during transitions children from sun exposure. By having such a policy, the facility encourages caregivers/teachers The facility should have written policies for the promotion and families to anticipate and prepare for outdoor activity of indoor and outdoor physical activity and the removal of when cold, hot, or wet weather prevails. Policies should cover the following areas: The inappropriate dress of a child is ofen a barrier in reach ing recommended amounts of physical activity in child care a. Duration: Children will spend 60 to 120 minutes each activity because of their inappropriate clothes. Children can play in the rain and snow and in physical activity and provisions for gross motor activi low temperatures when wearing clothing that keeps them ties indoors on days with more extreme conditions dry and warm. Setting: provision of covered areas for shade and shelter dren to mist, sprinkle, and drink while in warmer weather.

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The excessive involvement of tablets and games causes lots of worries as nearly all parents have experienced rather serious consequences of the uncontrolled usage of gadgets by their preschool aged kids prostate cancer clinical trials cheap 50 mg casodex amex. They complain that children can behave bad, stop going for a walks, communicate with other children, and become capricious if parents try to take their favorite gadget away. Parents tend to think that the most effective way to solving the problem is setting time limits for kids concerning the usage of devices and as a rule the results are really good. In general it can be noticed that parents attitude to the Internet and other technologies influences on their kids activity. The more positive parental attitude is, the more freedom and opportunities a child has; the more negative it is, the more bans and limits are set for kids. Many children would play with their favorite gadget all their leisure time if they had an opportunity ignoring both parents and peers. Yet when the access to gadgets is limited children comparably easy can get switched to any other activity. As it has been said before, kids use digital technologies mostly for entertaining. Most parents admit that online technologies play significant part in their life and in society in general, even those who have negative attitudes towards the internet. They use it for work, communication, entertaining, keeping in touch with relatives and friends living abroad or in other cities, etc. Although the majority of parents use different online technologies many times a day both in the office and at home they tend to diminish the role that the internet actually plays in their own lives stating it is not that essential for them. If a child behaves well he/she may take a device for a longer time for watching cartoons or gaming, if the behavior is bad a favorite device might be taken away. Tablets are widely used as a baby sitters entertaining children while parents are busy. Parents rarely use devices together with their kids; Skype is the only exception as it allows talking to relatives whom all family members know. The reason for that might be that parents do not know how to use devices and applications together with their kids. In most families parental mediation is reduced to setting rules and bans concerning time limits and the Internet access restriction. On average parents allow children to use gadgets for one hour daily; during the weekends and long journeys the period might be prolonged. Quite common are the bans for using gadgets during the meal and gaming before homework is done. As about the Internet, the majority of parents have quite a strict attitude and don?t allow their children go online. Parents rarely discuss rules with children and explain any reasons for limitations. It should be noticed also that parents themselves often do not follow their own rules concerning kids and make an indulgence for their children, unintentionally or consciously. Thus, parental position is rather unstable and the majority of children is aware of rules but admits they do not follow them when an occasion emerges. To summarize we can say that parents influence on how their children interact with gadgets. Buying to a kid a tablet for educational purposes, parents begin to use it for entertainment themselves and involve their children in these activities. Each of them asked their family members, friends or acquaintances to recommend families with kids under the age of 7 ready to participate in the interview and give their contacts or profiles in social networks. Thus, the sample consists mainly of ?second or third circle observers acquaintances. Then the observer contacted them and explained the aim of the research, its significance and procedure was being explained. Also links to some past studies were given so that parents could get information about how the final report will be performed (it was very illustrative example of the confidence principle so that all parents were fully sure that results would be presented in a common way without involving real names, photos etc. Afterward the observer answered to parents questions (if they had any) and asked for their agreement for being interviewed and made an appointment. We didn?t receive refusals as all families previously had information about us from their close friends so they had a certain amount of trust from the beginning. Interviews were mostly held in the evenings, when family gets together after working day or studying and is not very busy. Before the appointment the observers contacted to the family once again in order to confirm their address and time of meeting. In gratitude of participation in our research each parent got bright colorful manual issued by the Foundation for Internet Development (developed in collaboration with Google) for studying the issues of online safety together with their children, mini textbook with recommendations about safe Internet usage and informational leaflet about our helpline "Deti Online (Kids Online). The sample Alpha Family Low Alpha Sex Age Year school/ max level Ethnicity Family code medium Family of education high Member family Code income Mother 1 Medium 1. Mostly parents were very enthusiastic about the interview and appreciated it very much that their opinion would be taken into account in the international survey. So did children as they had an opportunity to gain the positive attention from the observer; besides during the interview they were allowed to take the most desired devices which are usually unavailable for them for a longer time. Thus, all family members had a very positive attitude towards the participating so the contact had been set in advance without any difficulties. Questions for interviews were being chosen from the total amount of questions suggested in the research guide. As a rule one interviewer was working with the family: children (or one child) was waiting in the other room and was kindly asked to not interfere with parents dialog with the observer, so did parents when it was necessary to communicate with children. After interview with parents the observer could enter the room where kids use gadgets more often and communicated with them in a child-friendly manner, sometimes sitting on the floor (with the smallest kids). The observer asked kids about gadgets usage, what they like in devices and what they can do with them etc. Such a structure of the interviewing process allowed implementing the in-depth qualitative analysis and checking the hypotheses emerged on discussing the topic with parents. It was found out that sometimes the real kids interaction with devices does not match with what parents declare in the interview and they are not actually aware of what their children can do with gadgets or think about family rules. Thus they mediate the process of the ice-breaking with the child and give the observer hints about the best ways for making child show his actual skills concerning gadgets. If two observers had worked some aspects obviously would had been missed because of the parallel way of process instead of sequential. If to speak about the protocol structure, observers were quite strict and followed the steps and topics precisely, always keeping in mind the time limits and main direction of the interview. Nevertheless, they inspired parents and other siblings to share their personal opinion about the Internet and digital technologies. Mostly observers used the standard method of the semi-structured interview and sometimes they asked family members to speak about some particular topics freely, especially about the advantages and disadvantages of using the Internet so it reminded a sort of an essay. During the interview with children observer asked them to make a mini-presentation of their favorite devices. Children were asked to bring their own device (or most used or favorite) and tell something about it, show the most frequently opened games and applications, cartoons. Also card with gadgets were used with the smallest kids in order to check which ones they know and can recall. We did not make full word-to-word transcripts because of the big amounts of the data gathered and because they contain some extra episodes not related to the topic and thus not necessary for the protocols. Yet is should be mentioned that protocols contain minimal interpretations and if presented they are always confirmed by exact citations or information obtained from the observational process. The data were analyzed, the brightest citations were chosen, also the recorded data were associated with paper notes made by observer while interviewing. There was no special encrypting of the recordings as they do not contain any personal data indentifying the families surveyed. The findings are consistent with our previous research data and illustrate statistic patterns obtained earlier (Soldatova, Shlyapnikov, 2014). Still this research gives us a deeper understanding of the problem, especially about questions of parental mediation and the role of the Internet in modern families. Certainly few cultural factors have influenced on the results of the research, such as:? As it was mentioned earlier, the research was conducted in Moscow, one of the most well-developed Russian regions;?

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The two studies cited here used aggregate estimates of screen time without considering the differences between digital devices prostate cancer for dummies discount 50 mg casodex otc, activities or content. Straker and colleagues (2013) showed empirically that different screen-time activities relate differently to physical activity and health indicators. Their fndings build on an early cross-sectional study of a representative sample of Finnish youth (14-18 year-olds) that found that only certain forms of technology were associated with higher obesity rates; watching television was associated with a small increase in the likelihood of being overweight for girls only, while playing digital games had no such effect (Kautiainen et al. Kautiainen and colleagues noted that when accounting for biological maturation and weekly physical activity, the statistical associations were weaker and non-signifcant for some of the age groups. This might suggest that it is the lack of physical activity rather than screen time that increases the risk of being overweight. The fact that digital technologies differ in their impact is corroborated by several cross-sectional studies included in this review; television viewing has been linked to a reduction in physical activity. Devis-Devis and colleagues speculate that the increase in physical activity could be explained by the fact that children use their mobile phones while moving around or engaging in other activities. These mixed results also appear in studies that use aggregate screen time measures, where 3 Screen time was, however, also associated with a positive increase in peer relationships. Some studies fnd no association between screen time and physical activity (Laurson et al. A large cross-national study drawing on survey data from over 200,000 adolescents aged 11-15 found that the relationship between time spent using digital technology and spare time physical activity also seems to differ depending on age, gender and nationality (Melkevik et al. Broadly speaking, the study found that spending two hours or more per day on screen-based activities resulted on average in half an hour less per week spent on leisure-type physical activity. Again, the form of screen-based activity adolescents engaged in mattered for the outcome; regular computer use was associated with an increase in physical activity, while gaming and watching television was associated with a decrease. For example, in Eastern and Southern Europe gaming, watching television and general computer use were associated with increases in spare time physical activity. The authors conclude that physical inactivity is unlikely to be a direct consequence of adolescents spending too much time on screen-based activities, but rather suggests that already-inactive adolescents have more time to spend in front of screens. This conclusion is supported by fndings from a separate longitudinal study of 11-13 year olds, demonstrating that increased engagement in computer use or video gaming was not directly associated with leisure-time physical activity, and indicating that screen-based activity and physical activity should be addressed separately in health promotion activities (Gebremariam et al. The authors suggest that factors other than computer use or gaming might better determine whether children spend more or less time on physical activity. Moreover, the association between screen time and obesity found in some studies may be due to dietary behaviours rather than a lack of physical activity. This claim was supported by a systematic review of studies on sedentary behaviour and dietary intake for children, adolescents and adults (Pearson and Biddle, 2011). In summary, evidence on the impact of time spent using digital technology on physical activity is mixed and inconclusive. While a number of longitudinal and cross-sectional studies have found a link between time spent using digital technology and reduced physical activity, other studies report no such associations. Explanations for reduced physical activity seem to depend on multiple factors beyond the time spent on digital technology, some of which have yet to be examined. Researchers do seem to broadly agree that the link between screen time and physical activity is unlikely to be direct. For example, Tolbert Kimbro and colleagues (2011) suggest that perceptions of neighbourhood safety and the residential environment. It has been suggested that indoor play offers a compelling alternative to outdoor play in less affuent neighbourhoods and in families where parents have less time available to supervise their children (Tandon et al. This claim is supported by studies showing that individuals who live in more disadvantaged neighbourhoods tend to have less access to portable play equipment and report lower levels of physical activity and higher rates of obesity, though the causal nature of these relationships is unclear (Tolbert Kimbro et al. The fnding that screen-based activity and physical activity seem to be independent behaviours is particularly important for health promotion policies and should be underlined. Longitudinal data suggests that reducing the amount of time spent on digital devices will not automatically increase the time spent on physical activities (Gebremariam et al. Some authors argue that promoting physical activity independently may be a more useful strategy. This argument is supported by previous longitudinal studies on television viewing and physical activity in adolescence (Taveras et al. Yes, and some people also spend too much time reading, watching television, and working and ignore family, friendships, and social activities. This behaviour has been given different labels, such as ?addictive use, ?pathological use, ?compulsive use, or ?disordered use, applied to digital devices or online applications or activities (Widyanto and Griffths, 2006; Smahel et al. In addition to the different labels, there is no consensus on the problems that such activities are assumed to cause. Few studies have explored in depth which problems may occur as a direct consequence of a hypothetically addictive use of technology, refecting the relative immaturity of the evidence base. At present, no consensus exists on how to defne this behaviour or how to measure it (Griffths et al. Some believe that ?addiction is a useful term to describe this behaviour, while others prefer different terminology that does not draw parallels with substance use behaviours. Addicted in a clinical sense means that the consequences of the behaviour are so severe that normal functioning in society is no longer possible. To justifably describe a child as ?addicted to digital technology, their use should lead to clear functional impairment and impact negatively on multiple domains of life. Researchers have not yet been able to present convincing evidence that excessive engagement with digital technology is followed by severe life impairment over time (Thege et al. There is plenty of disagreement among researchers as to whether digital technology should be considered addictive or not, outlined, in part, above. While no consensus exists on the causal factors for addiction in general, there is broad agreement that addiction is not directly caused by a substance or an activity. Rather, addiction seems to be a consequence of multiple interacting individual and environmental factors. In light of this, the popular science claim that time spent on digital technology alone could cause children to become addicted, is a misrepresentation of existing knowledge. This makes it unclear if the populations studied so far include people who experience a true problem behaviour, or whether studies have unintentionally captured people who experience an intense but ultimately positive engagement in a hobby or leisure activity (Billieux et al. What do we know about those who spend so much time using digital technology that they experience severe negative outcomes in life? No consensus exists on whether excessive use followed by severe negative outcomes might usefully be thought of as addiction or not, nor whether the outcomes of such behaviour truly mirror outcomes of substance addiction (Griffths et al. Despite these disagreements, researchers have been tentatively exploring risk-factors for nearly two decades. While these studies suffer from the same shortcomings as studies on media effects (see p. Some of the factors found to be associated with such behaviour are low psychosocial well-being. Caplan, Williams and Yee, 2009; Lemmens, Valkenburg and Peter, 2011), low self-esteem. However, it remains unclear whether these indicators are causes or consequences of the behaviour. Furthermore, most research in this area has been survey-based and conducted with largely healthy populations who do not meet the designated cut-offs for clinically relevant problems (Kardefelt-Winther et al. Calls have been made for less survey-based research and more clinical patient-focused research to address this issue (Kardefelt-Winther et al. In addition to studies on risk-factors, many studies on excessive use followed by severe negative outcomes have implicitly or explicitly suggested that this behaviour might be a consequence of attempts to cope with diffcult real-life situations through digital technology. Young, 1996; Griffths, 2000; Armstrong, Phillips and Saling, 2000; Whang, Lee and Chang, 2003; Caplan, Williams and Yee, 2009; Lemmens, Valkenburg and Peter, 2011; Smahel et al. For example, if an individual is feeling sad, they might go online and use an application that distracts them from the sadness, such as an online game or a social networking site. The consequences can be positive and negative; positive because the individual might feel better temporarily, but also negative because the real cause of the sadness may not be addressed (Kardefelt-Winther, 2014). In the long run, this might make the coping behaviour a recurring habit unless the underlying problem is resolved, which could lead to severe negative outcomes due to the time spent on the coping activity. In this sense, use of digital technology can be seen as a form of self-medication, though it remains unclear when and for whom it is positive and helpful and when it becomes maladaptive and harmful. Griffths (2000) speculated that for individuals with permanent real-life diffculties such as physical or mental disability, the need for compensation might be constant which would explain persistent excessive use followed by severe negative outcomes, though this might still be preferable to other alternatives. Many researchers agree that it is the underlying problems which prompt excessive screen time that need to be addressed to successfully overcome this problem behaviour, whereas a forced reduction in screen-time would represent a surface intervention that is unlikely to serve its purpose (Griffths et al. As Bax writes (2014), young people tend to see online activities as a welcome escape from the pressures of life. Bax (2014) suggests based on interviews with parents and children in China that the real problem may rather lie with fgures of authority who put pressure on children to conform to their own values, without considering what the children want for themselves.

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In article I wrote about how people with dementia and their India I was told that only one in ten receives a diagnosis prostate cancer 3 4 buy 50mg casodex mastercard. To be old and to have dementia is to be double the Dementia Friends programme to raise awareness stigmatised. It has started to impact on people’s involvement with the voluntary sector had informed understanding of dementia and awareness and will my view on stigma and how it might be overcome. First there was a need to establish, to a much greater There have been other improvements on the international degree, high quality, effective services for the diagnosis scene. But it is still not widely acknowledged that a diagnosis Since that time, there have been many signifcant of dementia is the start of usually many years of a improvements in our feld. According to offcial numbers, slowly deteriorating mental and physical disorder with unpredictable challenges for all involved. We need arthritis, heart bypasses, cancers, even depression and to train a workforce to take care of our older people with Parkinson’s disease, but admitting to dementia is a dementia. The establishment of such a workforce would accompanying radical physical and personality changes go some way to eliminate stigma. It is also partly because we do not have effective treatments but then this is also true Over the last seven years I’ve taken on several additional for many of the conditions I have just mentioned. In line with some other similar has taught me is what a difference it makes to carers if companies it has now fully acknowledged that the they can call on paid or voluntary help that is individually majority of its residents have some degree of dementia. As part of my role in the company, and previous experience that seems most important. In 2012 bringing me in close touch with the challenges people I was a woman of (not to be too specifc! I have professional knowledge meaning of living well with dementia by recording the about it and ready access to local excellent services. I experiences of people living with dementia and their have a family and many friends who would be supportive carers after diagnosis. I would feel no professionals, there are people living with dementia and shame at having the condition. Let us not dementia is regarded, diagnosed and managed in a exaggerate the effect that overcoming the disadvantages number of low and middle-income countries. The complete removal of recently met in Cape Town where I was able to take an stigma which, of course I fervently desire, would result in active part in our regional meeting of African National a better life for those with dementia and their carers but Associations. It has become even clearer over the past seven years that Finally, and very sadly, my personal experience of anything that can meaningfully be called a cure is still dementia has vastly increased over the last seven many years away. My husband and I see them regularly, invite them to our home with or without their partners to give their partners a break. I have to say I am often shocked, deeply taken aback 1 Alzheimer’s Disease International, 2012. World Alzheimer Report 2012: Overcoming the stigma of dementia online: <. Global action plan on the public who are intelligent, well read and highly educated. Geneva: World Health they simply cannot admit to signifcant memory problems Organization; 2017. Care systems focus on the dementia rather than Dementia is not an inevitable result of ageing. Inadequate medication as the risk of getting dementia greatly increases with management, and misinterpretation of symptoms mean age, people living with dementia are likely to experience that many people are receiving poorer services. Because age is the major risk factor addition to the broader ageism in the healthcare system, in developing dementia, those with the condition often which can also lead to reduced access to services. Old experience the effects of dementia stigma in addition age is perceived as a synonym of frailty and cognitive to the broader ageism older people encounter and decline and we are all put in the same bag, as if we were the distinction between the two types of stigma often all the same. However, everyone seems to want to live longer but only in good health and without Old age is perceived as getting older. There is a synonym of frailty and evidence to support that many people over 60 are able cognitive decline and we to function in the same way as many people in their 20s or 30s. Therefore, the assumption that old age equals are all put in the same bag, natural and inevitable decline is not totally accurate and has hidden preventable inequalities in the quality of life of as if we were all the same. Prejudice and assumptions rule and defeatist pessimism that characterize services for older people, especially those with dementia. We are forced to retire, or to give up many of our routine activities simply because either we reached People with dementia are likely to live with other medical a certain age or because we were diagnosed with an conditions, many of which could be preventable and are “age-related” disease, regardless of what a person can often undiagnosed. No other disability acquired at younger 4 the same way as people without dementia. Ageist attitudes lead to lower quality of Often, older persons may not want to be identifed as life, lack of access to preventive, adequate health care or having a disability, despite having signifcant diffculties rehabilitation services, and to abusive practices, such as in functioning, because they may consider their level refused or undignifed treatment. Should they be considered persons with disabilities because they encounter the same barriers even if they do not see themselves as having a disability? Persons with early onset dementia or another disability may not want to be When a person has identifed as old. Should a person consider herself or himself old simply because society has put an arbitrary dementia, the condition age or other characteristic to limit their activities and takes over as the main entitlements? Human Rights are indivisible, interdependent and descriptor of who they interrelated. We all are human rights holders, whatever our gender, race, the individual’s personality ability, health or any other status. The rights of persons with dementia need to be looked at with a perspective or personal history. It is crucial to ensure a human rights-based approach to systems focus on the dementia beyond the narrow medicalisation of the issue. People living with dementia have the right to participate dementia rather than the in society and those who violate their human rights should be held accountable. An conceived to cover care-related needs, but for the international convention on the rights of older persons loss of work-related income. In fact, only one in four will provide a defnitive, universal position that age people over 65 in low and middle-income countries discrimination is morally and legally unacceptable. Abuse, including social isolation, neglect, physical restraints, disrespect References for individual choices, being deprived of day-to-day 1 Evans S. This abuse is mostly hidden and tolerated volumes/95/11/16-187609/en/> Last accessed 20 August 2019. Older persons worldwide experience discrimination and 4 Scrutton, J and Brancati, C. There has been an assumption community and maximise their autonomy through that greater understanding and awareness are key to improved social participation”. The legacy of Tom Kitwood (author and people with dementia, their carers and families. Some of the main elements that are widely recognised to There has also been recognition of providing guidance contribute to quality of life are the following:4 on the language used around dementia avoiding terms like ‘dementia sufferers’ and in some countries a new Well-being. Being content, happy, feeling safe, word for dementia has been introduced to remove experiencing pleasure and joy, having a sense of self previous contemptuous connotations. Conversely, suffering pain, distress, fear, loneliness the thinking has been broadened beyond awareness and humiliation can all detract from the quality of one’s under the banner of dementia friendly. Health outcomes, income and quality dementia often meet, with informal carers and housing, to name just a few, are often taken to be reliable the wider community; volunteer programmes in indicators of some aspects of quality of life. Very poor community gardens, activity programmes to enable health, poverty, insecure or poor-quality housing can all the person to continue their interests negatively impact quality of life. It is hard to overstate the ‘dementia friends’ programmes in Japan, South prominence of respect for individual autonomy or Korea and the United Kingdom which provide basic decision-making in health care contexts over the last dementia awareness training in the community 50 years. Inclusive communities: setting up an alliance in the decision making or guardianship had been assumed, community involving local government, people with the emphasis has shifted to supported decision-making dementia and their families, and health services to where possible, or a reliance on advance directives. Along with autonomy, the value of equality has and identifying them as dementia friends been equally prominent in discussions of quality of life and in medical ethics. It is are active in their communities are more likely to report widely recognised that people who are routinely treated feeling satisfed with their lives, to have a sense of self with disrespect, as inferiors, have reduced quality of life. Training and education for informal the impact of awareness and dementia carers and paid staff will also help. So, dementia friendly projects that focus on inclusion, social engagement friendliness that enables the person with dementia to continue their How effectively are dementia-friendly programmes likely interests, and mentoring that enables voluntary and paid to promote well-being, autonomy and equality?

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Encourage your child to take part in social events and other activities that are offered at the hospital mens health books buy casodex 50mg mastercard. This is an education plan for children with certain health conditions or disabilities. It describes what special services are needed (such as special class placement, extra help with class assignments and tests, tutoring, and other services such as counseling, speech therapy, and physical therapy) and how these services will be provided to your child. Even small amounts of time and attention can make a big difference in helping your other children. This section addresses the needs and feelings of siblings?and suggests ways to help them. Does a formerly good student suddenly stop doing her homework, either to get your attention or because she is having trouble concentrating? My neighbors pitched in and made sure homework got done and kids got to their activities. I used my phone and computer to keep track of medical tests and treatment details. This section has tips to help you keep track of both medical and fnancial-related information. Increasingly, health care providers, insurance companies, and employers are providing parents with access to electronic tools. What is important is not the exact tool you use but that you keep key medical information organized and accessible. For example, you may keep a journal where you write down details about side effects your child is having or questions to ask the doctor. For example, you should ask for and keep copies of scans, pathology reports, and treatment plans. Keep these in a fle folder, or scan them into images that you save on your computer. He organized all the information, and called the hospital and insurance company when things did not match up. This means frst reading and understanding what is in your health insurance policy. Name and phone Date & time Issue discussed Next steps number of person called (at hospital or insurance company) Cancer treatment can be very expensive, even if you have insurance. Talk with the business offce at the hospital to learn about different payment options. Ask a social worker at the hospital for help with fnancial or insurance issues, and to fnd outside organizations and resources that can help. You can also learn about organizations that offer fnancial assistance on our list of Organizations That Offer Support Services. Take time to talk about special things that each person in your family has done during treatment. Some children who have been treated for cancer have many physical late effects, whereas others have relatively few. Treatments such as radiation therapy to the head and certain types of chemotherapy also increase the risk of cognitive late effects. These late effects are also more likely in children who were very young during treatment, who received very high doses of treatment, and whose treatment lasted for a long time. I?m glad we didn?t put our son through treatment that would have made him feel even worse, during the precious time he still had. Talk with them to learn what can help your child and family cope with end-of-life decisions, concerns, and emotions. When we talked with Ryan he asked if we would keep running in a race that gives funds to his hospital. Somehow, the doctors and nurses helped us come together so that our son knew how deeply he was, and is, loved. Hospice care helps your child to be as comfortable as possible near the end-of-life, when treatment is no longer controlling the disease. Hospice care is very individualized Hospice care may be given at your home, in the hospital, or in a hospice center. Hospice services include medical and nursing care, home health care services, medical supplies and equipment, drugs to help manage symptoms, spiritual support, counseling, social work services, and respite care, for example. You may fnd yourself refecting on the kindness of family, friends, and even strangers. Still, you may choose to remember certain days, such as the day of diagnosis or the last day of treatment?and do something special on those days. This care is given in addition to standard medical treatment which may include chemotherapy or radiation therapy. Acupuncture is the technique of inserting very thin needles (about the thickness of a hair) through the skin at specifc points on the body to control pain and other symptoms. It is based on the belief that vital energy fows along pathways in the body and that health problems occur when this energy is blocked. Acupuncture does not hurt, and even children who are afraid of needles can get acupuncture. Children can play games, watch a movie, read, or do other activities that help them focus on something other than the procedure or the discomfort it may cause. Guided imagery may help lower stress, pain, and nausea and give your child a sense of well-being. While under hypnosis, with the assistance of a clinical hypnotherapist, your child may feel calm, relaxed, and more open to suggestion. Laughter also causes the body to release endorphins, which can help to lower pain. Parents can be taught to give massages, or a massage therapist can give a massage. If your child bruises easily or has peripheral neuropathy, check with the doctor frst. They may also lower stress, pain, anxiety, and depression and give your child a sense of hope, peace, and optimism. It is being studied in the treatment of several cancer-related problems and other conditions. Sometimes her child life specialist used Blinky as the patient to explain what would happen. It makes these types of cells: amount of hemoglobin (substance in the blood that carries oxygen)? Platelets (also called thrombocytes) are tiny pieces of and the hematocrit (the amount blood cells that help form blood clots or stop bleeding of whole blood that is made up of and help wounds to heal. When platelet counts are red blood cells) to help diagnose low, your child may bleed or bruise more easily. Low red blood cell levels may cause anemia and your child may be very tired, short of breath, and dizzy. Bone marrow aspiration is a A small area of skin and procedure in which a small the surface of the bone Bone marrow needle sample of bone marrow (the underneath will be numbed soft, sponge-like tissue in the with an anesthetic. Then a Bone Hip center of most bones that special wide needle is inserted marrow bone makes white blood cells, red into the bone. A tumor marker test measures A sample (such as a stool, blood, urine, or other bodily fuid the amount of substances or tissue, depending on the marker to be measured) will be called tumor markers in tissue, taken and sent to a lab for testing. Transducer form pictures of the tissues and organs on a computer screen (sonogram). X-ray is a type of radiation used A technician will position your child and direct the x-ray to make pictures of bones and beam to the appropriate part of his body. Sedatives and anesthesia Each child has unique needs based on their age and the type of procedure. Children may be given medicine (called a sedative) to help them relax, stay very still, or sleep during a procedure. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. As a Child Care Food Program provider, you help children get the nourishment and energy they need to learn and grow by providing healthy meals. In addition, preschoolers who eat a variety of healthy foods and play actively several times every day are less likely to be overweight or obese. This workshop will show how you can easily and effectively implement these ?best practices for providing healthy meals and promoting healthy eating in your child care facility.

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One of their frst efforts will be to invite the community to an evening of conversation and free desserts in hopes of gathering great ideas prostate function purchase discount casodex, untapped resources, and better connections between schools, local businesses, and the greater Stellington community. The event is open to anyone interested in improving employment and community involvement for youth with disabilities. Business and community leaders, local policymakers, faith communities, youth agencies, families, and young people are especially encouraged to attend. Facilitate the “harvest” large in front of a group and group discussion at the end, “I felt it was important Aunderstands the purpose which connects participant ideas of the conversation can act as a and leads toward proposed to identify people ahead facilitator. One important feature because we had some of community conversations is that •฀ Redirect conversations that control then, versus most of the ideas should come go off-topic while honoring from the participants, not the facili participants’ perspectives, and the conversation going tator. If you are interested in using •฀ Identify connections and a professional facilitator, many completely off topic. Frame the event so people Extension Service, local univer understand why they were sity continuing/adult education invited; program, or inquire about private 2. Float between tables as more training tips and supports participants discuss the for facilitators, visit the World Café questions, redirecting the website at We recommend having event to get settled, review their their table, take notes during one or two extra volunteers in case roles, and welcome others. It would stray from the many parents in topic or focus on not have gone as problems instead our project asked individuals they of solutions. It also allows a personal meeting is not you to share with them informa feasible, send the group an tion about what their responsi email outlining these points bilities will be during the event. One planning comfortable redirecting conversa team that made arrangements tions and keeping the conversa to meet with their table hosts tions solution-focused. In general, a couple of weeks before people who tend to dominate the event emphasized that conversations do not make efec having this time to discuss the tive table hosts. Instead, choose conversation’s purpose and people who have the skills to draw the table hosts’ roles led to out ideas and feedback from all richer discussions and more participants. Because there should focused set of solutions at their be a host at each table, you can conversation. These details and tips will help you Where do you go in your free time, Participants may or may not need re through the evening. Encourage and ensure that people are are eager to tell you that something Facilitation tips jotting down key connections, ideas, won’t work because of personal bad Here are some possible statements discoveries and deeper questions on experience or because they can quickly you might use when during the to the placemats as they come up. Tangents: when there are long stories, happen, not so much on feasibility at personal struggles, or comments about. Let’s see Silence: when there is a prolonged lull or what other people have to say, Mary? Don’t be afraid to use these exact straightforward words as a reminder when needed. However, elicits creative conversations including reserving a beautiful after attending several other that result in action and space, ordering special food, community conversations, change. Ultimately, they and brainstorming who to they realized that no one decided to co-facilitate their invite. While both are responsible for welcoming participants and keeping the conversations on track, the facilitator is also charged with (a) framing the importance and intent of the event and (b) “harvesting” the best ideas, solutions, and connections at the end of the evening. The table hosts have additional responsibilities, Welcoming Framing the event including (a) facilitating Emily and Tanya wanted to create introductions among people at participants an atmosphere that welcomed their table, (b) taking notes of key n important element of participants the moment they ideas and encouraging participants community conversations arrived. Throughout the room, to write down or draw out ideas on Athat sets them apart from they posted inspirational quotes the paper placemats, and (c) briefly typical meetings is the informal highlighting the value of inclu summarizing the main points and hospitable atmosphere. They began the evening from previous conversations after Facilitators can contribute to such with a slide show underscoring people rotate to new tables. When a context by arriving early and the diference between “being facilitators and table hosts pay greeting participants as they arrive. Then they of their perspective to the event’s invited people to discuss how Although efective facilitation is success. Some organizers set up their own communities could pivotal to a conversation’s success, an attractive sign-in table and move toward realizing this vision. Instead, they successfully framed by the facilitator so all personally floated around the performed these roles themselves participants understand the con room welcoming participants. As or in partnership with one other versation process and their roles participants find a place to sit, the person. Living the good life we lose the excitement of disabled kids in public depends on whether those possibilities. Real inclusion must capabilities can be used, after all, is a form of occur in all aspects of daily abilities expressed and gifts planning. If they are, the person will be valued, feel powerful “The people who get on in and well-connected to the “We are less when we don’t this world are the people people around them. Always and second-class citizenship remember, you have within “Interdependence is and of that person. You compromise is all right, have an obligation to change as long your values don’t it. For example, a facili both the tone and direction for briefy summarize the previous tator’s introduction that welcomes the conversation. At Emily and round of conversation and asks the participants, explains the Tanya’s conversation highlighted each person to briefy share one event, and connects the issue on page 28, the quotes posted key idea or insight from the con to every participant in the room around the room and the opening versation at their previous table. To make acknowledged, and included made that have been discussed, thereby “We thought this connection, the case that inclusion is impor deepening the discussion on the a facilitator can tant and relevant to all people. Another matters to all of us organizer who hosted a conversa conversation then we realized because this is our tion on youth employment, asked we knew how we community, these her facilitator to point to local on track are our neighbors data showing that businesses trong facilitation ensures that wanted it to go, [individuals with with entry-level positions needed community conversations disabilities], these reliable employees, and youth Slead to new solutions, so no one could are our employ with disabilities needed early work connections, and resources, rather ers, these are our experiences. The facilitator then than yet another list of barriers facilitate it but employees. We called on the collected group to and seemingly insurmountable need everyone in think of ways to meet both groups’ problems. This will Facilitating Certainly, facilitators and table make our com hosts should honor participants’ to take it. Aframed the event, the first opening, the facilitator foats Framing begins with the invita question is posed and the small among tables to assist the table tion (see Figure 8 in the previous group discussions begin. Notice how this event was hosts start by asking everyone to toward local solutions. An example publicized as jointly sponsored by share their name and why they of how a facilitator or table host came. Extended introductions two diverse stakeholder groups: a can both validate individuals’ school district and a chamber of could easily take all of the time, experiences and guide discus commerce. The rationale outlined so keep them very brief so there sion toward community change in this invitation also underscores is plenty of time to discuss the might be to say, “It sounds like you the mutual benefts to both indi question. The table host Facilitators can begin the harvest have ideas of their own, a facilitator can use this information to summa by making connections with state can turn to the entire table to ask rize the conversation and to share ments like: for ideas. Otherwise, •฀ “It sounds like there was a lot of tor frequently used this approach: many of the creative and compel great discussion. It’s time to pull “John has not had a lot of success ling ideas that were discussed it all together and think about in advocating for inclusive school at individual tables may get lost. While some What were other potential ideas participants will readily share their Harvesting the best people came up with? If an individual does not comments like: the most concrete ideas feel comfortable sharing their idea Cfor change and personal in the large group, the facilitator •฀ “Sarah, we’re interested in what commitments from participants can summarize the example. What is time for a large-group discussion adults with disabilities were quite your perspective? Recognize their contribu this final 30 to 40 minutes of the the facilitator also is responsible tions and ask another participant evening invites all participants to for bringing the conversation to to speak by saying: discuss together the ideas they a close at the end of the harvest, •฀ “Those are good ideas. Let’s see heard during the evening that thanking people for their con what Marta has to say about resonated most strongly with tributions and sharing potential this. Although table hosts •฀ “Who else can build on Nathan’s most of the events in our project, will have taken notes of the ideas idea? This large-group discussion allows the allowed the organizers to share a very best ideas to be voiced and summary of the conversation and discussed by everyone together. A one or two next steps with par good facilitator will encourage all ticipants within a few days of the participants to share their ideas for conversation. It’s good to have Some conversations resulted in the questions on the table, so people can refer to them, or at least “action teams” forming that night up on the wall, so people can see them. See the talk to share her perspective, but realizing that this process is not a section “After the conversation” lecture format—it is for the participants to talk, to think about the for more information on follow-up topic, and to brainstorm solutions. Be positive; affirm that they aren’t doing anything wrong and that there aren’t any right or wrong answers.

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The possibility that poor and minority little information to systematically compare children are in double jeopardy?both more different approaches mens health zinc generic 50mg casodex with amex. And for some of them, well-designed improve the nutritional content of programs evaluations have shown that their benefts like the National School Lunch Program exceed their costs. The fact that we can?t compare repay current expenditures many times over, all policies shouldn?t keep us from imple both by allowing children to grow up to be menting or expanding those we know to productive citizens and by improving the be both effective and cost saving and from circumstances of the next generation. Also, articles in this issue highlight many pro while many policies and evaluations focus grams and policies?in the areas of health on young children, a number of interven care, behavioral health, child development, tions for adolescents have been shown to be nutrition, housing, income, and family func effective?for example, programs that target tioning?that promise to pay such dividends. The infectious diseases that once killed huge numbers of children have largely been conquered. Unlike the communicable diseases of the past, these are not equal-opportunity hazards. They are far more likely to affect poor children and the children of racial and ethnic minorities. For example, people who experience unhealthy levels of stress as children grow up to become less healthy, less produc tive adults. Though such spending has increased over time, the largest share of that increased spending has been for health care, while spending on other determinants of child health, which may be as or more important, has not kept pace. Chair of the Department of Population, Family, and Reproductive Health at the Bloomberg School of Public Health, Johns Hopkins University. Blum thanks Laura Covarrubis for identifying child health data and Alex Blum for feedback on the manuscript draft. Julien Teitler of Columbia University reviewed and critiqued a draft of this article. Furthermore, although public health-care expenditures for children have Measuring Child Health grown steadily, this growth has come from There are no comprehensive, agreed-upon expanded eligibility for publicly fnanced measures or indices as to what constitutes health insurance and substantial increases in child health. Rising health expen and Institute of Medicine conceive health ditures have coincided with the erosion of across four domains: sociodemographic, psy public investment in education, housing, and chological, behavioral, and contextual (com social services, all of which are thought to munity). Evidence over cognitive development); and birth-related time illuminates the social, behavioral, and characteristics such as low birth weight. These include both tax expenditures and direct investments across the areas of It is beyond the scope of this article to income support, education, social services, explore the characterization of child health housing, community development, national in depth or to attempt to reconcile differ infrastructure, public health, and health ences among measures. One reason we must view government however, is use marker conditions to indicate spending broadly is that direct investment in how U. For example, spending on the tated by the fact that most measures are not elderly, though frequently contrasted with available over long periods of time. The past century has witnessed dramatic Over this period, childhood vehicular deaths changes in child and adolescent mortality experienced an even more dramatic 41 per and illness. One hundred years ago, infec cent decline as a result of passive restraints, tious diseases were the leading causes of child passenger laws, graduated driver licenses for adolescents, and safer vehicles, childhood disease and death. Today, social indicating that nonmedical technologies can and environmental factors are the principal also play an important role in improving drivers of child health. In 1910, diphtheria, croup, and scarlet fever were among the top three Changing Trends over the Past Century causes of death for children ages fve to nine When we look at the changes in child sur years, while tuberculosis and typhoid fever vival in the Unites States over the twentieth joined injuries as the leading causes of death century, the improvements are nothing short in adolescence. In 1910, the infant mortal these infectious diseases are all but unknown ity rate was 127. Today, injury, suicide, 2012, the rate had dropped to 6 deaths per and homicide account for three-quarters of 1,000 live births. In 1910, causes have increased, but because other mortality among young children stood at 10 deaths have declined precipitously. Today, congenital anomalies, sudden ered a sentinel marker of health for both infant death, and prematurity are the leading mothers and children. Given the reduc 650 women died for every 100,000 live tions in infectious disease, injury and homi births. By 2010, the maternal mortality rate cide have joined congenital abnormalities had fallen to 21. Vaccines against preventable the past decade has seen a signifcant diseases; antibiotics and management of decline in childhood deaths from uninten infectious diseases; advances in the manage tional injuries, from 15. Census Bureau, Mortality Statistics: 1910; and Melonie Heron, ?Deaths: Leading Causes for 2009. Today, while nearly 60 per caused early death; and other technological cent of children live in two-parent biologic advances no doubt played important roles. Casey Foundation has shown, children who grow At the same time, the nation and its fami up in other than dual-parent families tend lies have changed dramatically. Over the to be disadvantaged socially and economi past century, America has become more cally. Since 1910, the proportion of care responsibilities have also changed dra the population living in cities has risen from matically over the past half-century. Today the average is opportunities, including access to health 21 hours, and in approximately 60 percent care. But it has also brought new health of two-parent families, both parents work risks, such as pollution, human conges outside the home. The success Despite the substantial reductions in infant of many of the programs discussed elsewhere and child mortality over the past century, the in this issue by Maya Rossin-Slater suggests U. Low-income children and members of racial and ethnic minority health inequalities are refected in mortal groups continue to die in infancy at rates far ity rate differentials for every age group in higher than those experienced by white and childhood, as shown in table 2. Infant and Child Mortality 2010, by Race/Ethnicity and Age (per 100,000 live births) Non-Hispanic Non-Hispanic Hispanic American Asian/Pacifc White Black (all races) Indian Islander Infant Mortality 528 1,051 458 378 445 Early Child Mortality, Ages 1?4 24 38 24 14 27 Child/Early Adolescent Mortality, Ages 5?14 13 18 11 9 12 Adolescent Mortality, Ages 15?19 58. Louis Pasteur, understanding of disease causes and path who identifed microbes as the underlying ways. Today, we under leading American surgeons for advocating stand that environmental toxins are not only aseptic surgical techniques. And we know that risk expo By the early 1900s, germ theory had become sures in fetal life and even before concep well entrenched, and a single-agent concept tion can drive chronic conditions across the of disease prevailed. Advocates also considered the including the families in which they live social context for health, but they tended to and the conditions that affect families lives focus on issues such as sanitation, access to and wellbeing, highlighting the effects of clean water, and safe milk and food sup socially toxic environments. Since then, research has documented strong associations between Investigators were unable to identify a single adverse childhood experiences and adult microbe causing these or many other condi cancers, sexually transmitted infections, tions. The fact, children who have adverse childhood case-control studies showing an association experiences show a risk of subsequent disease between lung cancer and cigarette smoking approximately two to four times as high as were a watershed that, among other things, children who did not have such experiences. For adults of any tion between genetics and the environment income level, early adverse childhood experi is a major factor in health. Advances in genetics have brain development extends well into the led to a better understanding of the gene/ third decade. Exposure to toxic environ environment interaction, and we now know ments what researchers call toxic stress that genes per se account for a relatively alters brain architecture in developing small fraction of human disease at any age. The result is reduced capacity for undesirable ways that may lead, for example, reasoning, stress reactivity, decision making, to cancer. The fetal origins hypothesis, of the Netherlands in 1945 have a signif championed by David Barker, has led to cantly higher prevalence of schizophrenia as research demonstrating that birth weight is adolescents than those born in other com strongly associated with adult disease risk. Neighborhoods are highly cor related with both family income and a host As our understanding of what drives health of environmental exposures (for example, has evolved, we have moved from focusing violence, unsanitary conditions, environmen strictly on gene/environment interactions to tal and social toxins). One important factor an ?upstream conceptual model in which is residential segregation, which continues to be pervasive in American life. These conditions arise from both life health and populations at heightened risk of style behaviors and the social environments poverty and deprivation, including members in which our most vulnerable children live. For example, in 2012, 14 percent of children Two researchers recently presented nation under the age of 18 had ever been diag ally representative statistics from the nosed with asthma, and 9 percent had per National Health and Nutrition Examination sistent asthma. The ratio were measured through physical exami remaining 17 percent (those not in good-to nations and/or laboratory reports. Their excellent health) were fve times as likely to fgures indicate clear income gradients in have asthma. But disparities persist, lent health, only 46 percent of those living in not only by income but also by racial/eth poverty did so. Children living in households headed by a Black children consistently had lower self single mother were twice as likely as their assessed health status than did non-Hispanic peers (6 percent vs. In 2012, 6 percent of children white odds ratios, while others (for example, had unmet dental needs because their autism) saw improvement. Poor health is disproportionately the dominant sources of child disability in associated with poverty, as well as with the U. That said, to use their resources, time, and energy; all groups have benefted, though not equally employment policies, ranging from wages so, as key markers of child health, such as to other forms of nonwage compensation infant mortality, have improved over time.

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The anteriorly located anus must be distinguished from an ectopic anus prostate cancer years to live order 50 mg casodex otc, condition may occur in the infant of a diabetic mother and in in which the anal canal and internal anal sphincter are displaced an cystic fbrosis, rectal aganglionosis, maternal drug abuse, and teriorly; the external anal sphincter remains in its normal posterior afer maternal magnesium sulfate therapy for preeclampsia. Constipation Guideline Committee of the North American Society for Newborn screening programs in the United States test for Pediatric Gastroenterology, Hepatology and Nutrition: Evaluation and 11 hypothyroidism. Inquire about a limited amount of bleeding and a clinical picture consistent with a family history of coagulopathies and Hirschsprung disease. A benign, self-limited condition (swallowed blood, Mallory-Weiss history of nosebleeds raises the possibility of swallowed blood tear), laboratory tests may not be indicated. Tera endoscopic methods to image the small bowel include balloon peutic doses of iron will cause black stools, but they will remain enteroscopy and capsule endoscopy. A rectal examination may reveal tags, fssures and fs Gastritis may be due to caustic ingestions, viral infections, 7 tulae (Crohn disease), or erythema with tenderness (group A Helicobacter pylori infection, radiation exposure, or bile b-hemolytic streptococcal infection). Confrming the presence of blood is important to avoid an 2 unnecessary evaluation. A stool test for occult blood must Peptic ulcer disease includes gastric and duodenal ulcers, 8 be part of the initial evaluation. Munchausen by proxy should be considered if a history present as irritability, vomiting, and regurgitation. Fecal leukocytes are consistent with an invasive peptic ulcer disease, although for children this ?classic constel infectious organism or an infammatory condition. Portal vein thrombosis problems as older age groups, some conditions tend to is the next most likely etiology. A series of tortuous collateral veins develop to prematurity and occasionally can have a late presentation. Occult blood may occur with acute diarrhea due to any An unsuspected coagulopathy is more likely to occur in 11 cause as a result of minor anal or perineal irritation. Be aware of in creased risk in breast-fed infants, especially those who did not Hirschsprung disease typically occurs as an obstruction, 18 receive vitamin K at birth. A Streptococcus to rule out a perianal cellulitis, which can predis pose patients to fssures and bleeding. Hemorrhoids involving Intussusception is the ?telescoping of one segment of the 15 veins above the anorectal line may not be visible on examination. Progression to vomiting diagnoses listed are among the most common that may present (sometimes bilious or bloody), lethargy, and shock may occur. The most common source Isoimmune hemolytic disease occurs when maternal anti 7 of bilirubin is the increased breakdown of hemoglobin. Jaundice bodies to the erythrocytes of the fetus cross the placenta may lead to kernicterus, which is a neurologic syndrome resulting and cause destruction of the fetal red blood cells. Examples include cephalohematoma, ecchymo should inquire about delivery complications, maternal infec ses, occult hemorrhage as well as swallowed maternal blood. Oxytocin during labor is Any condition causing obstruction or delayed passage of associated with an increased risk of jaundice. Tese may also cause conjugated ing, lethargy, poor feeding, and failure to thrive may suggest an hyperbilirubinemia. Detailed investigation is warranted in children with con 2 Normal liver enzymes indicate that hepatic injury or biliary jugated hyperbilirubinemia, defned as a conjugated bili 13 tract disease is less likely. Serum alkaline phosphatase is out infection, metabolic disorders, anatomic abnormalities, also increased in relation to aminotransferases. In obstructive jaundice there is ofen prolonged prothrom Some risk factors for development of severe hyperbilirubi bin time that corrects with vitamin K administration due to 3 nemia include prematurity, jaundice observed in frst 24 decreased absorption of fat-soluble vitamins. Hypoglycemia refects hepa bin levels owing to the relative immaturity of their hepatic tocellular damage; it indicates more severe disease and mandates excretory function. Extracorporeal membrane oxy 15 jugated hyperbilirubinemia without an obvious etiology genation, prosthetic heart valves, and burns may cause hemoly afer known infectious and metabolic and genetic causes have sis by a mechanical mechanism. Kayser-Fleischer tially asymptomatic at birth and become jaundiced afer a few rings in the cornea refect deposited copper and are pathogno weeks. Review the medical history in the older child who pre Some drugs that may cause hyperbilirubinemia in older 17 21 sents with jaundice because certain illnesses are associ children include antibiotics. A family history of jaundice, anemia, Autoimmune hepatitis may occur acutely (with symptoms liver disease, splenectomy, or cholecystectomy suggests a 22 such as malaise, anorexia, nausea, vomiting, jaundice) or hereditary disorder. Splenomegaly occurs in hemolytic disorders and in matory bowel disease) may be present. Neurologic fndings such as tremor, reveals elevated transaminase levels, mild hyperbilirubinemia, fne motor incoordination, clumsy gait, and chore form move hypergammaglobulinemia, and auto-antibodies (antinuclear ments suggest Wilson disease. A workup specifcally for jaundice may also be elevated, although it is usually associated with pri may not be necessary when an underlying diagnosis such as mary biliary cirrhosis. Mycoplasma pneumonia, Epstein-Barr infant 35 or more weeks of gestation, Pediatrics 114(1):297?316, 2004. Most cases of hemolytic anemia associated healthy term and near-term newborns, Pediatrics 103:6?14, 1999. Liver span may be measured by percussing the upper fbrosis (nonalcoholic steatohepatitis). It used to be an adult margin of dullness and by palpating the lower edge in the disease but is increasingly described in children. Other infections that cause hepatosplenomeg 1 as well as underlying conditions that may contribute to aly and anicteric hepatitis include cat-scratch disease, typhoid, liver disease. Tese include amino acid toms should be elicited, as well as a history of neonatal deaths. Diagnosis is by low serum ceruloplasmin venous outfow obstruction occurring in conditions predispos levels, high urinary copper excretion, and increased hepatic ing to thrombosis. Practical strategies in pediatric diagnosis and therapy, ed 2, Philadelphia, 2004, Saunders, pp 333?344. A splenic edge felt more than 2 cm below the lef Pain occurs secondary to stretching of the splenic capsule and costal margin is usually abnormal. A persistently palpable may occur as lef upper quadrant pain or referred pain to the lef spleen may be normal, but some workup is necessary before shoulder. Certain ethnic backgrounds suggest a risk of Viral infection is the most common cause of splenomeg 3 certain disorders, mostly hemolytic or storage disorders. Milder variants of the disease may 6 kemia requiring referral for bone marrow examination. Extracorporeal membrane oxy Practical strategies in pediatric diagnosis and therapy, ed 2, Philadelphia, genation, prosthetic heart valves, and burns may cause hemoly 2004, Elsevier, pp 345?352. Because the abdominal cav ity allows considerable room for growth, there may be few or Hydronephrosis is the most common cause of an abdomi 3 nonspecifc symptoms. A thorough re In infants, a history of polycythemia, dehydration, diabetic 4 view of symptoms and social history, including a sexual history, mother, asphyxia, sepsis, or coagulopathy are risk factors recent travel, and infectious contacts, should be obtained. Hematuria, hypertension, and The abdominal examination should note the location, size, thrombocytopenia are ofen present. Neuroblastoma is one of the most common malignancies 5 Hepatosplenomegaly is the cause of more than half of child in infants. The tumors occur as precocious puberty owing to the production of normal spleen is usually nonpalpable, although it may be felt in estrogen. Renal masses usually extend downward The etiology of a hepatic mass includes tumors, hemangio 7 from the kidney location, do not tend to cross the midline, and mas, cysts, and abscesses. Abdominal distention due to as plasia, and hamartomas can occur as solitary lesions. It is ofen Trichomonas, as well as bacterial vaginosis and vaginal candi associated with urinary symptoms such as frequency, urgency, diasis. Anal pruritus nal palpation of the kidneys, pelvic exam when indicated, and a may indicate pinworms, which can cause urethral irritation and careful neurologic exam in children with voiding dysfunction can be confrmed by examination with a tape slide test. Microscopic analysis of unspun urine for 3 glass-shaped area of atrophy and scarring with depigmentation. Gross hema 5 8 catheterization, or more than 10 colonies by clean-catch mid turia is seen with hemorrhagic cystitis (adenovirus, cyclo stream urine indicate infection. In infants and young children, the clinical picture dysuria, and occasional bleeding. Chapters 114, 116 Neurogenic bladder may develop secondary to a lesion of 4 the central or peripheral nervous system. Nocturnal enuresis, the most common form, is malities when the cause of the neurogenic bladder has not the involuntary passage of urine during sleep. Primary nocturnal enure 5 ful examination may indicate labial fusion in which there sis refers to a child who has never been continent at night and is retention of urine behind the fused labia.