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By I. Olivier. University of Wisconsin-La Crosse.

All relevant identification data shall be entered on one side of the card is fully devoted to growth monitoring buy viagra plus 400mg without prescription erectile dysfunction treatment karachi. At each visit growth monitoring should be done as follows: 122 Family Health ♦ Record the month of birth in the box for the month of the first year buy viagra plus line erectile dysfunction pump implant video. Weighing a child regularly purchase cheapest viagra plus and viagra plus icd 9 code erectile dysfunction 2011, plotting the weights on a growth chart and understanding the direction of the growth line are the most important steps in detection of early malnutrition. Nutrition Classification: Normal= > 80%; mild Malnutrition= 70-80%; Moderate malnutrition= 60-70%; Severe Malnutrition= < 60%. Importance of breast feeding, weaning food introduction Practical demonstrations on the use of locally available foodstuffs. In order to be prepared and respond to problems related to adolescence it is necessary to acquire a comprehensive knowledge concerning adolescence. The programme is designed to focus on the production of healthy adolescents that will effectively succeed the present generation. Objective: General objective: Adolescent reproductive health program in general and the extension package in particular aims at producing healthy adolescent population that is physically, mentally and socially well-developed. Specific objectives: – provide adequate information and education to reduce and/or gradually eliminate traditional harmful practices that cause adolescent reproduction health related problems. The volunteer house wives will be aids to the health extension workers and will have the task of educating their neighbors. The youth should provide sustained education on adolescent reproductive health and should commit itself to make the day a special occasion to strive to bring behavioral changes. Changes developing in young males: - • Change of voice; • Building and broadening of shoulder and chest; • Growing beard; starting to grow hair in the armpit, pubic and perhaps in the chest; • Development of male genitals and testicles; • Starting to release sperm; • Change in the amount and smell of body sweat; • Increased eagerness to know more about sex; • Developing keen interest and/or falling in love with opposite sex; and • Releasing sperm for the first time in bed during sleep. Female genital mutilation Female genital mutilation is one of the harmful traditional practices that cause problems of adolescent reproduction health. The immediate health problems of the young females include bleeding, unconsciousness, septicemia, problem of urination and sometimes death. In addition to the violation of human rights related to females, it seriously affects the happy and peaceful marriage of such victims. It is essential to prevent and eventually eliminate the harmful traditional practices of mutilation of female genitals. The choice of intervention would be to provide sustained and adequate information on reproductive health. High risk abortion The youth engages in casual sex in the absence of adequate knowledge on sex and reproductive health and often without contraceptive methods. The consequences of such traditional practices is that the young females are exposed to illegal and high risk abortion resulting in illness, disability and death. Main reasons for abortion:- • Lack of appropriate information on sex and reproductive health; • The non-existence of adequate services for abortion; • The victims don’t have access to adequate financial and other supports; and • Communities don’t effectively utilize available family planning services to prevent and control abortion. Activities to prevent and control high risk abortion:- • Increase awareness of the youth on sex abstinence and healthy behaviours that reduce reproductive health related problems. Therefore, they 139 Family Health should be educated and convinced strongly to commit themselves to utilize contraceptive methods to prevent unwanted pregnancy. In the rural areas, however, it is common practice by families to marry their young girls at an early age. Second, the marriage is accomplished with wealthy family in order to improve the living conditions of the bride’s family. Fourth, to prove that the bride is virgin, a litmus test that reassure that the bride is from a decent family. Consequences of early age marriage on young females:- Miss education opportunity and /or become out of school: young females miss the opportunity to go to school if she got married at an early age. Even though, girls are married at an early age and are too young, they continue to work for their husband and his family (the parents etc). This state of affairs becomes an impediment to develop and acquire knowledge and skills to decide on their fate and related affairs. High maternal and child morbidity and mortality Some of the consequences of early age marriage are delayed labor, fistula and rupture of the bladder. Fistula is a dirty injury that results in the loss of control of urine and stool which results in incontinence and body smell. Measures to prevent alcoholism:- • Educate students in schools in the kebele on the consequences of alcoholic drinks on their health. Therefore, the young farmers have to be made aware that such incidents can happen using pamphlets, health education in planned community meetings and other venues. Addictive substances and drugs:- Chat, hashish and cannabis are the major known addictive substances that cause the following health and related problems. Establishment and organization of youth recreational facilities:- Establish youth recreational centers with rooms and other spaces for traditional sports activities and meetings. Each disease is caused by a germ, bacteria or virus, which enters the body during intercourse with an infected person. A person carrying the bacteria when one mucus membrane comes into contact with another’s 148 Family Health transmits it. Incubation Period The average incubation period is 3–7 days after sexual contact although women may remain symptom – free for up to 3 months. In women • Vaginal discharge • Frequency of urination • Abdominal pain and backache • Irregular and painful menses • Pain with intercourse and post coital bleeding 5. In Men • A thick yellow/green purulent urethra discharge • Urethra irritation associated with dysuria and frequent urination 5. Complications of gonorrhoea If the disease is not properly treated at once, it can lead to permanent damage of the reproductive organs in the women. Syphilis: Is a sexually transmitted disease caused by the microorganism (spirochete)- Treponema pallidum. The organism usually enter the body through invisible breaks in the skin or through intact mucus membranes lining the mouth, rectum, or genital tract 5. It is transmitted mainly in the following way: ♦ Sexual intercourse ♦ Occasionally by kissing when one partner has moist syphilitic lesion of the month or throat ♦ Organism passing from the infected mother to fetus ♦ Blood transfused 5. Signs and Symptoms of Syphilis Unlike gonorrhoea, a person who has syphilis has on pain while passing urine. However, the person will notice a painless hard ulcer 150 Family Health (sore or would) on the penis or vagina about 10 days after sexual intercourse with an infected person. At this stage it is important to go for proper medical treatment because the disease can be cured at this time. If not treated, the sore and the swollen glands will go away on their own but the germs remain in the blood. Primary Syphilis Three weeks after exposure chancre in an undulated penis, anus, edge of vagina, cervix or mouth. Secondary Syphilis About six weeks after the healing of the primary infection rashes tend to be quickly passing and do not itch. One in four persons not treated for secondary syphilis will eventually suffer incapacity or death from the disease. Congenital syphilis - a serious infection in new born – occurs frequently if pregnant women with syphilis are not treated. Complications of Syphilis About two months later the infected person will develop a fever, headache and a skin rash.

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Movements are often at an angle order cheap viagra plus on line erectile dysfunction vitamin shoppe, so some horizontal components are necessary trusted 400 mg viagra plus erectile dysfunction therapy treatment, adding the medial and lateral rectus muscles to the movement buy viagra plus amex erectile dysfunction young age. The rapid movement of the eyes used to locate and direct the fovea onto visual stimuli is called a saccade. Notice the concentration of gaze on the major features of the face and the large number of paths traced between the eyes or around the mouth. Testing eye movement is simply a matter of having the patient track the tip of a pen as it is passed through the visual field. This may appear similar to testing visual field deficits related to the optic nerve, but the difference is that the patient is asked to not move the eyes while the examiner moves a stimulus into the peripheral visual field. Failure of one eye to abduct while the other adducts in a horizontal movement is referred to as internuclear ophthalmoplegia. When this occurs, the patient will experience diplopia, or double vision, as the two eyes are temporarily pointed at different stimuli. Diplopia is not restricted to failure of the lateral rectus, because any of the extraocular muscles may fail to move one eye in perfect conjugation with the other. As visual stimuli move closer to the face, the two medial recti muscles cause the eyes to move in the one nonconjugate movement that is part of gaze control. When the two eyes move to look at something closer to the face, they both adduct, which is referred to as convergence. To keep the stimulus in focus, the eye also needs to change the shape of the lens, which is controlled through the parasympathetic fibers of the oculomotor nerve. Accommodation ability changes with age; focusing on nearer objects, such as the written text of a book or on a computer screen, may require corrective lenses later in life. Coordination of the skeletal muscles for convergence and coordination of the smooth muscles of the ciliary body for accommodation are referred to as the accommodation–convergence reflex. A crucial function of the cranial nerves is to keep visual stimuli centered on the fovea of the retina. If the head rotates in one direction—for example, to the right—the horizontal pair of semicircular canals in the inner ear indicate the movement by increased activity on the right and decreased activity on the left. The information is sent to the abducens nuclei and oculomotor nuclei on either side to coordinate the lateral and medial rectus muscles. The left lateral rectus and right medial rectus muscles will contract, rotating the eyes in the opposite direction of the head, while nuclei controlling the right lateral rectus and left medial rectus muscles will be inhibited to reduce antagonism of the contracting muscles. Nerves of the Face and Oral Cavity An iconic part of a doctor’s visit is the inspection of the oral cavity and pharynx, suggested by the directive to “open your mouth and say ‘ah. Whereas this portion of a medical exam inspects for signs of infection, such as in tonsillitis, it is also the means to test the functions of the cranial nerves that are associated with the oral cavity. Testing this is as simple as introducing salty, sour, bitter, or sweet stimuli to either side of the tongue. Stimuli applied to specific locations on the tongue will dissolve into the saliva and may stimulate taste buds connected to either the left or right of the nerves, masking any lateral deficits. If the examiner moves the tongue depressor to contact the lateral wall of the fauces, this should elicit the gag reflex. The motor response, through contraction of the muscles of the pharynx, is mediated through the vagus nerve. The vagus nerve directly stimulates the contraction of skeletal muscles in the pharynx and larynx to contribute to the swallowing and speech functions. Further testing of vagus motor function has the patient repeating consonant sounds that require movement of the muscles around the fauces. The patient is asked to say “lah-kah- pah” or a similar set of alternating sounds while the examiner observes the movements of the soft palate and arches between This OpenStax book is available for free at http://cnx. Neurons in the salivary nuclei of the medulla project through these two nerves as preganglionic fibers, and synapse in ganglia located in the head. The parasympathetic fibers of the facial nerve synapse in the pterygopalatine ganglion, which projects to the submandibular gland and sublingual gland. The parasympathetic fibers of the glossopharyngeal nerve synapse in the otic ganglion, which projects to the parotid gland. Salivation in response to food in the oral cavity is based on a visceral reflex arc within the facial or glossopharyngeal nerves. Other stimuli that stimulate salivation are coordinated through the hypothalamus, such as the smell and sight of food. The hypoglossal nerve is the motor nerve that controls the muscles of the tongue, except for the palatoglossus muscle, which is controlled by the vagus nerve. The extrinsic muscles of the tongue are connected to other structures, whereas the intrinsic muscles of the tongue are completely contained within the lingual tissues. While examining the oral cavity, movement of the tongue will indicate whether hypoglossal function is impaired. If the hypoglossal nerves on both sides are working properly, then the tongue will stick straight out. If the nerve on one side has a deficit, the tongue will stick out to that side—pointing to the side with damage. Additionally, because the location of the hypoglossal nerve and nucleus is near the cardiovascular center, inspiratory and expiratory areas for respiration, and the vagus nuclei that regulate digestive functions, a tongue that protrudes incorrectly can suggest damage in adjacent structures that have nothing to do with controlling the tongue. But directed tests, especially for contraction against resistance, require a formal testing of the muscles. The strength test in this video involves the patient squeezing her eyes shut and the examiner trying to pry her eyes open. Motor Nerves of the Neck The accessory nerve, also referred to as the spinal accessory nerve, innervates the sternocleidomastoid and trapezius muscles (Figure 16. When both the sternocleidomastoids contract, the head flexes forward; individually, they cause rotation to the opposite side. Along with the spinal accessory nerve, these nerves contribute to elevating the scapula and clavicle through the trapezius, which is tested by asking the patient to shrug both shoulders, and watching for asymmetry. For the sternocleidomastoid, those spinal nerves are primarily sensory projections, whereas the trapezius also has lateral insertions to the clavicle and scapula, and receives motor input from the spinal cord. Though that is not precisely how the name originated, it does help make the association between the function of this nerve in controlling these muscles and the role these muscles play in movements of the trunk or shoulders. They can act as antagonists in head flexion and extension, and as synergists in lateral flexion toward the shoulder. To test these muscles, the patient is asked to flex and extend the neck or shrug the shoulders against resistance, testing the strength of the muscles. These strength tests are common for the skeletal muscles controlled by spinal nerves and are a significant component of the motor exam. When light hits the retina, specialized photosensitive ganglion cells send a signal along the optic nerve to the pretectal nucleus in the superior midbrain. A neuron from this nucleus projects to the Eddinger–Westphal nuclei in the oculomotor complex in both sides of the midbrain. Neurons in this nucleus give rise to the preganglionic parasympathetic fibers that project through the oculomotor nerve to the ciliary ganglion in the posterior orbit. The postganglionic parasympathetic fibers from the ganglion project to the iris, where they release acetylcholine onto circular fibers that constrict the pupil to reduce the amount of light hitting the retina. Light shined in one eye causes a constriction of that pupil, as well as constriction of the contralateral pupil.

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Because pulse indicates heart rate discount 400mg viagra plus with amex erectile dysfunction causes prescription drugs, it is measured clinically to provide clues to a patient’s state of health viagra plus 400mg cheap erectile dysfunction pump treatment. A high or irregular pulse rate can be caused by physical activity or other temporary factors best 400mg viagra plus erectile dysfunction drugs from india, but it may also indicate a heart condition. Pulse can be palpated manually by placing the tips of the fingers across an artery that runs close to the body surface and pressing lightly. While this procedure is normally performed using the radial artery in the wrist or the common carotid artery in the neck, any superficial artery that can be palpated may be used (Figure 20. Common sites to find a pulse include temporal and facial arteries in the head, brachial arteries in the upper arm, femoral arteries in the thigh, popliteal arteries behind the knees, posterior tibial arteries near the medial tarsal regions, and dorsalis pedis arteries in the feet. Measurement of Blood Pressure Blood pressure is one of the critical parameters measured on virtually every patient in every healthcare setting. Turbulent blood flow through the vessels can be heard as a soft ticking while measuring blood pressure; these sounds are known as Korotkoff sounds. The technique of measuring blood pressure requires the use of a sphygmomanometer (a This OpenStax book is available for free at http://cnx. The technique is as follows: • The clinician wraps an inflatable cuff tightly around the patient’s arm at about the level of the heart. Initially, no sounds are heard since there is no blood flow through the vessels, but as air pressure drops, the cuff relaxes, and blood flow returns to the arm. As more air is released from the cuff, blood is able to flow freely through the brachial artery and all sounds disappear. In this graph, a blood pressure tracing is aligned to a measurement of systolic and diastolic pressures. The majority of hospitals and clinics have automated equipment for measuring blood pressure that work on the same principles. The patient then holds the wrist over the heart while the device measures blood flow and records pressure. Variables Affecting Blood Flow and Blood Pressure Five variables influence blood flow and blood pressure: • Cardiac output • Compliance • Volume of the blood • Viscosity of the blood • Blood vessel length and diameter Recall that blood moves from higher pressure to lower pressure. If you increase pressure in the arteries (afterload), and cardiac function does not compensate, blood flow will actually decrease. Increased pressure in the veins does not decrease flow as it does in arteries, but actually increases flow. Since pressure in the veins is normally relatively low, for blood to flow back into the heart, the pressure in the atria during atrial diastole must be even lower. Any factor that causes cardiac output to increase, by elevating heart rate or stroke volume or both, will elevate blood pressure and promote blood flow. These factors include sympathetic stimulation, the catecholamines epinephrine and norepinephrine, thyroid hormones, and increased calcium ion levels. Conversely, any factor that decreases cardiac output, by decreasing heart rate or stroke volume or both, will decrease arterial pressure and blood flow. These factors include parasympathetic stimulation, elevated or decreased potassium ion levels, decreased calcium levels, anoxia, and acidosis. The greater the compliance of an artery, the more effectively it is able to expand to accommodate surges in blood flow without increased resistance or blood pressure. When vascular disease causes stiffening of arteries, compliance is reduced and resistance to blood flow is increased. A Mathematical Approach to Factors Affecting Blood Flow Jean Louis Marie Poiseuille was a French physician and physiologist who devised a mathematical equation describing blood flow and its relationship to known parameters. Although understanding the math behind the relationships among the factors affecting blood flow is not necessary to understand blood flow, it can help solidify an understanding of their relationships. Please note that even if the equation looks intimidating, breaking it down into its components and following the relationships will make these relationships clearer, even if you are weak in math. Poiseuille’s equation: 4 Blood fl w = π ΔP r 8ηλ • π is the Greek letter pi, used to represent the mathematical constant that is the ratio of a circle’s circumference to its diameter. One of several things this equation allows us to do is calculate the resistance in the vascular system. Normally this value is extremely difficult to measure, but it can be calculated from this known relationship: Blood fl w = ΔP Resistance If we rearrange this slightly, Resistance = ΔP Blood fl w Then by substituting Pouseille’s equation for blood flow: 8ηλ Resistance = 4 πr By examining this equation, you can see that there are only three variables: viscosity, vessel length, and radius, since 8 and π are both constants. The important thing to remember is this: Two of these variables, viscosity and vessel length, will change slowly in the body. Only one of these factors, the radius, can be changed rapidly by vasoconstriction and vasodilation, thus dramatically impacting resistance and flow. Further, small changes in the radius will greatly affect flow, since it is raised to the fourth power in the equation. We have briefly considered how cardiac output and blood volume impact blood flow and pressure; the next step is to see how the other variables (contraction, vessel length, and viscosity) articulate with Pouseille’s equation and what they can teach us about the impact on blood flow. Water may merely trickle along a creek bed in a dry season, but rush quickly and under great pressure after a heavy rain. Low blood volume, called hypovolemia, may be caused by bleeding, dehydration, vomiting, severe burns, or some medications used to treat hypertension. It is important to recognize that other regulatory mechanisms in the body are so effective at maintaining blood pressure that an individual may be asymptomatic until 10–20 percent of the blood volume has been lost. Hypervolemia, excessive fluid volume, may be caused by retention of water and sodium, as seen in patients with heart failure, liver cirrhosis, some forms of kidney disease, hyperaldosteronism, and some glucocorticoid steroid treatments. Restoring homeostasis in these patients depends upon reversing the condition that triggered the hypervolemia. The viscosity of blood is directly proportional to resistance and inversely proportional to flow; therefore, any condition that causes viscosity to increase will also increase resistance and decrease flow. Conversely, any condition that causes viscosity to decrease (such as when the milkshake melts) will decrease resistance and increase flow. Since the vast majority of formed elements are erythrocytes, any condition affecting erythropoiesis, such as polycythemia or anemia, can alter viscosity. Since most plasma proteins are produced by the liver, any condition affecting liver function can also change the viscosity slightly and therefore alter blood flow. Liver abnormalities such as hepatitis, cirrhosis, alcohol damage, and drug toxicities result in decreased levels of plasma proteins, which decrease blood viscosity. While leukocytes and platelets are normally a small component of the formed elements, there are some rare conditions in which severe overproduction can impact viscosity as well. Vessel Length and Diameter The length of a vessel is directly proportional to its resistance: the longer the vessel, the greater the resistance and the lower the flow. As with blood volume, this makes intuitive sense, since the increased surface area of the vessel will impede the flow of blood. The length of our blood vessels increases throughout childhood as we grow, of course, but is unchanging in adults under normal physiological circumstances. One pound of adipose tissue contains approximately 200 miles of vessels, whereas skeletal muscle contains more than twice that. Gaining about 10 pounds adds from 2000 to 4000 miles of vessels, depending upon the nature of the gained tissue. One of the great benefits of weight reduction is the reduced stress to the heart, which does not have to overcome the resistance of as many miles of vessels. In contrast to length, the diameter of blood vessels changes throughout the body, according to the type of vessel, as we discussed earlier.

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In this framework buy viagra plus 400mg on-line erectile dysfunction in young males causes, social and personal factors are considered to act together to facilitate the initiation and escalation of drug use discount viagra plus uk erectile dysfunction doctors augusta ga. Thus viagra plus 400mg with mastercard erectile dysfunction drugs and melanoma, some adolescents may be influenced towards consumption by the media, which sometimes normalize or glamorize drug use, while others may be more influenced by family or friends who use or have favorable attitudes and beliefs about substance consumption. These social influences are likely to have a greater impact on young people with poor social and personal skills or those with greater psychological vulnerability, such as low self-esteem, social anxiety and psychosocial stress. Fortunately, knowing how these variables lead to consumption is very useful when conceptualizing and designing prevention programs. For example, a preventive program that improves social skills and personal competence may have beneficial effects on several psychological factors (e. Dependency is the set of physiological manifestations, behavioral and cognitive in which the use of a drug is a priority for the subject. See the European Monitoring Center for Drugs and Drug Addiction annual report at the following direction: http://www. The occasional use of a drug is an intermittent pattern in intake, which depends on the emergence of situations that trigger the use. A criterion for the diagnosis of substance abuse is that the drug is frequently taken in large amounts or over a period longer than initially intended. Studies indicate that individuals who have more emotional problems and are socially isolated consume more alcohol, marijuana and other illegal drugs. Actitudes, habilidades sociales y autocontrol en la prevención del consumo abusivo de alcohol y tabaco. Teacher-ratings and self rating of social competency in adolescents with low-and high-depressive symptoms. Diferencias de género en el consumo de alcohol y tabaco de estudiantes de Educación Secundaria Obligatoria. Análisis jurídico y sociológico de sentencias emitidas en las audiencias provinciales y juzgados de la Comunidad Autónoma Vasca. The prevalence and risk factors associated with abusive or hazardous alcohol consumption in 16-years- olds. Interpersonal aggression in urban minority youth: Mediators of perceived neighborhood, peer, and parental influences. Parenting practices as predictors of substance use, delinquency and aggression among urban minority youth: Moderating effects of family structure and gender. Factore psicosociales relacionados con el consumo de alcohol y tabaco: estudio de una muestra de estudiantes españoles. Comorbid disruptive behavior disorder symptoms and their relationship to adolescent alcohol use disorders. Demographic influences in sensation seeking and expressions of sensation seeking in religion, smoking, and driving habits. Adolescents acquire new cognitive capacities which lead them to question their parents and the family´s norms and values. In addition, while not legally adult, the adolescent takes on the appearance of one; thus, parents must negotiate which adult roles they will permit their children to exercise and to what degree they will allow them to do so. These conflicts and disputes decrease as the child transits through adolescence and new family roles are negotiated. Regardless, the family continues to be a strong emotional anchor point for adolescents, who trust their parents more than their friends or any other person when they are in real distress or need to decide on matters of profound importance. One of the most studied risk and protective factors in relation to substance use is the family context. In this sense, research shows that adolescents who grow up in families that are models of substance use (i. Within family dynamics, it has been shown that families that act as a protection factor against substance consumption are those in which openly expressed affection, communication and a positive family atmosphere combine with the promotion of autonomy, requirements of maturity and the existence of clear and explained rules of conduct. These families have created a family atmosphere in which it is normal for the children to share their problems, concerns and extra-familial activities with their parents. Nevertheless, we cannot consider family relationships to be merely cause and effect; parents do not exercise a direct and unilateral influence on their children. Thus, the conduct of substance consumption by 1 Family Context and Substance Consumption during Adolescence one of its members (be it occasional use or addiction) will affect the entire system and we must seek to act on said system if we want the behavior to disappear or decrease. Should they find friends who do not share those issues they consider relevant, they will leave that group for one in which they feel more comfortable. As the first and principal development context, in the family boys and girls learn values, social skills or lifestyles. Accordingly, a substantial continuity has been found to exist between the family context and that of peers. Those boys and girls who have displayed healthy lifestyle habits within their families will seek out similar friends; the same occurs in contrary cases. Once a group of friends has formed, they socialize with each other and increasingly resemble each other in terms of dress habits, behavior and even thoughts. It is more frequent that this socialization is for conduct viewed as positive by the adult world than for conduct considered negative or unhealthy. Nonetheless, if adolescents enter a deviant group (frequently because in their family they have not acquired positive values) they are socialized into increasingly problematic behavior, including substance consumption. To analyze the influence of friends on substance consumption, it is important to bear in mind the different levels of analysis: the cohort, the crowd, the clique and the best friend. There are a multitude of drug prevention programs launched from the school context whose target population is the family of adolescent students. Before putting a program into practice it is important to establish fluid communication channels between parents and the school; therefore, everything possible should be done to get parents to come to the center to set this communication in motion. Drug dependency prevention programs often have similar characteristics which include information about drugs, drug use prevalence, and phases prior to addiction, as well as risk and protective factors for families, individuals, and groups. On other occasions, it may be advisable to not conduct sessions directly related to substance consumption, but rather to adolescence and family relationships during adolescence. This will serve equally to collaborate with 2 parents in the job of parenting and, of course, to educate them about the responsible consumption of substances. Families of adolescents who consume substances share similar characteristics with any other family in which the children reach adolescence. In fact, as noted in international reports, experimental and recreational substance consumption is common to most Western adolescent boys and girls (see Figure 1), making this an issue that inserts itself into the dynamics of a sizable number of these families. For this reason, research has continued on what causes some boys and girls to consume different types of substances while others do not. Likewise, there has been ongoing research on the characteristics of adolescents who are more or less moderate consumers and those who begin in adolescence with the consumption of substances that are 4 legal for adults, and bit by bit begin to use and abuse other substances, starting with cannabis (gateway to other drugs) and continuing onto other substances (e. In this search for causative factors for substance consumption, familial aspects have acquired particular relevance. In the following pages we explore some normative processes that occur when children reach adolescence, later we focus a bit more on those familial factors that predispose to substance use, highlighting some myths that could be erroneously considered influential in the consumption of substances. To the contrary, it is an essential environment to overcome developmental tasks characteristic of adolescence such as identity formation, autonomy acquisition or adolescent psychosocial adjustment (Lila, Van Aken, Musitu and Buelga, 2006).

All copies must retain all author credits and copyright notices included in the original document buy viagra plus 400 mg with visa erectile dysfunction evaluation. Under no circumstances is it permissible to sell or distribute on a commercial basis purchase viagra plus 400mg free shipping impotence natural remedy, or to claim authorship of buy cheap viagra plus on-line erectile dysfunction medication for high blood pressure, copies of material reproduced from this publication. Except as expressly provided above, no part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission of the author or authors. This material is intended for educational use only by practicing health care workers or students and faculty in a health care field. Acknowledgments The development of this lecture note for training Health Extension workers is an arduous assignment for Ato Melkie Edris at University of Gondar Essentially, it required the consolidation and merging of existing in depth training materials, examination of Health Extension Package manuals and the Curriculum. They do not grow well, they become ill, many die or they do not grow up as clever, as healthy. Causes and consequences of poor nutrition are better understood now, and so are the ways to prevent and manage it. The underlying causes are insufficient household food security, inadequate childcare and insufficient basic health services in the community. It includes poor living conditions, lack of education, heavy physical work, and frequent childbearing. And the basic causes are economic structure, political and ideological superstructure. The mortality among preschool children is extremely high in developing countries in general and in Ethiopia in particular. It is quite clear that malnutrition in combination with infection, more often than not is, the cause of high morbidity and mortality in Ethiopia. Micronutrient deficiencies such as vitamin A, iodine and iron are the most prevalent in Ethiopia and it affects mothers and children at large. The entire efforts in the preparation of this lecture note require that the elements of nutrition should be understood by Health Extension 1 Nutrition Students and their Instructors for the implementation of nutrition interventions. Those, which regulate chemical process in the body, are the vitamins and minerals. It is the means of transportation for most nutrients and is needed for all cellular activities. Nutrition: - is the sum total of the process by which living things receive and utilize the necessary materials for survival, growth and maintenance of worn out tissues. Malnutrition: - is the condition that results from an imbalance between dietary intake and requirements. It includes under nutrition, which results from less food intake and hard physical work and over nutrition results from excess food intake and less physical activities. Diet: - is defined as food containing all the nutrients in a sufficient amount and in proper ratio. It prevents gastrointestinal disorders (gastritis, appendicitis, gallbladder stone and constipation) and metabolic disorders (diabetes mellitus, hypertension, ischemic heart disease and colon cancer). Dietary guidelines ƒ Eat a wide variety of foods ƒ Maintain healthy weight ƒ Choose a diet low in fat, saturated fat, and cholesterol ƒ Choose a diet with plenty of vegetable, fruits and grain products ƒ Use sugar in moderation ƒ Use salt and sodium in moderation ƒ If you drink alcoholic beverage, do so in moderation. Food groups ♦ Milk, cheese, yoghurt ♦ Meat, poultry, fish and alternates ♦ Fruits and vegetables ♦ Bread and cereals ♦ Fats, sweets and alcohols 5 Nutrition Why human beings need food? Human beings need food to provide energy for the essential physiological functions like:- ƒ Respiration ƒ Circulation ƒ Digestion ƒ Metabolism ƒ Maintaining body temperature. Health and nutrition are closely linked and to ensure proper development and life quality they must be adequate from early childhood on and most vulnerable groups are infants, young children, pregnant women and lactating mothers. It is important to make sure that any recommended ration scale is compared with acceptable standards and that its use is not likely to cause deficiency disease 6 Nutrition Major causes of malnutrition ƒ Lack of knowledge in selecting foodstuff with high nutritive value ƒ Poverty and infectious diseases ƒ Drought ƒ Uneven distribution of the available foods ƒ Social arrest and civil conflicts, ƒ Transport problems (inaccessibility) ƒ Increased populations ƒ Inadequate weaning ƒ Farming technique-insufficient ƒ Poor management of resources ƒ Topographical differences in different regions (variation in productivity) ƒ Loss of food through destruction by insects ƒ Exploited land due to planting the same type of food crop for many years, erosion because of overgrazing and moreover the farmers could not use the fertilizers due to many reasons. Harmful traditional practices with regard to nutrition ƒ During period of fasting important nutrients are not eaten, such as milk, eggs, butter, meat, fish, meal pattern, etc. Injera with wat prepared from - Cereals - Legumes - Vegetable ƒ Traditional use of dark green leaves “Hbesha Gommen. Enjory, Kega, Sholla, ƒ Honey mixed with butter is eaten in the morning ƒ Giving to children a tea-like drink made out of Abish (fenugreek) is rich in protein (27 gm/100gm) ƒ Good hospitality and sociability ƒ Eating of raw vegetables and cereals ƒ Taking care of elders. Good nutrition must meet the needs of varying ages and activities and always with individual differences. Therefore, the planning of food to meet especial needs begins with: • Pregnant women • Nursing mothers • Infants • Adolescents and • Adults A well-nourished individual:- ƒ Is alert mentally and physically fit ƒ Has optimistic outlook on life ƒ Has good resistance to infection ƒ Shows numerous other signs of good health such as an increased life span extending the active and vigorous period of life. In general feeding is dependent on the controlling centres, appetite and satiety in the brain. There are a variety of stimuli, nervous, chemical and thermal, which may affect the centres and so alter feeding behaviour. Daily calorie requirements of individuals Š Infants 1 - 3 years need 1,000 cal/day Š Children 5 years need 1,500 cal/day Š Children 5 – 8 years need 1,800 cal/day Š Children 10 – 12 years need 2,000 cal/day Š For adolescents and adults calorie requirements depend on the degree of physical activities 10 Nutrition From 13 – 20 years of age Office worker Heavy work 2, 800 cal/day 3,500 cal/day Adults 2,300-cal/day 2,700 cal/day Very heavy work up to 4,000 cal/day For pregnant woman, the daily figure must be increased by 150 calories for the first trimester and 350 for the second and third trimester. Staple foods Staple foods are foods, which form the largest part of a nation’s diet. They are of plant origin and are classified into three main groups Š The grain and cereals Š The roots and tubers Š The starchy fruits Discussion questions 1. In the diet of poor people, especially in the tropics, up to 85% of the energy may come from this source. On the other hand, in the diet of the rich people in many countries the proportion may be as low as 40%. Carbohydrates are components of body substances needed for the regulation of body processes. Nervous tissue, connective tissue, various hormones, and enzymes also contain carbohydrate. Carbohydrate is also a component of a compound in the liver that destroys toxic substances. If carbohydrate intake is low, larger than normal amounts of fats are called on to supply energy. As a result, the fat does not burn completely, and abnormal amounts of certain breakdown products accumulate in the blood, causing a condition known as ketosis. Types of carbohydrates Monosaccharides: ƒ Glucose ƒ Fructose ƒ Mannose ƒ Galactose Disaccharides: ƒ Sucrose (a disaccharide present taste sugar) ƒ Lactose (a disaccharide present in milk) ƒ Maltose (a disaccharide present in starch) Sugar alcohol: is found in nature and also prepared commercially. Mannitol and dulcitol are alcohol derived from mannose and 13 Nutrition galactose. It is a balanced diet as it contains all the nutrients in sufficient amount and proper ratio. The bees first cover the beehive with antibiotics to prevent the growth and multiplications of micro- organisms. The glycogen in the liver is a reserve fuel and it serves between meals and over night. Starch: is one form of carbohydrate that is stored in granules in the roots and seeds of plants. Carbohydrate content of some food Food Carbohydrate Sugar 100% White Flour 80% Honey 76% Biscuit, semi-sweet 75% Jam 69% Chocolate, milk 59% White bread 50% Potatoes 21% Apple 12% Peas 11% Carrots 5. Digestion occurs mainly in the small intestine through the action of pancreatic and intestinal juices: ƒ Amylase ƒ Lactase ƒ Sucrase ƒ Maltase 15 Nutrition ƒ Dextrin is degradation products of starch in which the glucose chains have been broken down to smaller units by partial hydrolysis.

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Population may exceed the carrying capacity of the fragile environment in some areas At the household level the food produced from the same plot of land that the household has may not be sufficient order viagra plus once a day erectile dysfunction caused by spinal cord injury. The chances of drought occurring in parts of Ethiopia have increased the probability of food insecurity order 400mg viagra plus mastercard erectile dysfunction after 80, especially in the arid and pastoralist areas (northern and eastern parts of Ethiopia) Traditional rain-dependent farming systems Lack of agricultural intensification and low agricultural productivity means that many of those in rural areas remain subsistence producers buy 400mg viagra plus with mastercard erectile dysfunction alcohol. Therefore, the large quantity of food at low prices which is essential for economic growth in urban areas is not available Stop reading for a while and think of the causes of food insecurity in your area. Indirect indicators can also give clues to the presence of household food insecurity. These include measuring the percentage of children under five years old who are malnourished and other early warning signs of vulnerability such as low rainfall or the presence of other disasters. One of the most common methods for identifying food-insecure households or regions is to look at the frequency and types of coping strategies. The different types of coping strategies are markers of the severity of conditions, often categorised into four distinct stages of food insecurity. Stage 1: Insurance strategies The first stage of household food insecurity is marked by the initial shortage of food, or inability to provide sufficient quantities of food to all members of the household. Households may have prepared for a food quantity shortfall, as in the case of seasonal production, by storing quantities of grain or owning livestock that can be quickly sold, traded, or used for food (in the case of agricultural societies). These are often referred to as insurance (reserve food crisis), and are not intended to be a main source of income or an integral part of income generation, simply crisis insurance. But, before any assets are sold, changes in diet and frequency of meals per day are the first adaptations undertaken. Rationing of food consumption is a very common response, and is started and planned generally far in advance of selling any assets. The frequency and severity of coping strategies practiced will vary according to the causes of the food shortage (chronic vs. Stage 2: Crisis strategies I The second stage of food insecurity is marked by the sale of assets, specifically non-productive assets. At this point, in the food security crisis, food consumption becomes more important than holding onto assets. Jewellery, goats, chickens, other livestock and any other asset that serves as crisis insurance would be sold. Generally, the assets that are preserved are those related to income generation, such as land, farming equipment, oxen and cattle. In addition to non-productive asset sales, the second stage also sees the onset of loans or credit from merchants (as opposed to family), which also has serious implications for the future security of the household and recovery to their original livelihood systems. At this point, all else has either failed to provide sufficient food quantities or the crisis has prolonged itself into a dire situation. All livestock remaining at this juncture will be sold, all personal items sold, possibly even the sale of housing material, and the pledging and/or sale of land or productive rights. This disposal of all assets ensures current survival, but severely jeopardises the future security (livelihood system) of the household. In the case of natural disasters, such as drought, many assets will be lost involuntarily, specifically livestock succumbing to disease or starvation. When the crisis has reached this stage, famine conditions have essentially set in. Stop reading for a while and think of some of the coping strategies that are used in your community or in another community you know when food insecurity occurs. Stage 4: Distress strategies Stage 4 is the last in the line and represents complete destitution. Permanent migration (either the whole or part of the household) occurs in order to attempt to resettle on suitable land, find wage labour or, more likely, to seek food aid assistance. Individuals are generally too weak to work and simply need food and care to survive. There is a spectrum of situations that may precipitate crises, possibly ranging from normal, seasonally linked low or zero production, to consecutive years of poor production, to natural disasters and armed conflict. Coping strategies need to be seen in context, and in complex emergencies the situation is different from those situations relating to consecutive seasons of crop failure or seasonal dips in the amount of stored food or resources to obtain food. For example, people suffering due to poor agricultural production might slowly move from stage 1 to stage 2 or 3, whereas in acute emergencies, people might be ‘shocked’ directly into strategies of state 3 or 4, due to sudden external forces such as a flood or armed conflict. It is usually measured by summing up the number of foods or food groups consumed over a period of time. Consumption of a more diversified diet is an indicator that the household is food secure; while a less diversified diet is an indicator of food insecurity. The body’s response to chronic hunger and malnutrition is a decrease in body size. As you will recall from an earlier study session, in small children this is known as stunting, or stunted growth, and is indicated by low weight for height. This process starts as the baby is growing in the uterus, if the mother is malnourished, and continues until approximately the third year of life. It leads to higher infant and child mortality, with rates increasing significantly during famines. Once stunting has occurred, improved nutritional intake later in life cannot reverse the damage. Stunting itself is viewed as a coping mechanism, designed to bring body size into alignment with the calories available during adulthood in the location where the child is born. Limiting body size as a way of adapting to low levels of energy (calories) adversely affects health in many ways:. For example, a 50-year-old individual might die of heart problems because their heart suffered structural defects during early development 104 Study Session 8 Household Food Security. Stunted individuals suffer a far higher rate of disease and illness than those who have not undergone stunting. Severe malnutrition in early childhood often leads to defects in mental development. Chronic food insecurity will lead to poor growth, slower development, low educability, school absenteeism or dropout, and increased morbidity and decreased survival impacting on the socioeconomic development through several generations. Stunting itself is viewed as a coping mechanism, designed to bring body size into alignment with the calories available during adulthood in the location where the child is born. Therefore, the food security strategy places a significant focus on the following issues:. Environmental rehabilitation: Measures to reverse the level of land degradation and create a source of income generation for food-insecure households through a focus on biological measures, such as re-forestation and land preservation. Water projects: Water harvesting and the introduction of high-value crops, livestock and agro-forestry development. Enhancing agricultural productivity: Agriculture is considered to be the starting point for initiating the structural transformation of the economy. Controlling population growth: High population growth rates continue to undermine Ethiopia’s ability to be food secure and provide effective education, health and other essential social and economic services. The central elements of the policy focus on a multi-sector approach, improving family planning services and expanding education. The government has put in place a national policy and countrywide programme for the whole population to control and reduce the spread of the disease. Gender: Women have a substantive productive role in the rural sector, including participation in livestock maintenance and management, crop production, and the marketing of rural produce.

The presence of the father in the delivery room cheap 400mg viagra plus amex impotence quit smoking, massaging of the baby’s back after birth purchase cheap viagra plus line impotence trials, not cutting the umbilical cord until it stops pulsating discount 400 mg viagra plus mastercard erectile dysfunction at age 28, and gentle bathing in warm water by the father may be other factors. In adults and children, the bacteria usually causes no symptoms and is harmless, but if a pregnant woman is infected, the bacteria may spread through her bloodstream to the placenta and foetus, where it may cause widespread infection, miscarriage, or death of the foetus and a stillbirth. Treatment is more successful if started during pregnancy, but the infection is rarely detected before the infant is born. Infants that survive birth suffer from a form of septicaemia (blood infection) that soon progresses to a form of meningitis that is frequently fatal. It starts as blood stained, but gradually becomes brown and then pale yellow, slowly disappearing over the next four to six weeks. Initially it consists of blood, amniotic fluid, lining of the uterus (endometrial tissue) and foetal skin cells, and has a rather unpleasant odour. If the baby is breech (sitting with the bottom down) or transverse in the uterus, a doctor may try by a series of pressure movements on the mother’s belly, to push the baby’s head around and down into the pelvis. It usually occurs if one of the many lobes in the breast does not adequately empty its milk, and may spread from a sore, cracked nipple. The breast becomes painful, very tender, red and sore, and the woman may become feverish, and quite unwell. Antibiotic tablets such as penicillin or a cephalosporin usually cure the infection rapidly and the woman can continue breastfeeding, but if an abscess forms, an operation to drain away the accumulated pus is necessary. The presence of meconium in the amniotic fluid surrounding the foetus before birth is a sign that the foetus is distressed and should be delivered as soon as possible. The vomiting and subsequent inhalation (breathing in) of meconium by the baby immediately after birth, can cause serious breathing problems for the baby including pneumonia or asphyxiation. The blockage may resolve naturally, with the help of special fluids given by mouth and in a drip, or may need to be removed surgically. If pregnancy does not occur, the endometrium starts to deteriorate as the hormones that sustain it in peak condition alter. After a few days, the lining breaks down completely, sloughs off the wall of the uterus, and is washed away by the blood released from the arteries that supplied it in a process known as menstruation or the menses. The obvious causes for periods to stop are pregnancy and menopause, and every woman between 15 and 50 who misses a period should be considered pregnant until proved otherwise. There are also a number of medical conditions that may be responsible for amenorrhoea (a lack of menstruation) or oligomenorrhoea (infrequent menstruation). The oral contraceptive pill may cause menstrual periods to become lighter and lighter until they disappear completely. Some women take the pill constantly, without a monthly break off the pill or taking sugar tablets, and stop their periods for the sake of convenience. A miscarriage usually starts with a slight vaginal bleed, then period- type cramps low in the abdomen. A miscarriage occurs when a pregnancy fails to progress, due to the death of the foetus, or a developmental abnormality in the foetus or placenta. After 20 weeks, doctors consider it to be a premature birth, although the chances of the baby surviving if born before 28 weeks are very slim. Most miscarriages occur in the first twelve weeks of pregnancy, and many occur so early, that the woman may not even know that she has been pregnant and may dismiss the problem as an abnormal period. What develops in the womb can be considered to be just placenta, without the presence of a foetus (a blighted ovum is the technical term). There is obviously no point in continuing with this type of pregnancy, and the body rejects the growth in a miscarriage. Some women do not secrete sufficient hormones from their ovaries to sustain a pregnancy, and this can also result in a miscarriage. These women can be given additional hormones in subsequent pregnancies to prevent a recurrence of the problem. This problem may be surgically corrected to prevent the cervix from opening prematurely, or to remove fibrous growths that may be distorting the womb. There are dozens of other reasons for a miscarriage, including stress (both mental and physical), other diseases of the mother (eg. Up to 15 percent of diagnosed pregnancies, and possibly 50 percent of all pregnancies, fail to reach 20 weeks. There is virtually no treatment for a threatened miscarriage except strict rest, sedatives and pain relievers. Once a miscarriage is inevitable, doctors usually perform a simple operation to clean out the womb, and ready it as soon as possible for the next pregnancy. Heavy bleeding, that may lead to anaemia, infections in the uterus, and the retention of some tissue in the uterus are the most common complications. It is only if a woman has two miscarriages in succession that doctors become concerned, and investigate the situation further. Its severity varies markedly, with about one third of pregnant women having no morning sickness, one half having it badly enough to vomit at least once, and in 5% the condition is serious enough result in prolonged bed rest or even hospitalisation, when it is called hyperemesis gravidarum. Although it usually ceases after about three months, it may persist for far longer in some unlucky women. Because morning sickness is a self-limiting condition, treatment is usually given only when absolutely necessary. In rare cases, fluids given by a drip into a vein are necessary for a woman hospitalised because of continued vomiting. There is a canal through the centre of the cervix that is normally only a couple of millimetres in diameter. During pregnancy this canal is filled with a mucous plug to protect the growing foetus from anything entering the uterus through the vagina. As the cervix starts to dilate in the early stages of labour, this mucous plug becomes dislodged, and may be noticed as a slightly blood stained vaginal discharge (a show) by the mother. Provided medical care is readily available, it is probably the perfect solution to childbirth for both mother and child, but because critical problems can arise very rapidly during childbirth (eg. The mother may also require pain relief, particularly in a first birth, and the baby may require resuscitation. Home births can be very risky, as even with a woman who has had no problems in previous births, unexpected problems may occur. In both sexes it is an erogenous area in that stimulation of the nipple is sexually stimulating, but in men it serves no other purpose. The nipple contains numerous small muscles that contract to make the nipple erect when stimulated by suckling, plucking, cold or anxiety. The nipple is surrounded by pigmented skin called the areola, which enlarges at puberty, and may darken further (chloasma) after pregnancy or hormonal medication use (eg. The areola contains sebaceous (oil) glands (Montgomery glands) that give it a bumpy appearance, particularly around its edge.