Dana Cooley Clifton, MD

• Assistant Professor of Medicine
• Assistant Professor in the Department of Pediatrics

https://medicine.duke.edu/faculty/dana-cooley-clifton-md

One of the things that makes his problems harder to cope with is his lack of a family support system hypertension of the heart discount norvasc 10mg with mastercard. Jorge has one brother who lives on the West Coast and some contact with his mother (his father died 4 years ago) heart attack young adults buy norvasc 10 mg on line. He states that his business has taken a hit in the economy arrhythmia stress cheap norvasc 5mg with amex, although he thinks things are beginning to improve white coat hypertension xanax buy discount norvasc 2.5 mg line. When asked what the negative thoughts are about arrhythmia nutrition buy norvasc 5mg overnight delivery, he responds Well this will seem weird arrhythmia qt interval prolongation order genuine norvasc online, but I worry about my heart and my business. For him, we might view that as a developmental task, addressing the line of interpersonal development. As noted ear lier, there has been an explosion in the diagnosis of Bipolar I Disorder in children as young as 2 years old, and this has been a controversial topic in child psychiatry (Paris, 2009; Youngstrom, Birmaher, & Findling, 2008). It is estimated that a 40-fold increase in the diagnosis of Bipolar I Disorder in children took place between 1994 and 2003. Many of these children had what are called subthreshold symptoms, meaning the symptoms did not meet the adult criteria for severity. Here again, we see that the onto logical assumptions of researchers are important in understanding the type of research they do. Those who want to believe that the increase in diagnoses is legitimate try to make the case that Bipolar I Disorder is actually part of a spectrum and that we should diagnose this entire spectrum (Merikangas et al. Bear in mind that there is no conclusive evidence to support this, other than the conjecture of the researchers (one of whom was consultant to 13 pharmaceutical companies, and there is a note at the end that the preparation of the article was supported by AstraZeneca) (Merikangas et al. Bipolar I Disorder is one of the disorders in which it appears that we need di agnostic criteria specific to children and adolescents. This is imperative because of the radically different nature of the nervous system and mind between children and adults, not to mention different developmental levels in general. In many cases, the children are acting out or showing what is called mood lability or aggression; whether this actu ally constitutes Bipolar I Disorder remains to be determined (Duffy, 2007). Normal events in the life of a family (like the arrival of a new baby) can be inordinately stress ful for some children. What is also assessed is the extent to which the caregiving en vironment can shield the child from stressors. The checklist helps clinicians identify multiple sources of stress as well as the duration and severity of stress. Capacities the child is rated on include attention and regulation (usually observ able between birth and 3 months), forming relationships and mutual engagement (ob servable between 3 and 6 months), intentional two-way communication (observable beginning between 4 and 10 months), complex gestures and problem solving (observ able between 10 and 18 months), use of symbols to express thoughts and feelings (observable between 18 and 30 months), and connecting symbols logically (observ able between 30 and 48 months). The third dimension, the S dimension, stands for Manifest Symptoms and Concerns. Concluding Thoughts We have covered a great deal of material in efforts at diagnostic systems that are available. What is statistical about the Diagnostic and and dimensional approaches to diagnosis What are four general components of the clini biological markers that cause specific mental cal interview What are the four components of the mental predecessors, and why were the changes made Diagnostic development of a pathophysiologically based and statistical manual of mental disorders (2nd ed. Do comprehensive idiographic assessment in integral we really know how to treat a child with Bipolar psychotherapy. Establishment of considerations for the fifth edition of the Diagnos diagnostic validity in psychiatric illness: Its appli tic and Statistical Manual of Mental Disorders. Pediatric bipolar disorder: Validity, phe A new meta-structure of mental disorders: A help nomenology, and the recommendations for diag ful step into the future or a harmful step back to nosis. Awareness Are you aware of your personal biases and prejudices toward cultures different than your own The following guidelines are intended to help you organize your thinking, summarize salient information about your patient in a coherent manner, identify areas where the therapy is stuck (resistance), and formulate questions that may offer insight into the process. Speculate on what experiential contributors from the past might be driving the current symptoms Do you feel intense emotions, like or dislike, anger, admiration, humiliation, fear, revulsion, sleepy, dizzy, disoriented, a desire to nurture or rescue, the urge to confront. Do you wish you could get rid of this patient, or are you afraid of losing him or her Then put a + in the column to the left of those activities you would like to try in the future. Select one with your therapist to try for the following week, and check off how often you do it. However, it is still important for the therapist to assess each goal directly, because clients may not be aware of some needs. Notes Unhealthy living situations include short-term shelter, living with a person who abuses substances, an unsafe neighborhood, and a domestic violence situation. Psychiatric Medication Goal Treatment that client fnds helpful for psychiatric symptoms. Notes If the client has never had a psychopharmacologic evaluation, one is strongly recommended, unless the client has serious objections; even then, evaluation and information are helpful before making a decision. Job, Volunteer Work, and School Goal At least 10 hours per week of scheduled productive time. Notes If the client is unable to meet the goal of 10 hours/week, have the client hand in a weekly schedule with constructive activities out of the house. Self-Help Groups and Group Therapy Goal As many groups as the client is willing to attend. However, do not insist on self-help groups or convey negative judgment if the client does not want to attend. If the client is not in acute danger but cannot get off substances, detox may or may not be helpful; many clients are able to stay off substances during the detox but return to their usual living environment and go back to substance use. For such clients, helping set up adequate outpatient supports is usually preferable. Psychiatric inpatient care is typically recommended if the client is a serious suicide or homicide risk*. In some circumstances, the client may need to be invol untarily committed; seek supervision and legal advice on this topic. Parenting Skills and Resources for Children Goal If the client has children, inquire about parenting skills training and about referrals to help the chil dren obtain treatment, health insurance, and other needs. If so, you are required by law to report it to your local protective service agency. Medical Care Goals Annual examinations for (1) general health, (2) vision, (3) dentistry, and (4) gynecology (for women), including (5) instruction about adequate birth control and prevention of sexually transmitted diseases. If any of the fve goals is not met or other medical issues need attention, check here and fll out the Case Management Goal Sheet for each. Notes It is crucial to help the client obtain health insurance and entitlement benefts. The client may need help flling out the forms; the client may be unable to manage the task alone, because the bureaucracy of these programs can be overwhelming. If much help is needed, you may want to refer the client to a social worker or other professional skilled in this area. Notes Leisure includes socializing with safe people and activities such as hobbies, sports, outings, and movies. Some clients are so overwhelmed with responsibility that they do not fnd time for them selves. Domestic Violence and Abusive Relationships Goal Freedom from domestic violence and abusive relationships. Notes It may be extremely diffcult to get the client to leave a situation of domestic violence. Notes Many clients have thoughts of harming self or others; however, to determine whether the client is at serious risk for action and how to manage this risk, see the guidelines developed by the Interna tional Society of Study for Dissociative Disorders in Chapter 3. Notes Clients should be informed that some people in early recovery beneft from acupuncture, medita tion, and other nonstandard treatments. Self-Help Books and Materials Goal the client is offered one or two suggestions for self-help books and other materials, such as audio tapes or Internet sites, that offer education and support. Notes All clients should be encouraged to use self-help materials outside of sessions as much as possible. Self-help can address posttraumatic stress disorder, substance abuse, or any other life problems. Additional Goal Goal Notes *For homicide risk or any other intent to physically harm another person, the therapist must follow duty to warn legal standards, which usually involve an immediate warning to the specifc person the client plans to assault. Always seek supervision and legal advice, and be knowledgeable in advance about how to manage such a situation. Additional goal Yes/Maybe/No Permission to photocopy this form is granted to purchasers of this book for personal use only. As with all learning, the more it is practiced, the more readily available it is when needed. If the person still cannot fnd a safe place, ask them to think of a place where they feel relaxed or comfortable. Sometimes clients become more distressed when they relax and it may take some time before the per son is able to identify a positive resource. Sometimes this exercise is conducted with soothing music and/ or background nature sounds. Some therapists tape the exercise with their voice to give to the client to practice at home. Ask the person to identify an image of a safe place that he or she can easily evoke that creates a personal feeling of calm and safety. Use soothing tones to enhance the imagery, asking the person to see what you see, feel what you feel, notice the sounds, smells, and colors in your special place. Ask for details so that you can assist the person in accessing this place in the future. Ask how he or she feels and if the experience has been diffcult for the person and/or no positive emotions are expe rienced, explore other resources that might be helpful. If at any time the person indicates that he or she is not feeling safe, the exercise should be stopped immediately. If successful in accessing a safe place, the person is asked for a single word that fts the picture. Then ask the person to repeat on his or her own, bringing up the image, emotions, and body sensa tions. Reinforce, after this exercise, that his or her safe place can be used as a resource and ask the client to prac tice over the next week, once a day.

Syndromes

• Your health care provider may recommend a low-protein diet.
• Abscess (infection) of the eye area
• Vascular ultrasound
• Is it getting worse?
• What other symptoms do you have?
• Urinary frequency

Chalmers J prehypertension what to do norvasc 2.5mg fast delivery, Morgan T blood pressure medication yellow pill discount norvasc online american express, Doyle A prehypertension nhs discount norvasc 10 mg otc, Dickson B heart attack lyrics 007 best norvasc 5mg, Hopper J arteria sacralis cheap norvasc 2.5 mg overnight delivery, Mathews J arrhythmia genetic buy generic norvasc 5mg line, Matthews G, Moulds R, Myers J, Nowson C, Scoggins B, Stebbing M. Australian Na tional Health and Medical Research Council dietary salt study in mild hyper tension. Effect of varying potassium intake on atrial natriuretic hormone-induced suppression of aldosterone. Excre tion of sodium, potassium, magnesium and iron in human sweat and the rela tion of each to balance and requirements. Coruzzi P, Brambilla L, Brambilla V, Gualerzi M, Rossi M, Parati G, Di Rienzo M, Tadonio J, Novarini A. Compari son of dietary calcium with supplemental calcium and other nutrients as fac tors affecting the risk of kidney stones in women. Randomized controlled trial of potassium chlo ride versus placebo in mildly hypertensive blacks and whites. Estimates of electrolyte blood pressure associations corrected for regression dilution bias. Potassium and the mono phasic action potential, electrocardiogram, conduction and arrhythmias. Plasma aldoster one, renin activity, and cortisol responses to heat exposure in sodium de pleted and repleted subjects. Resting metabolic rate and body composition of healthy Swedish women during pregnancy. Hypokalemia associated with diuretic use and cardiovascular events in the Systolic Hypertension in the Elderly Program. Effect of age on blood acid-base composition in adult humans: Role of age-related renal functional decline. Potassium bicarbonate reduces uri nary nitrogen excretion in postmenopausal women. Estimation of the net en dogenous noncarbonic acid production in humans from diet potassium and protein contents. Blood pressure in blacks and whites and its relationship to dietary sodium and potassium intake. On the mechanism of the effects of potassium restriction on blood pressure and renal sodium retention. Dietary electrolyte intake and blood pressure in older subjects: the Rotterdam Study. Blood pressure response to changes in sodium and potassium intake: A metaregression analysis of randomised trials. Racial differences in blood pressure in Evans County, Georgia: Relation ship to sodium and potassium intake and plasma renin activity. Effect of potassium supplementation combined with dietary sodium reduction on blood pressure in men taking antihyperten sive medication. The influence of oral potassium chloride on blood pressure in hypertensive men on a low-sodium diet. Fatal hyper kalemia related to combined therapy with a cox-2 inhibitor, ace inhibitor and potassium rich diet. Prevention of the glucose intolerance of thiazide diuretics by mainte nance of body potassium. Nutrient intake and use of beverages and the risk of kidney stones among male smokers. Sodium and potassium intake and balance in adults consum ing self-selected diets. Studies on the hypotensive effect of high potassium intake in patients with essential hypertension. Prospective study of calcium, potassium, and magne sium intake and risk of stroke in women. Effects of fruit and veg etable consumption on plasma antioxidant concentration and blood pressure: A randomised controlled trial. Association between urinary potassium, uri nary sodium, current diet, and bone density in prepubertal children. Potassium supple mentation in hypertensive patients with diuretic-induced hypokalemia. Increasing sensitivity of blood pressure to di etary sodium and potassium with increasing age. Randomised double-blind cross-over trial of potassium on blood-pressure in normal subjects. The effect of dietary sodium chloride on blood pressure, body fluids, electro lytes, renal function, and serum lipids of normotensive man. Ulceration and stricture of the esophagus due to oral potassium chloride (slow release tablet) therapy. Effect of dietary potassium on blood pressure, renal function, muscle sympathetic nerve activ ity, and forearm vascular resistance and flow in normotensive and borderline hypertensive humans. Relationship between urinary calcium and net acid excretion as determined by dietary protein and potassium: A review. The effects of chronic acid loads in normal man: Further evidence for participation of bone mineral in the defense against chronic metabolic acidosis. Potassium bicarbonate, but not sodium bicar bonate, reduces urinary calcium excretion and improves calcium balances in healthy men. Potassium administration reduces and potassium deprivation increases urinary calcium excretion in healthy adults. The effects of diet and stool composition on the net external acid balance of normal subjects. Blood pressure in young blacks and whites: Relevance of obesity and lifestyle factors in determining differences. Urinary cations and blood pressure: A collaborative study of 16 districts in China. Nutritional associations with bone loss during the menopausal transition: Evidence of a beneficial effect of calcium, alcohol, and fruit and vegetable nutrients and of a detrimental effect of fatty acids. Total exchangeable sodium and potassium in non-pregnant women and in normal and preeclamptic pregnancy. Potassium supplementation in blacks with mild to moderate essential hyper tension. Neutralization of West ern diet inhibits bone resorption independently of K intake and reduces corti sol secretion in humans. Maternal prenatal dietary potassium, calcium magnesium, and infant blood pressure. Blood pressure response to potas sium supplementation in normotensive adults and children. Potassium homeostasis during hyperinsulinemia: Ef fect of insulin level, `-blockade, and age. Modan M, Halkin H, Fuch Z, Lusky A, Cherit A, Segal P, Eshkol A, Almog S, Shefi M. Hyperinsulinemia: A link between glucose intolerance, obesity, hy pertension, dyslipoproteinemia, elevated serum uric acid and internal cation imbalance. Sodium sensitivity and cardiovascular events in patients with essential hypertension. Nutrient intake and hypertensive disorders of preg nancy: Evidence from a large prospective cohort. Expression of osteoporosis as determined by diet-disordered electrolyte and acid-base metabolism. The effect of low-dose potassium supplementation on blood pressure in apparently healthy volunteers. Nutritional influences on bone mineral density: A cross-sectional study in premenopausal women. Dietary influences on bone mass and bone me tabolism: Further evidence of a positive link between fruit and vegetable con sumption and bone health. Lower estimates of net endogenous noncarbonic acid production are positively associated with indexes of bone health in premenopausal and perimenopausal women. Norbiato G, Bevilacqua M, Meroni R, Raggi U, Dagani R, Scorza D, Frigeni G, Vago T. Effects of potassium supplementation on insulin binding and insulin action in human obesity: Protein-modified fast and refeeding. Placebo-controlled trial of potassium supplements in black pa tients with mild essential hypertension. Divergent hemodynamic and hormonal responses to varying salt in take in normotensive subjects. Idiopathic hypocitraturic calcium-oxalate nephrolithiasis successfully treated with potassium citrate. Prevention of spinal bone loss by potas sium citrate in cases of calcium urolithiasis. Effi cacy of potassium and magnesium in essential hypertension: A double blind, placebo controlled, crossover study. Respiratory symptoms and bronchial responsiveness are related to dietary salt intake and urinary potassium excretion in male chil dren. A comparison of the effects of hydrochlorothi azide and captopril on glucose and lipid metabolism in patients with hyper tension. Prevention of recurrent cal cium stone formation with potassium citrate therapy in patients with distal renal tubular acidosis. Effect of low-carbohy drate high-protein diets on acid-base balance, stone-forming propensity, and calcium metabolism. Blood-pressure response to moderate sodium restriction and to potassium supplementation in mild essential hypertension. Rose G, Stamler J, Stamler R, Elliott P, Marmot M, Pyorala K, Kesteloot H, Joossens J, Hansson L, Mancia G, Dyer A, Kromhout D, Laaser U, Sans S. NaCl-induced renal vasoconstriction in salt-sensitive African-Americans: Antipressor and he modynamic effects of potassium bicarbonate. Renal considerations in angiotensin converting enzyme inhibitor therapy: A statement for healthcare professionals from the Council on the Kidney in Cardiovascular Disease and the Council for High Blood Pressure Research of the American Heart Association. Estima tion of the net acid load of the diet ancestral preagricultural Homo sapiens and their hominid ancestors. Potassium citrate prevents increased urine calcium excretion and bone resorption induced by high sodium chlo ride diet. Controlled trial of long term oral potassium supplements in patients with mild hypertension. Effect of low sodium diet or potas sium supplementation on adolescent blood pressure. Effects of oral potassium supple ments on upper gastrointestinal mucosa: A multicenter clinical comparison of three formulations and placebo. Low sodium/high potassium diet for pre vention of hypertension: Probable mechanisms of action. Moderate potassium chloride supplementation in essential hypertension: Is it additive to moderate sodium restriction Potassium chloride lowers blood pres sure and causes natriuresis in older patients with hypertension. Comparative validation of the Block, Willett, and National Cancer Institute food frequency questionnaires. Reduced dietary potassium reversibly enhances vasopressor response to stress in African-Americans. Double-blind, placebo-controlled trial of potassium chloride in the treatment of mild hyper tension. Relationship of blood pressure to sodium and potassium excretion in Japanese women. Chloride-sensitive renal microangiopathy in the stroke-prone spontaneously hypertensive rat. Hyperkalemia in azotemic pa tients during angiotensin-converting enzyme inhibition and aldosterone re duction with captopril. High-potassium diets markedly protect against stroke deaths and kidney disease in hypertensive rats, an echo from prehistoric days. Potassium prevents death from strokes in hypertensive rats without lowering blood pressure. Potas sium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women. Does dietary potassium lower blood pressure and protect against coronary heart disease and death Comparison of the prediction of 27 different factors of coronary heart disease and death in men and women of Scottish heart health study: Cohort study. Potassium supplementation low ers blood pressure and increases urinary kallikrein in essential hypertensives. The blood pressure-raising effects of high dietary sodium intake: Racial differences and the role of potassium. Physiological responses to a 20-mile run under three fluid replacement treatments. The effect of potassium supple mentation in persons with a high-normal blood pressure. Effects of potassium loading in normal man on dopamin ergic control of mineralocorticoids and renin release. Nutritional factors for stroke and major cardiovascular diseases: International epidemiological com parison of dietary prevention.

Treatment of migraine attacks with subcutaneous sumatriptan: frst placebo-controlled study heart attack signs and symptoms buy generic norvasc canada. Home administration of intramuscular dihydroergotamine mesylate for the treatment of acute migraine headache arrhythmia 24 order norvasc 2.5mg overnight delivery. A randomized hypertension questionnaire questions cheap norvasc 10 mg visa, double-blind blood pressure 7949 cheap 10mg norvasc amex, placebo-controlled trial of the effcacy and tolerability of a 4-mg dose of subcutaneous sumatriptan for the treatment of acute migraine attacks in adults blood pressure medication used for adhd norvasc 2.5mg without prescription. A double-blind study of subcutaneous dihydroergotamine vs subcutaneous sumatriptan in the treatment of acute migraine blood pressure 120 0 order norvasc mastercard. Therefore, this is not intended as an inclusive listing of medication treatment options. All drugs are listed in alphabetical order, not in order of work group preference. Drugs are listed by their generic names and include brand names only where the generic name may not be well recognized. When viewing the following Drug Treatment tables, please consider the following key for the symbols used in each table: * Patient, lying down supine, head extended 45 degrees and rotated 30 degrees, drips 0. The rationale for the use of corticosteroids is uncertain, but they may reduce perivascular infammation or sensitize the blood vessels to the vasoconstrictive effect of circulating catecholamines and specifc anti-migraine agents. Almotriptan: Magnesium Sulfate: (Demirkaya, 2001 [Low Quality (Spierings, 2001 [High Quality Evidence]) Evidence]) Acetaminophen, aspirin, caffeine Meperidine: (Duarte, 1992 [High Quality Evidence]) combination: Because there is no good evidence to support the use of acetaminophen for treatment of mild migraine, the work group has replaced it with acetaminophen, aspirin and caffeine (Lipton, 1998 [High Quality Evidence]; Stang, 1994 [Low Quality Evidence]). Many of the medications listed are available in a variety of formulations for different routes of administration. Must not be given within o Acute treatment: 24 hours of receiving any triptan or ergot derivative. Due to fetal risk and the complications of medication management, pregnant women, those who desire to become pregnant, or those who are breastfeeding should be treated based on the appropriate chronic pain and obstetrical guidelines. This committee has adopted the Institute of Medicine Confict of Interest standards as outlined in the report, Clinical Practice Guidelines We Can Trust (2011). Where there are work group members with identifed potential conficts, these are disclosed and discussed at the initial work group meeting. These members are expected to recuse themselves from related discussions or authorship of related recommendations, as directed by the Confict of Interest committee or requested by the work group. Funding Source the Institute for Clinical Systems Improvement provided the funding for this guideline revision. This comprehensive review provides information to the work group for such issues as content update, improving clarity of recommendations, implementation suggestions and more. Patient advisors who serve on the council consistently share their experiences and perspectives in either a comprehensive or partial review of a document, and engaging in discussion and answering questions. Invited Reviewers During this revision, the following groups reviewed this document. Patients and families are urged to consult a health care professional regarding their own situation and any specifc medical questions they may have. Document Development and Revision Process the development process is based on a number of long-proven approaches and is continually being revised based on changing community standards. The work group uses this information to develop or revise clinical fows and algorithms, write recommendations, and identify gaps in the literature. The work group gives consideration to the importance of many issues as they develop the guideline. These considerations include the systems of care in our community and how resources vary, the balance between benefts and harms of interventions, patient and community values, the autonomy of clinicians and patients and more. They provide comment on the scientifc content, recommendations, implementation strategies and barriers to implementation. This feedback is used by and responded to by the work group as part of their revision work. Implementation Recommendations and Measures these are provided to assist medical groups and others to implement the recommendations in the guidelines. Where possible, implementation strategies are included that have been formally evaluated and tested. Measures are included that may be used for quality improvement as well as for outcome reporting. Document Revision Cycle Scientifc documents are revised every 12-24 months as indicated by changes in clinical practice and literature. Work group members are also asked to provide any pertinent literature through check-ins with the work group midcycle and annually to determine if there have been changes in the evidence signifcant enough to warrant document revision earlier than scheduled. This process complements the exhaustive literature search that is done on the subject prior to development of the frst version of a guideline. Due to electronic rights restrictions, some third party content may be suppressed. The publisher reserves the right to remove content from this title at any time if subsequent rights restrictions require it. For valuable information on pricing, previous editions, changes to current editions, and alternate formats, please visit No part of this work covered by the copyright herein Dianne Hales may be reproduced, transmitted, stored, or used in any form or by any means Publisher: Yolanda Cossio graphic, electronic, or mechanical, including but not limited to photocopying, recording, scanning, digitizing, taping, Web distribution, information networks, Acquisitions Editor: Aileen Berg or information storage and retrieval systems, except as permitted under Developmental Editor: Nedah Rose/Jake Warde Section 107 or 108 of the 1976 United States Copyright Act, without the prior Assistant Editor: Kristina Chiapella written permission of the publisher. Editorial Assistant: Shannon Elderon For product information and technology assistance, contact us at Media Editor: Katie Walton Cengage Learning Customer & Sales Support, 1-800-354-9706. Marketing Manager: Tom Ziolkowski For permission to use material from this text or product, Marketing Assistant: Jing Hu submit all requests online at Further permissions questions can be e-mailed to Marketing Communications Manager: Linda Yip permissionrequest@cengage. Personal Sexuality At 28 Charles is a veteran of military service, Sexual responsibility means learning about your a married man, and an expectant father. You make decisions that Human Sexuality thoughts and feelings with affect how you express your sexuality, how you each other either verbally or respond sexually, and how you give and get sex nonverbally. But while sexual expres relationships an awareness and appreciation sion and experience can provide intense joy, that lifts them beyond the physical. Responsible sexuality makes people more aware of the impact of their decisions on others. Protecting yourself from sexual threats and creating a supportive Sexuality and environment in which to study and work are crucial to high-level health and to healthy the Dimensions sexuality. Responsible sexu ality and high-level sexual health contribute or Female to the fullest possible functioning of body, mind, spirit, and social relationships. In turn, other Physiological maleness or femaleness, or biolog aspects of health enhance our sexuality. Here ical sex, is indicated by the sex chromosomes, are some examples: hormonal balance, and genital anatomy. As described in Chapter 11, der refers to the psychological and sociological, safer sex practices reduce the risk of sexu as well as the physical, aspects of being male or ally transmitted infections that can threaten female. You are born with a certain sexual identity sexual health, physical health, and even based on your sexual anatomy and appearance; survival. When our bodies are healthy and you, your parents, and society mold your gender well, we feel better about how we look and identity. By acknowledging and respect Biologically, few absolute differences separate ing the intimacy of a sexual relationship, the sexes: Males alone can make sperm and con responsible sexuality builds trust and com tribute the chromosome that causes embryos to mitment. When our emotional health is high, develop as males; females alone are born with sex we can better understand and cope with the cells (eggs, or ova), menstruate, give birth, and complex feelings related to being sexual. Only after several Having strong friendships, intimate relation weeks do the sex organs differentiate, becoming ships, and caring partnerships enables us to either male or female gonads (testes or ovaries), explore our sexuality in safe and healthy ways. This initial differen sexual health the integration ships involve a meeting of minds as well tiation process depends on genetic instructions of the physical, emotional, as bodies. High-level intellectual health intellectual, social, and spiritual in the form of the sex chromosomes, referred enables us to acquire and understand sexual aspects of sexual being in ways to as X and Y. If a Y (or male) chromosome is that are positively enriching information, analyze it critically, and make present in the embryo, about seven weeks after and that enhance personality, healthy sexual decisions. Individuals who have developed logical factors, and learned produced by the gonads, not the chromosomes, behaviors. The absence of testosterone ous organs in the body, including the sex organs, in an embryo causes female genitals to form. Except As puberty begins, the pituitary gland initiates them directly into the blood for for the sex organs, males and females have iden transport to target organs. When a boy is estrogen the female sex hor system is the hypothalamus, a pea-sized section of mone that stimulates female about 14 years old and a girl about 12, their secondary sex characteristics. The pituitary gland, directly beneath brains stimulate the hypothalamus to secrete the hypothalamus, turns the various glands on progesterone the female sex a hormone called gonadotropin-releasing hormone that stimulates the and off in response to messages from it. This substance causes the uterus, preparing it for the pituitary gland to release hormones called arrival of a fertilized egg. The ovaries produce the sex hormones most crucial to women, estrogen and progester gonadotropins. These, in turn, stimulate the testosterone the male sex hormone that stimulates male one. In girls, these stimulating hormones pro women have small amounts of the hormones of duced by the pituitary gland. Estrogen keeps her hair thick and skin and longer, and their muscles become stronger. She begins menstruating because she the sex hormones released during puberty has begun ovulating, the process that prepares change the growth pattern of childhood, so that her body to conceive and carry a baby. Although most people have the biologi arche until the relatively ripe age of fifteen. They also grow up from extreme stereotypical masculine notions amid a host of environmental influences that to extreme stereotypical feminine behaviors. Androgyny includes students, the most common emotions expressed those who are positively androgynous, com by American women at menarche were embar bining positive attributes linked with both rassment, pride, and anxiety. American girls worried about whether they could still play sports but labia majora the fleshy outer folds that border the female felt superior to friends who had not reached genital area. Health more beautiful because they could now have clitoris A small erectile children. Only recently has medical research devoted structure on the female, corresponding to the penis major scientific investigations to issues in In boys, the gonadotropins stimulate the tes on the male. Until about a decade ago, the urethral opening the outer National Institutes of Health routinely excluded opening of the thin tube that development of male secondary sex character carries urine from the bladder. They cover soft flaps of skin (b) Internal structure (inner lips) called the labia minora. The inner Fallopian tube (oviduct) Fimbriae lips join at the top to form a hood over the cli Endometrium Ovary toris, a small elongated erectile organ, and the Uterus (womb) Cervix most sensitive spot in the entire female genital Pubic bone area. Below the clitoris is the urethral open and mons pubis Rectum ing, the outer opening of the thin tube that Bladder Vagina carries urine from the bladder. Below that is a Urethra Perineum larger opening, the mouth of the vagina, the Anus canal that leads to the primary internal organs Clitoris of reproduction. The perineum is the area Labia majora Vaginal opening between the vagina and the anus (the opening Labia minora to the rectum and large intestine). At the back of the vagina is the cervix, the opening to the womb, or uterus (see Figure 9.

You are aware of your other options 1 5 5 mg norvasc with mastercard, but you still decide as a grown woman that hormonal birth control is the best method of contraception for you arteria femoralis communis buy norvasc line. Readers always ask me about the pill Zoelyand Qlairawhich use the natural estrogen estradiol instead of the usual synthetic ethinylestradiol arrhythmia epidemiology buy norvasc 5mg without prescription. The blood clot risk from NuvaRingis higher than the pill because the ethinylestradiol goes directly into your blood without first passing through your liver blood pressure natural discount norvasc 5 mg with mastercard. Contraceptive Patch (Estrogen plus Progestin) the patches Xulaneand Evraare also similar to the combined pill in that they deliver both ethinylestradiol and a progestin called norelgestromin blood pressure medication for asthmatics buy norvasc 2.5mg amex. Progestin-only methods of birth control are known to cause irregular menstruation blood pressure zone norvasc 2.5mg amex, which I would argue is a misnomer. The breakthrough bleeds that occur on progestin-only birth control are different from the pill bleeds of the combined pill, which are scheduled withdrawal bleeds from the synthetic estrogen and progestin. Injection (Progestin-Only) the injection Depo-Proveradelivers a high dose of the progestin medroxyprogesterone acetate, which completely suppresses both estrogen and progesterone. Like other progestin-only methods, they work primarily by thinning the uterine lining and impairing cervical fluid. But you do need ovarian hormones, and a menstrual cycle is the only way to make them. Scientists had long known that the old high-dose estrogen pills increased the risk of breast cancer, but had hoped that the modern lower dose pills and progestin-only devices were safer. However, it will give more likely you one or more of these minor side-effects: depression, loss of sex drive, hair loss, and weight gain. The fact that it remained unproven for fifty years is basically because no one was bothering to research it. Professor Jayashri Kulkarni from Monash University in Melbourne, Australia put it this way: The onset of depression can happen within a day of taking (the pill) or within a year of taking it. Hormones are often a contributing cause of yeast infections, so I asked about her periods. Many women cannot say how their libido was before they started the pill because they were too young at the time. Progestins with a low androgen index include drospirenone, norgestimate, and cyproterone. Both ethinylestradiol (synthetic estrogen) and the progestins drospirenone, norgestimate, and cyproterone strongly suppress sebum (skin oil). Fortunately, your ovaries should also start to make the hormones estrogen and progesterone, which are both good for skin. With the help of this book, you can now go back to the drawing board and figure out what that something is, and fix it. Settings Oxygen during the day or night liters per minute. Typical hours of sleep: hours Typical amount of time it takes to fall asleep hours Typical number of awakenings per night Time it takes to fall back asleep after awakening q Yes q No My sleep pattern is irregular. Sleep environment habitS Typical sleep position(s) q back q side q stomach q head elevated q in a chair q I sleep alone. My bedroom is q comfortable q noisy q too warm q too cold q Yes q No I have pets in the bedroom. Use the following scale and indicate the most appropriate number for each situation. While guidelines are useful aids to assist providers in determining appropriate practices for many patients with specific clinical problems or prevention issues, guidelines are not meant to replace the clinical judgment of the individual provider or establish a standard of care. Populations excluded from this guideline include pregnant women and children aged 13 years and younger. Diagnosis Red flag warning signs For patients with a rapidly accelerating course, a recent history of head injury, or focal neurologic findings, consult with a neurologist or neurosurgeon. Migraine versus tension headache Source: International Headache Society 2013 Table 1. Cut your coffee or tea intake to no more than 2 cups a day to help avoid these headaches. Patients may opt to use a smartphone app, such as Migraine Buddy, an electronic headache diary. For questions about coverage for acupuncture, patients can contact Member Services. The choice of medication should be directed by the severity of the attack, the type of symptoms present, patient preference, and patient-specific factors. For patients who have repeated refractory migraines, consider medication overuse as an underlying cause. The choice of migraine prevention medication should be made based on comorbid conditions. If you have neck pain, apply heat and ice to relieve pain and do gentle stretches to help loosen tension in your neck. Cefaly device One high-quality randomized controlled trial indicates that transcutaneous supraorbital stimulation using the Cefaly device may be more effective than sham procedure in the short term as prevention therapy. Start a prophylactic medication at the same time or, ideally, prior to stopping acute headache medications. The external guidelines should meet several quality standards to be considered for adaptation. They must: be developed by a multidisciplinary team with no or minimal conflicts of interest; be evidence based; address a population that is reasonably similar to our population; and be transparent about the frequency of updates and the date the current version was completed. In addition to identifying the recently published guidelines that meet the above standards, a literature search was conducted to identify studies relevant to the key questions that are not addressed by the external guidelines. What is the clinical effectiveness of acupuncture for the treatment of tension-type headaches What is the clinical effectiveness of oral contraceptive pills or triptans for prophylactic treatment of menstrual migraine with aura in adolescents and adults Six of these studies compared sumatriptan with placebo, and sumatriptan nasal spray, transdermal, and in combination with naproxen were assessed. Studies comparing oral corticosteroids to placebo or other medications were not identified. The study on flunarizine (Lai 2017) indicated that flunarizine may be more effective than topiramate (moderate evidence). No new studies comparing amitriptyline and nortriptyline versus placebo were identified. The effectiveness of amitriptyline increased when combined with aerobic exercise (Santiago 2014). Valproate was equally or possibly more effective than comparators (amitriptyline, cinnarizine, topiramate, and 14 acupuncture) in reducing migraine frequency, intensity, duration, and disability. Riboflavin Moderate evidence from three studies (Athaillah 2012, Gaul 2015, Rahimdel 2015) supported the effectiveness of riboflavin alone or in combination with magnesium and coenzyme Q10 in reducing migraine frequency, duration, and disability in adolescents and pain intensity in the short term (3 months). Magnesium Two studies (Bian 2013, Tarighat Esfanjani 2012) provided low evidence to support the use of magnesium in migraine prophylaxis. Moderate evidence supports the effectiveness of acupuncture in reducing migraine frequency in patients who did not respond to prophylactic medications. The evidence supports the use of acupuncture in reducing migraine frequency over sham acupuncture. Comparisons were made between aspirin and placebo; oral aspirin 500 mg and 1000 mg were assessed. In addition, active treatments did not show statistical difference between one another. Nevertheless, the studies in the meta-analysis provided very low to low quality evidence. Key question 6 What is the clinical effectiveness of acupuncture for the treatment of tension-type headaches Triptans While three reviews were identified (Hu 2013, Maasumi 2017, Nierenburg Hdel 2015), only one systematic review with meta-analysis (Hu 2013) was reviewed; the Maasumi and Nierenburg Hdel reviews did not challenge the outcomes of the Hu review. Adverse events were minimal with triptans; the most common events were nausea, headache, dizziness, dyspeptic symptoms, somnolence, and asthenia. The evidence is insufficient to recommend for or against the use of naratriptan 2. However, inpatient withdrawal may be more effective in reducing days with medication use. Seven studies were reviewed (Cull 1995, Demaerel 1996, Grimaldi 2009, Jordan 2000, Sempere 2005, Tsushima 2005, Wang 2001). A comparative study of the effects of low-dose topiramate versus sodium valproate in migraine prophylaxis. Clinical observation on potassium magnesium asparate oral solution combined with flinarizine capsule for migraine prophylaxis. Two center, randomized pilot study of migraine prophylaxis comparing paradigms using pre-emptive frovatriptan or daily topiramate: research and clinical implications. Acupuncture versus valproic acid in the prophylaxis of migraine without aura: a prospective controlled study. Improvement of migraine symptoms with a proprietary supplement containing riboflzvin, magnesium and Q10: a randomized, placebo-controlled, double-blind, multicenter trial. An open labeled randomized controlled trial of pregabalin versus amitriptyline in chronic low backache. Flunarizine versus topiramate for chronic migraine prophylaxis: a randomized trial. A randomized, one-year clinical trial comparing the efficacy of topiramate, flunarizine, and a combination of flunarazine and topiramate in migraine prophylaxis. Solubilized ibuprofen: evaluation of onset, relief, and safety of a novel formulation in the treatment of episodic tension-type headache. Efficacy and safety of acetaminophen and naproxen in the treatment of tension-type headache. Prednisone for the treatment of withdrawal headache in patients with medication overuse headache: a randomzied, double-blind, placebo-controlled study. Effectiveness of Vitamin B2 versus Sodium Valproate in Migraine Prophylaxis: a randomzied clinical t rial. Migraine prevention with a supraorbital transcutaneous stimulator: a randomized controlled trial. Efficacy of Enalapril in Migraine Prophylaxis: A Randomized, Double-blind, Placebo-controlled trial. Celecoxib vs prednisone for the treatment of withdrawal headache in patients with medication overuse headache: a randomized, double-blind clinical trial. Tarighat Esfanjani A, Mahdavi R, Ebrahimi Mameghani M, Talebi M, Nikniaz Z, Safaiyan A. This edition of the guideline was approved for publication by the Guideline Oversight Group in April 2018. Team the Headache Guideline development team included representatives from the following specialties: Adolescent Medicine, Family Practice, Neurology, Nursing Operations, Obstetrics/Gynecology, Pharmacy, Residency, and Urgent Care. Team members listed above have disclosed that their participation on the Migraine and Tension Headache Guideline team includes no promotion of any commercial products or services, and that they have no relationships with commercial entities to report. Improving estrogen metabolism can be of benefit in load by supporting preferred pathways of estrogen metabolism women with various conditions and family histories, including a and detoxification. These include isoflavones, indole-3-carbinol, family history of breast, uterine, or ovarian cancer, and condi B vitamins, magnesium, limonene, calcium D-glucarate, and tions such as endometriosis, premenstrual syndrome, uterine antioxidants. The influences of these nutrients on estrogen fibroid tumors, fibrocystic or painful breasts, cervical dysplasia, metabolism may have profound significance for diseases and and systemic lupus erythematosis. Beneficial modulation of conditions in which estrogen plays a role in clinical expression.

Norvasc 10 mg on line. Gk Tricks Hindi | रसायन विज्ञान :- Chemical Formula | SSC/MPPSC/UPSC/Railway Exam.

References

• Hutcheson JC, Stein R, Chacko S, et al: Murine in vitro whole bladder model: a method for assessing phenotypic responses to pharmacologic stimuli and hypoxia, Neurourol Urodyn 23(4):349n354, 2004.
• Nicols CR. Ifosfamide in the treatment of germ cell tumors. Semin Oncol 1996; 23:65-73.
• Hugenholtz PG, Ryan TJ, Stein SW, et al: The spectrum of pure mitral stenosis. Hemodynamic studies in relation to clinical disability, Am J Cardiol 10:773-784, 1962.
• Waltzer WC: The urinary tract in pregnancy, J Urol 125(3):271-276, 1981.
• Griswold M, Jakob P, Heidemann R, Nittka M, Jellus V, Wang J, Kiefer B, Haase A. Generalized autocalibrating partially parallel acquisitions (GRAPPA). Magn Reson Med 2002;47:1202-1210.