Although the systemic benefit of fuoride having distinctive needs3 erectile dysfunction morning wood cheap tadalis sx online american express,4 due to: (1) a potentially high caries incorporation into developing enamel is not considered neces rate; (2) increased risk for traumatic injury and periodontal sary past 16 years of age erectile dysfunction treatment in unani buy tadalis sx 20mg fast delivery, topical benefts can be obtained disease; (3) a tendency for poor nutritional habits; (4) an through optimally-fuoridated water impotence vitamins discount 20 mg tadalis sx, professionally-applied and prescribed compounds erectile dysfunction and zantac order tadalis sx with a visa, and fuoridated dentifrices erectile dysfunction filthy frank lyrics discount tadalis sx 20 mg visa. Accurate erectile dysfunction questionnaire uk order tadalis sx online now, comprehensive erectile dysfunction doctor dc generic 20 mg tadalis sx visa, and up-to-date medi based on the individual patient’s caries-risk assessment does erectile dysfunction cause premature ejaculation cheap tadalis sx american express, as determined by the patient’s dental provider. Familiarity with the patient’s medical history is essential for decreasing the risk of aggravating a medical condition while rendering dental care. The type, number, and fre quency of radiographs should be determined only after Oral hygiene: Adolescence can be a time of heightened caries an oral examination and history taking. Previously ex activity and periodontal disease due to an increased intake posed radiographs should be available, whenever possible, of cariogenic substances and inattention to oral hygiene pro for comparison. Adolescents should be educated and motivated to main tain personal oral hygiene through daily plaque removal, Restorative dentistry: In cases where remineralization of non including flossing, with the frequency and technique cavitated, demineralized tooth surfaces is not successful, as based on the individual’s disease pattern and oral hygiene demonstrated by progression of carious lesions, dental restora needs. Professional removal of plaque and calculus is recom and each individual patient’s needs must be considered when mended highly for the adolescent, with the frequency selecting a restorative material. Referral should be made Recommendation: Diet analysis, along with professionally when treatment needs are beyond the treating dentist’s scope determined recommendations for maximal general and dental of practice. Epidemiologic and immunologic data sug technique that should be considered on an individual basis. The rise of sex hormones during adolescence habits, oral microfora, or physical condition, and unsealed is suspected to be a cause of the increased prevalence. An individual’s caries risk may change studies suggest circulating sex hormones may alter capillary over time; periodic reassessment for sealant need is indicated permeability and increase fuid accumulation in the gingival throughout adolescence. This infammatory gingivitis is believed to be transient as the body accommodates to the ongoing presence of the Secondary prevention sex hormones. Malposition of teeth, malrelationship of teeth to jaws, Personal oral hygiene and regular professional intervention can tooth/jaw size discrepancy, skeletal malrelationship, or minimize occurrence of these conditions and prevent irrever craniofacial malformations or disfgurement that presents sible damage. Treatment of malocclusion by a dentist should be based and prevention of periodontal diseases, as well as self on professional diagnosis, available treatment options, hygiene skills. Sulcular brushing and fossing should be included Tird molars: Tird molars can present acute and chronic in plaque removal, and frequent follow-up to determine problems for the adolescent. Impaction or malposition leading adequacy of plaque removal and improvement of gingival to such problems as pericoronitis, caries, cysts, or periodontal health should be considered. Referral should Occlusal considerations be made when the diagnostic and/or treatment needs are Malocclusion can be a signifcant treatment need in the adoles beyond the treating dentist’s scope of practice. Although the genetic basis of much maloc Congenitally missing teeth: The impact of a congenitally miss clusion makes it unpreventable, numerous methods exist to ing permanent tooth on the developing dentition can be treat the occlusal disharmonies, temporomandibular joint signifcant. Within the area of occlusal consideration including, but not limited to , esthetics, patient problems are several tooth/jaw-related discrepancies that can age, and growth potential, as well as orthodontic, periodontal, afect the adolescent. Congenitally missing teeth present complex manent teeth should include both immediate and long-term problems for the adolescent and often require combined management. Referral should be made when the treatment orthodontic and restorative care for satisfactory resolution. Due to the complexity of the growing adolescent, a team approach Malocclusion: Any tooth/jaw positional problems that present may be indicated. Tese can Ectopic eruption: Abnormal eruption patterns of the adoles include single or multiple tooth malpositions, tooth/jaw size cent’s permanent teeth can contribute to root resorption, bone discrepancies, and craniofacial disfgurements. Prevention and use of bleaching can be considered part of a comprehensive, treatment may include extraction of deciduous teeth, surgical sequenced treatment plan that takes into consideration the intervention, and/or endodontic, orthodontic, periodontal, patient’s dental developmental stage, oral hygiene, and caries and/or restorative care. A dentist should monitor the bleaching process, ensur Recommendations: The dentist should be proactive in diag ing the least invasive, most efective treatment method. Dental nosing and treating ectopic eruption and impacted teeth in professionals also should consider possible side efects when the young adolescent. Early diagnosis, including appropriate contemplating dental bleaching for adolescent patients. Referral should be made when the treatment needs are beyond the treating den Tobacco use: Signifcant oral, dental, and systemic health con tist’s scope of practice. Tese include the use of products such as cigars, Traumatic injuries cigarettes, snus, hookahs, smokeless tobacco, pipes, bidis, The most common injuries to permanent teeth occur secondary kreteks, dissolvable tobacco, and electronic cigarettes. For those adolescent patients who use be reduced signifcantly by introducing mandatory protective tobacco products, the practitioner should provide or refer the equipment such as face guards and mouthguards. This Psychosocial and other considerations: Behavioral considerations prevention plan should consider assessment of the patient’s when treating an adolescent may include anxiety, phobia, and sport or activity, including level and frequency of activity. The self-concept development pro must include consideration of the following: cess, emergence of independence, and the infuence of peers. Use of bleaching agents, remaining primary teeth; (2) eruption of remaining permanent microabrasion, placement of an esthetic restoration, or a com teeth; (3) gingival maturity; (4) facial growth; and (5) hormonal bination of treatments all can be considered. Developing Adoles dentist who has appropriate training in managing the cents: A Reference for Professionals. Consensus development assent, confidentiality, and compliance should be ad conference statement: Diagnosis and management of dressed in the care of these patients. A complete oral health care program for the adolescent Dent Assoc 2001;132(8):1153-61. What psychosocial particular concerns and needs of the adolescent patient factors influence adolescents’ oral health? Fac oral manifestations in this age group;22 tors associated with use of preventive dental and health b. Pediatr Transitioning to adult care: As adolescent patients approach Dent 2015;37(special issue):71-5. Oral parent on the value of transitioning to a dentist who is knowl Health In America: A Report of the Surgeon General— edgeable in adult oral health care. Department needs may go beyond the scope of the pediatric dentist’s of Health and Human Services, National Institute of training. The transitioning adolescent should continue pro Dental and Craniofacial Research, National Institutes fessional oral health care in an environment sensitive to his/ of Health; 2000. Confdential health care will choose the time to seek care from a general dentist and for adolescents: Position paper of the Society for may elect to seek treatment from a parent’s primary care Adolescent Medicine. National who is knowledgeable and comfortable with adult oral health Center for Health Statistics. Centers for Disease Control care needs often is difcult due to a lack of trained providers and Prevention. Vital Health Stat 2007;11(248): Recommendations: At a time agreed upon by the patient, 1-92. Health for Teens in Care: A Judge’s Guide dental care should be recommended when needed. Guideline between soft drink consumption, oral health, and some on prescribing dental radiographs for infants, children, lifestyle factors in Swedish adolescents. Pediatric Restorative Dentistry Consensus mendations for using fluoride to prevent and control Conference April 15-16, 2002, San Antonio, Texas. Topical fuoride controlled clinical trial on proximal caries infiltration: for caries prevention: Executive summary of the updated Tree-year follow-up. Epidemiology of gingival and peri schedule, motivation, and ‘lifestyle’ behaviours in 7,770 odontal disease. Guideline on in children and adolescents: A guide for general dental periodicity of examination, preventive dental services, practitioners. Congenitally missing maxil dental decay in the permanent teeth of children and lary incisors and orthodontic treatment considerations for adolescents [review]. Updated comparison of the caries susceptibility management considerations for pediatric surgery and oral of various morphological types of permanent teeth. A retrospective study effectiveness and cost-effectiveness of prophylactic re of traumatic dental injuries in a Brazilian dental trauma moval of wisdom teeth. J Oral Maxillofac Surg 2005; dental trauma in 6,000 patients with facial injuries: 63(8):1106-14. Policy on use disorders in children and adolescents: Reliability of a of dental bleaching for child and adolescent patients. A randomized clinical trial comparing at treatment of adolescent patients with missing teeth. Oral home and in office tooth whitening techniques: A Maxillofac Surg 2008;12(2):49-60. Dental morphologic venting Tobacco Use Among Young People: A Report characteristics of normal versus delayed developing of the Surgeon General. Am J Orthod of Health and Human Services, Public Health Service, Dentofacial Orthop 2002;121(4):339-46. External root Center for Chronic Disease Prevention and Health Pro resorption of the maxillary permanent incisors caused motion, Ofce on Smoking and Health; 1994. Angle Orthod 2000;70 use among high school students-United States, 2011 and (6):415-23. Traumatized permanent teeth in Brazilian children assisted at the Federal University References continued on the next page. J Disease Control and Prevention, Ofce on Smoking and Am Dent Assoc 2002;133(12):1689-91. Available at: maxillofacial trauma in children: A review of 3,385 cases “. Prevention of sports-related dental trauma: of the adolescent smoker: Models of tobacco use among the role of mouthguards. American Cancer Society, National Cancer Institute, Na Available at: “ijahsp. McDonald and Avery’s Dentistry for the Child tices for Comprehensive Tobacco Programs-2014. Self-esteem as a predictor of Center for Chronic Disease Prevention and Health toothbrushing behavior in young adolescents. A Message Dear Colleague: I am pleased to present this comprehensive report on the Impact of Oral Disease in New York State. The report summarizes the most current information available on the burden of oral disease on the people of New York State and was developed by the New York State Department of Health in collaboration with the Centers for Disease Control and Prevention, Division of Oral Health. New York State has a strong commitment to improving oral health care for all New Yorkers and in reducing the burden of oral disease, especially among minority, low income, and special needs populations. This report not only highlights the numerous achievements made in recent years in the oral health of New Yorkers and in their ability to access dental services, but also describes groups and regions in our State that continue to be at highest risk for oral health problems and provides a roadmap for future prevention efforts. We hope that the information provided in this report will help raise awareness of the need for monitoring oral health and the burden of oral diseases in New York State and guide efforts to prevent and treat oral diseases and enhance the quality of life of all New York State residents. Poor oral health, which ranges from cavities to cancers, causes needless pain, suffering, and disabilities for countless Americans. The mouth is an integral part of human anatomy, with oral health intimately related to the health of the rest of the body. A growing body of scientific evidence has linked poor oral health to adverse general health outcomes, with mounting evidence suggesting that infections in the mouth, such as periodontal disease can increase the risk for heart disease, put pregnant women at greater risk for premature delivery, and can complicate the control of blood sugar for people living with diabetes. Additionally, dental caries in children, especially if untreated, can predispose children to significant oral and systemic problems, including eating difficulties, altered speech, loss of tooth structure, inadequate tooth function, unsightly appearance and poor self-esteem, pain, infection, tooth loss, difficulties concentrating and learning, and missed school days. Behaviors that affect general health, such as tobacco use, excessive alcohol use and poor dietary choices are also associated with poor oral health outcomes. Conversely, changes in the mouth are often the first signs of problems elsewhere in the body, such as infectious diseases, immune disorders, nutritional deficiencies, and cancer. In addition to providing us a way to take in water and nutrients to sustain life, it is our primary means of communication and the most visible sign of our mood and a major part of how we appear to others. Oral health is more than just having all your teeth and having those teeth being free from cavities, decay, or fillings. It is an essential and integral component of people’s overall health throughout life. Oral health refers to your whole mouth: not just your teeth, but your gums, hard and soft palate, the linings of the mouth and throat, your tongue, lips, salivary glands, chewing muscles, and your upper and lower jaws. Good oral health means being free of tooth decay and gum disease, but also being free from conditions producing chronic oral pain, oral and throat cancers, oral tissue lesions, birth defects such as cleft lip and palate, and other diseases, conditions, or disorders that affect the oral, dental and craniofacial tissues. Together, the oral, dental and craniofacial tissues are known as the craniofacial complex. Good oral health is important because the craniofacial complex includes the ability to carry on the most basic human functions such as chewing, tasting, swallowing, speaking, smiling, kissing, and singing. This report summarizes the most current information available on the burden of oral disease on the people of New York State. It also highlights groups and regions in our State that are at highest risk for oral health problems, and discusses strategies to prevent these conditions and provide access to dental care. Comparisons are made to national data whenever possible, and to Healthy People 2010 objectives when appropriate. For some conditions, national data, but not State data, are available at this time. It is hoped that the information provided in this report will help raise awareness of the need for monitoring oral health and the burden of oral diseases in New York State and guide efforts to prevent and treat oral diseases and enhance the quality of life of all New York State residents. Efforts of the Bureau of Dental Health, New York State Department of Health, to promote oral health through research, community-based prevention interventions and programs are a testament to its commitment to achieve optimum oral health for all New Yorkers. Borrowing from the World Health Organization’s definition of health, oral health is a state of complete physical, mental and social wellbeing, not merely the absence of tooth decay, oral and throat cancers, gum disease, chronic pain, oral tissue lesions, birth defects such as cleft lip and palate, and other diseases and disorders that affect the oral, dental and craniofacial tissues. The mouth is our primary means of communication, the most visible sign of our mood, and a major part of how we appear to others. Diseases and disorders that damage the mouth and face can negatively impact on an individual’s quality of life, self-esteem, social interactions, and ability to communicate; disrupt vital functions such as chewing, swallowing, and sleep; and result in social isolation. The impact of oral disease, or burden of disease, is measured through a comprehensive assessment of mortality, morbidity, incidence and prevalence data, risk factors, and health service availability and utilization, and is defined as the total significance of disease for society beyond the immediate cost of treatment. Estimates of the burden of oral disease reflect the amount of dental care already being provided, as well as the effects of all other actions which protect. Analysis of the burden of oral disease can provide a comprehensive, comparative overview of the status of oral health among New Yorkers, help identify factors affecting oral health, identify vulnerable population groups, assist in developing interventions and establishing priorities for surveillance and future research, and be used to measure the effectiveness of interventions in reducing the burden of oral disease. This report presents the most currently available information on the burden of oral disease on the people of New York State, highlights groups and regions at highest risk for oral health problems, and discusses strategies to prevent these conditions and provide access to dental care. Based on an analysis of the data, the burden of oral disease is spread unevenly throughout the population, with dental diseases and unmet need for dental care more prevalent in racial/ethnic minority groups and in populations whose access to oral health care services is compromised by the inability to pay for services, lack of adequate insurance coverage, lack of available providers and services, transportation barriers, language barriers, and the complexity of oral and medical conditions. Third graders 3 in New York City had more untreated caries (38%) than third graders statewide and nationally. New York State also performed better than the Healthy People 2010 targets of 42% of 35-44 year olds having no tooth extractions and not more than 20% of 65-74 year olds having lost all of their natural teeth. Not all groups, however, have benefited to the same extent, with disparities noted in the level of improvements in oral health. During the same time period, however, complete tooth loss among Blacks, Hispanics, and other racial/ethnic minority individuals increased from 14% to 19%. Black males, however, were the least likely to have been diagnosed at an early stage (21. In New York City, 100% of the population is on a fluoridated community water supply; outside of New York City, 46% of the population receives fluoridated water. Nearly 27% of Upstate 3 graders surveyed reported the regular use of fluoride tablets, with fluoride tablet use greater among higher income (30. A smaller percentage of Black (66%), Hispanic (70%), and other racial/ethnic minority (63%) individuals also reported having had their teeth cleaned within the prior 12 months compared to Whites (75%). Blacks (24%), adults 25-34 years of age (28%) those with incomes under $15,000 a year (28%), and individuals not completing high school (27%) were found to be most at risk for smoking. Increasing the number of dental care professionals from under-represented racial/ethnic groups, as well as enhancing the oral health literacy of consumers are essential for improving access to and utilization of services and reducing disparities in the burden of oral disease. There are many rural and inner city areas in the State where shortages of dentists and dental hygienists exist, where specialty services may not be available, and where the number of dental professionals treating underserved populations is inadequate. During the same time period, the demand for dental hygienists and dental assistants are both projected to increase by nearly 30%. Although 352 new dental hygienists register annually in New York State, it is not known how many of these individuals actually practice in the State. During the same time period, 7 however, only 3,845 dentists statewide (26%) had at least one claim paid by Medicaid. Approximately 15% of Medicaid eligible individuals in New York City and 14% in the rest of the State utilized dental services. Only 14¢ of every Medicaid dental-service dollar was for diagnostic services, while just 11¢ was for preventive services 4 During calendar year 2004, gross expenditures for dental health education provided by local departments of health totaled nearly $5. Fifty-one of 57 counties and New York City received funding to provide dental education, while 15 of 57 counties and New York City received funding for the provision of dental health services. Numerous achievements in the oral health of New Yorkers and reductions in the burden of oral disease have been realized in recent years. Compared to national data, more New York State adults report never having had a tooth extracted as a result of caries or periodontal disease, fewer older adults have lost all of their natural teeth, more children and adults have visited a dentist or dental clinic within the past year, more children and adults have had their teeth cleaned in the last year, fewer adults are smoking and fewer high school students are smoking or using smokeless tobacco, more New Yorkers are being diagnosed with oral cavity and pharyngeal cancers at an earlier stage and less are dying from these cancers, and more New Yorkers have access to dental services through Family Health Plus, Child Health Plus B, Medicaid, school-based oral health programs, community health centers, and through special programs targeting the homeless, migrant and seasonal farm workers, and residents of public housing sites. Explore opportunities to form regional oral health networks to work together to identify prevention opportunities and address access to dental care in their communities. Encourage professional organizations, educational institutions, key State agencies, and other stakeholders to examine and make recommendations on laws and regulations that affect the provision of dental services, the financing of dental education, approaches to address disparities in oral health, and strengthening the dental health workforce. Assess gaps in dental health educational materials and identify ways to integrate oral health into health literacy programs. Develop and widely disseminate guidelines, recommendations, and best practices to address childhood caries, maternal oral health, and tobacco and alcohol use. Strengthen the oral health surveillance system to periodically measure oral diseases and their risk factors in order to monitor progress. Attendees were provided the opportunity to meet with individuals and agencies involved with promising new and innovative ways to promote oral health for Early Head Start, Head Start and school-aged children; develop action plans to promote oral health; and to explore the roles they can play in improving oral health in Head Start/Early Head Start/Migrant Head Start children and school-aged children. Regional oral health networks/coalitions are presently being established as a result of the Regional Oral Health Forums. One regional coalition has already brought stakeholders together to identify the dental needs of the community, available dental services in the area, propose activities to meet service needs, and to develop and implement activities to promote and improve oral health for all children in the region. The goal of the Listserv is to support and encourage ongoing communication and collaboration on a local, regional and statewide level; link private and public sectors; and to involve as many stakeholders as possible in order to enhance oral health information and knowledge sharing, facilitate improved collaborations, communicate best practices, and to replicate effective programs and proven interventions. The mission and vision of the 9 coalition were finalized, priorities for establishing the Coalition identified, and two work groups formed to work on rules of operation/By-Laws and sustainability. The first meeting of the statewide Oral Health Coalition was held on May 9, 2006, with more than 130 persons from health agencies, social service organizations, the business community, and educational institutions in attendance.
Many patients will receive their oral therapy at All observations and actions must be home erectile dysfunction 55 years old buy 20mg tadalis sx otc. Where the therapy is to be administered documented in the patient records including outside the hospital setting by the patient or education provided erectile dysfunction low testosterone buy tadalis sx paypal, side effects and care of their carer it must be ensured that appropriate patient during and after administration erectile dysfunction fix purchase tadalis sx 20mg mastercard. Subcutaneous route Chemotherapy tablets and capsules must not be Checking and cautionary points that apply crushed impotence gel cheap tadalis sx 20 mg. Crushing tablets carries both exposure to intravenous administration apply to the risks and change to bioavailability l-arginine erectile dysfunction treatment discount 20mg tadalis sx free shipping. Guidelines for the Safe Prescribing impotence pumps purchase 20 mg tadalis sx with amex, Supply and Administration of Cancer Chemotherapy administration via the topical route administration via the intrathecal route Topical chemotherapy is usually applied for Formal training and regular competency treating non melanoma skin cancer and other skin assessment for all staff involved in the conditions erectile dysfunction caused by statins discount tadalis sx master card. The medication may be in the form of administration of Intrathecal medicines should be an ointment impotence hypertension medication generic tadalis sx 20mg without a prescription, solution or suspension. The formulation should be applied in a thin layer Staff administering intrathecal medicines must to the affected area with an applicator at the use checking procedures that includes a ‘time frequency ordered by the prescriber (usually out’ involving at least two health professionals. Care should be taken ‘Time Out’ is a fnal patient safety check to avoid contact with the unaffected skin, the undertaken immediately before commencing mucous membranes of eyes, nose and mouth. The patient should be advised that the skin may be temporarily unsightly in appearance and local discomfort may be experienced during the application of the product but they need to report any “burning” pain. Chemotherapy error reduction: a multidisciplinary approach to create templated order sets. Standards of chemotherapy administration: using failure mode and Practice for the Provision of Pharmaceutical Care of effects analysis in computerized prescriber order entry. Vincristine Cancer Chemotherapy Errors Part 1&2 Clinical Oncology therapy: days “4-11” misunderstood as days 4 through 11. Guidelines for the Safe Prescribing, Supply and Administration of Cancer Chemotherapy 1 29. The Society of Hospital Pharmacists of Australia Committee of Consumer Medicines Information by Pharmacists in of Specialty Practice in Oncology. Standards of Practice for the Transportation of Cytotoxic Drugs from Pharmacy Departments J Pharm Pract Res. Neurourologic for nurses involved in the administration of cytotoxic consequences of accidental intrathecal vincristine: a case drugs. Former Australian Council for Safety and Quality in Health Eastern Cooperative Oncology Group. Recommendations ends tragically, but application of lessons learned will save for Terminology, Abbreviations and Symbols used in the lives. Guidelines for the use of the National Inpatient Medication Chart 2004 [updated 2004; cited 2008]; Available from: Guidelines for the Safe Prescribing, Supply and Administration of Cancer Chemotherapy. Cardiotoxicity: Common in patients with a prior history of coronary artery disease. Other adverse reactions, including serious adverse – In combination with docetaxel after failure of prior anthracycline reactions, have been reported. Subsequent dose adjustment is recommended as outlined in Table 2 and Table 3 (depending on the regimen) if a patient develops a grade 2 to 4 adverse event [see Warnings and Precautions (5. Each light peach-colored tablet contains 150 mg of capecitabine and each peach-colored tablet contains 500 mg of capecitabine. Most adverse reactions are reversible and do not need to result in discontinuation, although doses may need to be withheld or reduced [see Dosage and Administration (2. Patients with severe diarrhea should be carefully monitored and given fluid and electrolyte replacement if they become dehydrated. Dose modifications should be applied for the precipitating adverse event as necessary [see Dosage and Administration (2. Patients with mild and moderate renal impairment at baseline should be carefully monitored for adverse reactions. Prompt interruption of therapy with subsequent dose adjustments is recommended if a patient develops a grade 2 to 4 adverse event as outlined in Table 2 [see Dosage and Administration (2. Grade 1 is characterized by any of the following: numbness, dysesthesia/paresthesia, tingling, painless swelling or erythema of the hands and/or feet and/or discomfort which does not disrupt normal activities. Grade 2 hand-and-foot syndrome is defined as painful erythema and swelling of the hands and/or feet and/or discomfort affecting the patient’s activities of daily living. Grade 3 hand-and-foot syndrome is defined as moist desquamation, ulceration, blistering or severe pain of the hands and/or feet and/or severe discomfort that causes the patient to be unable to work or perform activities of daily living. A total of 82 deaths due to all causes occurred either on study or within 28 days of receiving study drug: 50 (8. In the monotherapy arm docetaxel was 2 administered as a 1-hour intravenous infusion at a dose of 100 mg/m on the first day of each 3 week cycle for at least 6 weeks. The mean duration of treatment was 129 days in the combination arm and 98 days in the monotherapy arm. A total of 13 out of 162 patients (8%) discontinued treatment because of adverse reactions/intercurrent illness. Monotherapy (Metastatic Colorectal Cancer, Adjuvant Colorectal Cancer, Metastatic Breast Cancer) Gastrointestinal: abdominal distension, dysphagia, proctalgia, ascites (0. Leucovorin the concentration of 5-fluorouracil is increased and its toxicity may be enhanced by leucovorin. Capecitabine at doses of 198 mg/kg/day during organogenesis caused malformations and embryo death in mice. Malformations in mice included cleft palate, anophthalmia, microphthalmia, oligodactyly, polydactyly, syndactyly, kinky tail and dilation of cerebral ventricles. The first trial was conducted in 22 pediatric patients (median age 8 years, range 5-17 years) with newly diagnosed non-disseminated intrinsic diffuse brainstem gliomas and high grade gliomas. In the dose-finding portion of the trial, patients received capecitabine with concomitant radiation 2 2 therapy at doses ranging from 500 mg/m to 850 mg/m every 12 hours for up to 9 weeks. After 2 a 2 week break, patients received 1250 mg/m capecitabine every 12 hours on Days 1-14 of a 21 day cycle for up to 3 cycles. All patients received 650 mg/m capecitabine every 12 hours with concomitant radiation therapy for up to 9 weeks. Medical management of overdose should include customary supportive medical interventions aimed at correcting the presenting clinical manifestations. The peach or light peach film coating contains hydroxypropyl methylcellulose, talc, titanium dioxide, and synthetic yellow and red iron oxides. Distribution Plasma protein binding of capecitabine and its metabolites is less than 60% and is not concentration-dependent. Excretion Capecitabine and its metabolites are predominantly excreted in urine; 95. Systemic exposure to capecitabine was about 25% greater in both moderately and severely renal impaired patients [see Dosage and Administration (2. Capecitabine was clastogenic in vitro to human peripheral blood lymphocytes but not clastogenic in vivo to mouse bone marrow (micronucleus test). Impairment of Fertility In studies of fertility and general reproductive performance in female mice, oral capecitabine 2 doses of 760 mg/kg/day (about 2300 mg/m /day) disturbed estrus and consequently caused a decrease in fertility. In males, this dose caused degenerative changes in the testes, including decreases in the number of spermatocytes and spermatids. Patients in the study were required to be between 18 and 75 years of age with histologically-confirmed Dukes’ stage C colon cancer with at least one positive lymph node and to have undergone (within 8 weeks prior to randomization) complete resection of the primary tumor without macroscopic or microscopic evidence of remaining tumor. The starting dose was reduced in patients with moderate renal impairment (calculated creatinine clearance 30 to 50 mL/min) at baseline [see Dosage and Administration (2. Subsequently, for all patients, doses were adjusted when needed according to toxicity. The two clinical studies were identical in design and were conducted in 120 centers in different countries. The 2 approved dose of 100 mg/m of docetaxel administered in 3-week cycles was the control arm of the phase 3 study. In the monotherapy arm, 256 patients received docetaxel 100 mg/m as a 1 hour intravenous infusion administered in 3-week cycles. Resistance was defined as progressive disease while on treatment, with or without an initial response, or relapse within 6 months of completing treatment with an anthracycline-containing adjuvant chemotherapy regimen. Storage and Handling Store at 25°C (77°F); excursions permitted to 15° to 30°C (59° to 86°F). Procedures for the proper handling and disposal of anticancer drugs should be considered. Treatment should not be restarted until the patient is rehydrated and any precipitating causes have been corrected or controlled. If you have severe bloody diarrhea with severe abdominal pain and fever, call your doctor or go to the nearest emergency room right away. If you lose your appetite, feel weak, and have nausea, vomiting, or diarrhea, you can quickly become dehydrated. Tell your doctor if you have any side effect that bothers you or that does not go away. If your white blood cell count is very low, you are at increased risk for infection. Active ingredient: capecitabine Inactive ingredients: anhydrous lactose, croscarmellose sodium, hydroxypropyl methylcellulose, microcrystalline cellulose, magnesium stearate and purified water. We’ll maintain the content of this toolkit and make updates available on our website. Other parties are permitted to make use of the content within this toolkit and append locally applicable material. In addition, we will not endorse, support or otherwise accept any liability in relation to any amended versions of the toolkit. Please note the toolkit aims to share learning and good practice, but it is, of necessity, brief in nature. Information contained in the toolkit is not a substitute for your own clinical judgment or taking specialist professional advice in appropriate circumstances. Tell your patients to call the Macmillan Support Line free on 0808 808 00 00 (Mon–Fri, 9am–8pm) if they need additional support with practical, emotional or fnancial issues related to cancer. Direct access: When a test is performed and primary care retain clinical responsibility throughout, including acting on the result. Immediate: An acute admission or referral occurring within a few hours, or even more quickly if necessary. Key Non-urgent: the timescale generally used for a referral or investigation that is not considered very urgent or urgent. Head and neck Name Title/responsibilty Phone number Email address Call the Macmillan Support Line free on 0808 808 00 00 (Mon–Fri, 9am–8pm) or visit macmillan. Accompanying notes: Features suggestive of a basal cell Accompanying notes: carcinoma include: the 7-point weighted checklist. Skin Name Title/responsibilty Phone number Email address Call the Macmillan Support Line free on 0808 808 00 00 (Mon–Fri, 9am–8pm) or visit macmillan. Non-urgent referral: Consider urgent referral (appointment within Consider referral in patients aged 60 and over two weeks) in men with any of the following, after Accompanying notes: with recurrent or persistent urinary tract infection exclusion of sexually transmitted infection as a cause Prostate-specifc antigen ranges: that is unexplained. Urological Name Title/responsibilty Phone number Email address Call the Macmillan Support Line free on 0808 808 00 00 (Mon–Fri, 9am–8pm) or visit macmillan. Accompanying notes: In symptomatic patients, the majority of chest X-rays will be abnormal, but a normal chest X-ray does not exclude diagnosis of lung cancer. Lung Name Title/responsibilty Phone number Email address Call the Macmillan Support Line free on 0808 808 00 00 (Mon–Fri, 9am–8pm) or visit macmillan. Consider urgent referral (appointment within two Pancreatic cancer weeks) for patients with an upper abdominal mass Accompanying notes: consistent with stomach cancer (G). Urgent referral: Consider that 10% of pancreatic cancers are Urgently refer patients (appointment within missed by abdomen ultrasounds, whilst tumours Non-urgent direct access endoscopy: two weeks) if aged 40 and over with jaundice. Upper gastrointestinal Name Title/responsibilty Phone number Email address Call the Macmillan Support Line free on 0808 808 00 00 (Mon–Fri, 9am–8pm) or visit macmillan. Urgent direct access: Consider urgent direct access ultrasound scan Very Urgent referral: (performed within two weeks) in adults with: Consider very urgent referral in children and. Bone and sarcoma Name Title/responsibilty Phone number Email address Call the Macmillan Support Line free on 0808 808 00 00 (Mon–Fri, 9am–8pm) or visit macmillan. Non-urgent referral: Consider non-urgent referral in patients under the age of 30 with an unexplained breast lump (with or without pain). Breast Name Title/responsibilty Phone number Email address Call the Macmillan Support Line free on 0808 808 00 00 (Mon–Fri, 9am–8pm) or visit macmillan. Accompanying notes: Refer adults, children and young people with a blood count or blood flm reported as acute leukaemia immediately. Haematological Name Title/responsibilty Phone number Email address Call the Macmillan Support Line free on 0808 808 00 00 (Mon–Fri, 9am–8pm) or visit macmillan. A smear test is not required before referral, and Urgent Investigation: a previous negative result should not delay referral. Changes in bowel habits Gynaecological Name Title/responsibilty Phone number Email address Call the Macmillan Support Line free on 0808 808 00 00 (Mon–Fri, 9am–8pm) or visit macmillan. Give the person information on the possible Macmillan’s Online Community is a network appropriate, that most people referred will diagnosis (both benign and malignant) in of people affected by cancer which anyone can not have a diagnosis of cancer, and discuss accordance with their wishes for information join to get support from others going through alternative diagnoses with them. When referring a person with suspected cancer has more than 500 free booklets available at to a specialist service, assess their need for be. If the person does have additional offer information and guidance on the day-to support needs because of their personal day issues of living with cancer. You know more than most that cancer doesn’t just affect the people you support physically. We want to work with you to help you provide the best support possible for people affected by cancer and their families. So as well as offering resources to support you in your role, we can provide information to the people you support, so they know they’ll never have to face cancer alone. Together, we can help make sure people affected by cancer get the support they need to feel more in control – from the moment they’re diagnosed, through treatment and beyond. Our cancer support specialists, benefts advisers and cancer nurses are available to answer any questions your patients might have through our free Macmillan Support Line on 0808 808 00 00 (Monday to Friday, 9am – 8pm). Respirology 2003; 8: 419–431 Abstract: South Asia is a major producer and net exporter of tobacco. Traditional forms like betel quid, tobacco with lime and tobacco tooth powder are commonly used and the use of new products is increasing, not only among men but also among children, teenagers, women of reproductive age, medical and dental students and in the South Asian diaspora. Smokeless tobacco users studied prospectively in India had age adjusted relative risks for premature mortality of 1. Current male chewers of betel quid with tobacco in case-control studies in India had relative risks of oral cancer varying between 1. Oral submucous fibro sis is increasing due to the use of processed areca nut products, many containing tobacco. Preg nant women in India who used smokeless tobacco have a threefold increased risk of stillbirth and a two to threefold increased risk of having a low birthweight infant. In recent years, several states in India have banned the sale, manufacture and storage of gutka, a smokeless tobacco product containing areca nut. In May 2003 in India, the Tobacco Products Bill 2001 was enacted to regulate the promotion and sale of all tobacco products. In two large-scale educational interventions in India, sizable proportions of tobacco users quit during 5–10 years of follow-up and incidence rates of oral leukoplakia measured in one study fell in the intervention cohort. Tobacco education must be imparted through schools, existing government health programmes and hospital outreach programmes. Key words: areca, asthma, health policy, hypertension, intervention studies, morbidity, mortality, neoplasms, oral submucous fibrosis, pregnancy outcomes, smokeless tobacco, South Asia. The chewing of betel quid (a mixture of the leaf Habitual betel quid chewing is commonly prac of the Piper betle vine, aqueous calcium hydroxide tised by men and women in Bangladesh, India, Paki paste [slaked lime], pieces of areca nut [supari], and stan and Sri Lanka, while tobacco smoking is much frequently some spices) was a popular habit that had more common among men in these countries com already been integrated into social and cultural life in pared to women, except for certain small geographic this region for over a millennium. Current pro introduction, tobacco soon became a new ingredient duction figures are shown in Table 1. Tobacco leaf in betel quid (pan), which has become the most production has been increasing steadily for many decades, and has doubled since the 1960s. It is commonly used and increasingly so, especially as new forms of smokeless tobacco have been emerging over the last few decades, enticing new consumers. In India, per capita smokeless Figure 1 A pan seller outside a major railway station in tobacco consumption has increased among the poor Mumbai, India. Pattiwala is sun-dried, flaked tobacco with or with out lime, used mainly in Maharashtra and several north Indian states. A similar preparation popular in Forms of smokeless tobacco northern areas is khaini, a mixture of tobacco and lime generally made by the user but now available In South Asia, the use of smokeless tobacco is com ready made in sachets as well. The various forms are chewed, sucked or mandibular or labial groove and sucked slowly for applied to teeth and gums. The use of unprocessed tobacco, the northern state of Uttar Pradesh, contains finely the cheapest form, varies in different parts of India. Mawa, popular It is sold as bundles of long strands in Kerala or as among teenagers especially in Gujarat, contains thin leaf tobacco (hogesoppu) in Karnataka. Kaddipudi shavings of areca nut with some sun-dried tobacco are cheap ‘powdered sticks’ of raw tobacco stalks and slaked lime. Gundi, also 1975, containing areca nut, slaked lime, catechu, con called kadapan, is a mixture of coarsely powdered diments and powdered tobacco, was originally avail tobacco with coriander seeds, other spices and aro able custom-mixed from pan vendors. For the last matic, resinous oils, popular in Gujarat, Orissa and couple of decades, gutka has been available in several West Bengal. A similarly packaged mixture without India and Pakistan, is a thick paste of boiled tobacco tobacco, often with an identical brand name, is called mixed with powdered spices such as saffron, carda pan masala. These products have become very pop mom, aniseed and musk, and is also available as ular especially among teenagers and young adults in granules or pellets. A commercial mixture of many states of India, as shown by a number of sur tobacco, lime and spices is zarda. It is typically fla veys, both published and unpublished, in Gujarat, voured with cardamom and saffron and often Maharashtra, Bihar and Punjab (Fig. Tobacco and health: India and South Asia 421 Figure 2 Smokeless tobacco seller on a busy road near a mar ketplace in Mumbai, India. Having begun to expe rience the public health impact of these products and having been warned by tobacco control experts about the high carcinogenicity of pan masala and gutka, three state governments (Tamil Nadu, Andhra Pradesh, Maharashtra) have taken the initiative to ban the sale of these products.
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Remember most effective erectile dysfunction pills 20mg tadalis sx free shipping, the answers you give for this survey will not be linked to you in any way erectile dysfunction keeping it up purchase genuine tadalis sx line. Maybe some of the answers you give today will help us and our community leaders address some of these types of issues cost of erectile dysfunction injections generic 20mg tadalis sx free shipping. A blood stool test is a test that may use a special kit at home to determine whether the stool contains blood erectile dysfunction treatment nyc generic 20mg tadalis sx with visa. How many days a week do you do moderate physical activity for at least 30 minutes that makes you break a sweat? In the last 12 months impotence in 30s purchase generic tadalis sx pills, did you or others in your household ever cut the size of your meals or skip meals because there was not enough money for food? Do you have health insurance or some type of health plan that helps you pay medical expenses? What are the different ways you pay for healthcare erectile dysfunction doctors in nc cheap tadalis sx 20 mg fast delivery, for example erectile dysfunction icd 9 code wiki buy discount tadalis sx line, when you go to the doctor or emergency room? In the past 12 months erectile dysfunction hypnosis purchase tadalis sx 20mg on line, did you ever have problems getting the health care you needed from any type of health care provider or facility? What were some problems you had getting the health care you needed from any type of health care provider or facility. About how long has it been since you last visited a doctor for a routine physical exam or wellness checkup? In the past 12 months, did you have problems getting a medically necessary prescription for yourself? What were some problems getting a medically necessary prescription for yourself the problems you had? In the past 12 months, did you ever have problems getting the dental care you needed from any type of dental care provider or facility? What some of the problems you had getting the dental care you needed from any type of dental care provider or facility? In the past 12 months, did you ever have problems getting the mental health or substance abuse services you needed from any type of medical care provider or facility? What some of the problems you had getting the mental health or substance abuse services you needed? What mode of transportation do you normally use to get to health care (doctor’s office, health department, etc. Have you or another adult taken them for their regular Well Child visit in the last 12 months? Orange County Community Health Opinion Survey, 2011 13 If you have it in the home, do you lock-up your: 83. Many, but not all government buildings are tobacco-free inside and within 50 feet of the buildings. Do you think that all government owned buildings and grounds should have this same restriction prohibiting all tobacco use? Do you think that people using government owned outdoor facilities, such as parks and recreation land, should also be restricted from using tobacco anywhere on the property? Which of these things stand out for you as significant environmental problems in Orange County? This question is not asking about you and your family, but which three of these issues are problems in our community as a whole. What would be your main way of getting information from authorities in a large-scale disaster or emergency? Would it because 1 you have no transportation 2 you do not trust public officials 3 you are worried about leaving property behind 4 you are worried about personal safety 5 you are worried about family safety 6 you are worried about leaving pets 7 you are worried about traffic jams and not being able to get out 8 you have health problems and cannot be moved 9 or some other reason? Have you used Orange County Health Department medical services in the past two years? If you or your family were in need of services, would these hours be convenient for you? The Orange County Health Department has locations in both Hillsborough and Chapel Hill. What are some reasons that may prevent you or your family from receiving services from the Health Department’s Hillsborough location. What are some reasons that may prevent you or your family from receiving services from the Health Department’s Chapel Hill location. Demographic Questions the next set of questions are general questions about you, which will only be reported as a summary of all answers given by survey participants. What is the highest level of school, college or vocational training that you have finished? Is there anything else that was not asked previously that you feel affects your health and well-being? What would you change to make Orange County or your neighborhood a healthier place to live? Orange County Community Health Opinion Survey, 2011 21 2011 Orange County Community Health Assessment Appendix G. El Departamento de Salud del Condado de Orange y Healthy Carolinians del Condado de Orange utilizarán estos resultados para crear planes que sirvan para solucionar algunos de los problemas de salud y comunitarios que tiene este condado. Quizás usted recuerde haber recibido recientemente en el correo, una carta que habla sobre esta encuesta. Si usted se da cuenta que ya ha participado en esta encuesta este año, dígamelo, y puedo detenerme. Para estas preguntas, al igual que para todas las preguntas a continuación, no hay respuestas correctas o incorrectas. Solo estamos interesados en recibir su honesta opinión, en base a sus experiencias. En base a lo que usted a visto y vivido, por favor dígame que tanto está usted de acuerdo o en desacuerdo con cada afirmación diciendo: “Totalmente de acuerdo”, “De acuerdo”, “En desacuerdo”, o “Totalmente en desacuerdo” para cada uno de estas afirmaciones. Totalmente de Totalmente en Afirmaciones De acuerdo En desacuerdo acuerdo desacuerdo 1. Hay buenos trabajos disponibles para las personas que viven en el Condado de 4 3 2 1 Orange. En el Condado de Orange las personas pueden obtener los servicios de salud que 4 3 2 1 necesitan. Se puede encontrar vivienda o alojamiento a precio razonable en el Condado de Orange. El Condado de Orange tiene buenos recursos para los padres de niños pequeños, incluyendo buenas guarderías a precio 4 3 2 1 razonable. Los que viven el en Condado de Orange son tratados de una manera justa o imparcial sin importar sus características físicas, posición 4 3 2 1 económica, antecedentes o creencias. Los niños tienen igual acceso a una buena educación en las escuelas del Condado de 4 3 2 1 Orange. En el Condado de Orange, hay buenos servicios disponibles para las personas que 4 3 2 1 necesitan ayuda. En el Condado de Orange, hay transporte público disponible para las personas que lo 4 3 2 1 necesitan. Las personas que viven en el Condado de Orange tienen igual acceso al aire limpio, el agua, y los lugares públicos bien 4 3 2 1 mantenidos. Específicamente considere si usted piensa que este es un problema en nuestra comunidad. Igual que hizo antes, dígame por favor que tanto está usted de acuerdo o en desacuerdo con cada afirmación diciendo: “Totalmente de acuerdo”, “De acuerdo”, “En desacuerdo”, o “Totalmente en desacuerdo” para cada uno de estas afirmaciones. Totalmente Totalmente en Afirmaciones De acuerdo En desacuerdo de acuerdo desacuerdo 15. Falta de acceso a los parques y las recreaciones es un problema en el 1 2 3 4 Condado de Orange. Los crímenes contra la propiedad como robos y hurtos dentro de las viviendas son un problema en el Condado de 1 2 3 4 Orange. Orange County Community Health Opinion Survey, 2011 3 Totalmente Totalmente en Afirmaciones De acuerdo En desacuerdo de acuerdo desacuerdo 19. La discriminación contra los inmigrantes es un problema en el 1 2 3 4 Condado de Orange. La discriminación contra las personas con discapacidades es un problema en 1 2 3 4 el Condado de Orange. La discriminación contra personas homosexuales (gay o lesbiana), personas bisexuales o transgéneros es 1 2 3 4 un problema en el Condado de Orange. La violencia contra las mujeres (o violencia doméstica) es un problema en 1 2 3 4 el Condado de Orange. Jóvenes dejando la escuela antes de completarla es un problema en el 1 2 3 4 Condado de Orange. El abuso de substancias (drogas y alcohol) es un problema en el Condado 1 2 3 4 de Orange. La falta de recursos de salud mental y de abuso de substancias es un 1 2 3 4 problema en el Condado de Orange. Orange County Community Health Opinion Survey, 2011 4 Totalmente Totalmente en Afirmaciones De acuerdo En desacuerdo de acuerdo desacuerdo 32. La falta de recursos para personas de edad avanzada es un problema en el 1 2 3 4 Condado de Orange. Muchas personas encuentran algunas palabras y consejos médicos difíciles de entender. Usted alguna vez pide ayuda a otras personas cuando tiene que llenar un formulario, leer las etiquetas de las medicinas recetadas, formularios de seguro y/o panfletos de educación de salud? Quizás algunas de sus respuestas que nos dé hoy nos ayuden a nosotros y a nuestros líderes de la comunidad a resolver algunos de estos problemas. Las siguientes preguntas son sobre las pruebas para detectar diferentes tipos de cáncer. La prueba de sangre en la heces es una prueba en que puede usar un equipo especial en casa para determinar si hay sangre en las heces. En los últimos 12 meses, usted o alguien en su casa alguna vez disminuyó el tamaño de sus comidas o dejó de comer (se saltó comidas) porque no había suficiente dinero para la comida? En los últimos 12 meses, ¿Alguna vez tuvo problemas para obtener la atención médica que necesitó de cualquier tipo de proveedor o establecimiento médico? En los últimos 12 meses, ¿Tuvo problemas para obtener una prescripción/receta médica que necesitaba para usted? En los últimos 12 meses, ¿Alguna vez tuvo problemas para obtener el cuidado dental que necesitó de cualquier tipo de proveedor o establecimiento de cuidado dental? En los últimos 12 meses, ¿Alguna vez tuvo problemas para obtener los servicios de salud mental o de abuso de sustancias que necesitó de cualquier tipo de proveedor o establecimiento de cuidado médico? En los últimos 12 meses ¿Usted u otro adulto ha llevado al niño a su examen físico regular de Niño Sano (Well Child Check)? Tomen medicinas que necesitan receta médica 4 3 2 1 que no les fueron recetas a ellos por un doctor Si los tiene en su casa, usted guarda bajo llave su: 83. Muchos, pero no todos los edificios del gobierno son lugares libres de humo de tabaco adentro y a 50 pies del edificio. Esta pregunta no es sobre usted y su familia, pero cuáles tres de estos son problemas en su comunidad en general. Si contestó No, ¿Por qué su familia no tiene un paquete de suministros de emergencia? Si las autoridades anuncian una evacuación obligatoria de su barrio o comunidad debido a una catástrofe de gran magnitud u otra emergencia, ¿seguiría usted la orden de evacuación? Sería porque 1 No tiene transporte 2 No confía en las autoridades oficiales 3 Le preocupa dejar sus posesiones/propiedad 4 Le preocupa la seguridad personal 5 Le preocupa la seguridad de la familia 6 Le preocupa dejar sus mascotas 7 Le preocupan los tranques/atascos de tráfico y el no poder salir 8 Tiene problemas de salud y no se le podría trasladar 9 ó ¿algún otro motivo? En los últimos dos años ¿Ha utilizado los servicios médicos del Departamento de Salud del Condado de Orange? En los últimos dos años ¿Ha utilizado los servicios dentales del Departamento de Salud? Si usted o su familia necesitaran servicios, ¿Sería este horario conveniente para usted? El Departamento de Salud del Condado de Orange tiene ubicaciones en Hillsborough y en Chapel Hill. Orange County Community Health Opinion Survey, 2011 22 2011 Orange County Community Health Assessment Appendix H. They may make brief notes to themselves in order to keep track of probes or issues to return to). Note taking is important even if the session is also being taped in order to highlight strong quotes and themes, record observed non-verbal activity, or any discussion missed in the event of the audio tape failure. Have plenty of legal pad paper available for note taking and 2 pens, in case one runs out of ink. While participants’ names will not appear in the final written summary of the listening session, it is helpful to indicate participants’ initials by their specific comments in your handwritten notes. Listen for sentences or phrases that are particularly enlightening or eloquently express a particular point of view. Watch for the obvious, such as head nods, physical excitement, eye contact between certain participants, or other clues. Place an asterisk by key points or ideas where there was agreement by several people. You can also record in brackets other observed signs of consensus (for example, “lots of yes’s here” or “lots of head-nodding here”). Homogeneity is important for successful analysis and the group’s comfort (remember: an “expert” or an “authority” destroys the group’s participation). Selecting participants these general guidelines for selecting participants will help ensure that our methodology is sound. If you are working with only one or the other, be sure to note that in the description of your group that you provide on your cover sheet. This includes any list of clients, members, or service providers that you have access to . It is important to further narrow recruitment to select a group of people who share some common characteristics related to the health assessment. I am working with the Orange County Health Department and Healthy Carolinians of Orange County – a group of agency and community members who are interested in learning about the health of Orange County residents. Today we would like to hear what you think about the physical, mental, and environmental health of your community. The information that you share, along with information gathered from a community survey, other discussions and existing statistics, will help us plan future programs that better meet the needs of residents of Orange County. We will share what we learn with community and agency members during open forums in the fall. In the winter we will write a report about our county’s health, to submit to the state. If you would like to be invited to a community forum, please write your name and contact information on the sign-up sheet. If there are no objections, we will be recording this discussion to make sure we do not miss any comments. After this discussion, we will listen to the recording and write down all of the responses, then we will erase/destroy the recording. Since this is a group discussion, you do not have to wait for me to call on you to speak. You are here because you voluntarily agree to participate in this group discussion. However, if for any reason you feel uncomfortable and do not want to continue in the discussion, you are free to withdraw at any time. This will not affect in any way your the services you receive in the future from Orange County or this agency. Since we will be talking about health, what does being healthy mean to you, personally? Another way to think about health is looking at the health of a community, not just individuals. Today we will be talking about people’s health here in Orange County where you live or work. What do you think are the most healthy things about your physical community/Orange County? Now, thinking about less healthy things, which things concern you the most about the health of your physical community/Orange County? Are there groups of people within your community whose healthcare needs seem to be overlooked, or not met? If you were in charge, what specific things would you do to improve the health status of community members? Are there things you would do to improve people’s access to care, health information, quality of care, subsidies/cost, types of services available? We want to make sure that the health programs in this community will help you and your community. With that in mind, is there anything that we have not asked or that you would like to add? Name Email Address Mailing Address Street Address: City: State: Zip Code 3 2011 Orange County Community Health Assessment Appendix J. Estoy trabajando con el Departamento de Salud del Condado de Orange y Healthy Carolinians del Condado de Orange un grupo de miembros de la agencia y de la comunidad que están interesados en aprender sobre la salud de los residentes del Condado Orange. Hoy nos gustaría saber qué piensan acerca de la salud física, mental y ambiental de su comunidad. La información que ustedes compartan, junto con información obtenida de una encuesta comunitaria, otros diálogos y las estadísticas existentes, nos ayudará a planear futuros programas que satisfagan mejor las necesidades de los residentes del Condado de Orange. Los invitamos a participar porque ustedes son líderes de la comunidad Latina Inmigrante, que puede hablar de su experiencia personal y de sus experiencias como líderes. Compartiremos lo que aprendamos con miembros de comunidad y de la agencia durante foros abiertos en el otoño. En el invierno escribiremos un informe acerca de la salud de nuestro condado, para enviarlo al estado.
B) If there is any chance that the person is still in the water: a) Adults take the participants out of the water and remove them from the area erectile dysfunction treatment natural medicine generic 20mg tadalis sx mastercard. A) For day events – after determining that the person is not with a troop/group or event staff member how to cure erectile dysfunction at young age tadalis sx 20 mg sale, a pair of responsible adults should ask person to leave the premises impotence drugs generic tadalis sx 20mg otc. If there is a resident caretaker erectile dysfunction ed drugs buy tadalis sx with amex, security person or camp ranger impotence bike riding purchase tadalis sx 20 mg visa, notify that person impotence what does it mean purchase tadalis sx from india. If it is determined that the person is not with a troop/group or event staff erectile dysfunction doctors in memphis tn purchase tadalis sx 20 mg mastercard, call the police immediately erectile dysfunction psychological order tadalis sx mastercard. If there is a resident caretaker, security person or camp ranger, notify that person by phone or radio. E) Ensure that you have an escape route (or exit) before fighting a small controllable fire. F) If fire is small, use the following methods of control: a) Grass or woods fire: i) Put out small fires before they grow; smother with dirt or sprinkle water directly on fire. Beat toward the wind (beating with the wind at your back tends to fan the flames and may cause sparks or flames to jump ahead into unburned areas). At council campsites, the continuous blowing of a car horn (or three consecutive horn blasts) is the alarm signifying the need to evacuate. H) Evacuation Procedures: a) Adults in charge secure first aid kits and have girls in troop/group count off. One of the troop leaders will keep a copy with them during the activities outside of the regular troop meeting. Keep in mind that any information from health forms or examinations is confidential and may be shared only with people who must know this information (such as the girl herself, her parent/caregiver, the first-aider or a health practitioner). For various reasons, some parents/caregivers may object to immunizations or medical examinations. Councils must attempt to make provisions for these girls to attend Girl Scout functions in a way that accommodates these concerns. It is important for you to also be aware of any medications a girl may take or allergies she may have. Some girls may need to carry and administer their own medications, such as bronchial inhalers, an EpiPen, or diabetes medication. This means that, before serving any food (such as peanut butter and jelly sandwiches, cookies, or chips), ask whether anyone is allergic to peanuts, dairy products, or any other food products. Even Girl Scout Daisies and Brownies should be aware of their allergies, but double-checking with their parents/caregivers is always a good idea. These should be carried by trained volunteers at all times when engaged in girl activities. The Basic Coverage is for a person as long as they have purchased a membership whether current, future, extended year or lifetime. This criteria replaces any pervious understanding and literature that may have made reference to time periods such as 14 months. This is a terrific, no-cost benefit of membership and a great reason for all adults and girls to register. Non-registered parents, tag-alongs (brothers, sisters, friends), and other persons are not covered by Basic Coverage. This insurance coverage is not intended to diminish the need for or replace family health insurance. If there is no family insurance or healthcare program, a specified maximum of medical benefits is available. Additional Activity Insurance is recommended for Girl Scouts taking extended trips, international travel and for non members who participate in Girl Scout activities. This insurance program is available for any Girl Scout activity that involves non-Girl Scouts or lasts longer than three days and two nights. Thus for extended trips troops must complete the Extended Travel/High Risk Application eForm and purchase the required Additional Activity Insurance for the longer trip. Please submit your order at least three weeks prior to the event date to allow for processing. Additional Activity Insurance is a simple and inexpensive way to take care of your group. The Safety Activity Checkpoints for most activities require having an expert on hand to help girls learn an activity. Some things to keep in mind: Does the person have documented training and experience? She or he should have documented experience for the activity in question, such as course completion certificates or cards, records of previous training to instruct the activity, and letters of reference. This person should have the knowledge and experience to make appropriate judgments concerning participants, equipment, facilities, safety considerations, supervision, and procedures for the activity. At the very least, she or he should be able to give clear instructions to girls and adults, troubleshoot unexpected scenarios, and respond appropriately in an emergency. Appropriate level of proficiency in the activity Ability to procure, assemble, maintain, and store equipment Ability to create a safe space for girls participating in the activity Ability to give clear directions to both girls and adults Ability to create an instructional plan in which girls are able to learn new skills, step by step Ability to troubleshoot unexpected scenarios Ability to monitor the safety of the participants Ability to respond appropriately in emergency situations Even when not required to have an expert instruct girls for a specific activity for safety reasons, it is always a great idea to use your personal and troop networks to find experts to teach particular skills. Girls need to receive proper instruction in how to care for themselves and others in emergencies. They also need to learn the importance of reporting to adults any accidents, illnesses, or unusual behaviors during Girl Scout activities. Please consult with our council for the most relevant information for you to share with girls. For example, you and the girls, with the help of a fire department representative, should design a fire evacuation plan for meeting places used by the group. First aid administered in the first few minutes can mean the difference between life and death. In an emergency, secure professional medical assistance as soon as possible, normally by calling 911. Should an uncertified person be the only or best choice to offer first aid, he should not hesitate. Troop adults will notice that most activities outside of the regular meeting place require a first-aider. All adults attending an activity should have their Adult Emergency Information and Authorization for Treatment* (green card) cards easily reachable. In addition, it is also the responsibility of the first-aider for a troop/group activity or event, to give care to all in the group while on duty. This is the adult familiar with the medical histories in the group and will be the first to recognize a medical emergency. When attending a large event, they may advertise a First Aid Station on site, however in a perfect scenario a troop shouldn’t need to use the First Aid station other than for medical situations beyond basic first aid. Should a troop need assistance from a First Aid Station an adult should accompany that girl with her medical paperwork ready to answer questions asked by the station representative. Such courses do not offer enough opportunities to practice and receive feedback on your technique. Safety Activity Checkpoints always tell you when a first-aider needs to be present. For the safety of all involved during Girl Scout activities, the first-aider position must adhere to the following requirements: An individual needs to be mobile and move quickly to the scene of an injury, as well as handling potential emergency situations. If anyone feels they do not have the ability to perform the skills as a first-aider they should not serve as a first-aider. Activities can take place in a variety of locations, which is why first aid requirements are based on the remoteness of the activity—as noted in Safety Activity Checkpoints for that activity. It’s important that you or another volunteer with your group has the necessary medical experience (including knowledge of evacuation techniques) to ensure group safety. The levels of first aid required for any activity take into account both how much danger is involved and how remote the area is from emergency medical services. It is important to understand the differences between a first aid course, and a wilderness-rated course. If several first aid stations are required a Wilderness or higher first-aider should be present at at least one of the stations. The event director shall be in the possession of the physical document to give to first-aider. After helping a troop or in a station the first-aider is responsible for ensuring the privacy of all medical logs and transfer back to the event director with a debrief of any incidents. Make sure a general first aid kit is available at your group meeting place and accompanies girls on any activity (including transportation to and from the activity). The troop first-aider should have the first aid kit near them ready to respond (not in the car) during the activity or event. Please be aware that you may need to provide this kit if one is not available at your meeting place. You can purchase a first aid kit, buy a commercial kit, or you and the girls can assemble a kit yourselves. The Red Cross offers a list of potential items in its Anatomy of a First Aid Kit. Note that the Red Cross’ suggested list includes aspirin, which you will not be at liberty to give to girls without direct parent/caregiver permission. You can also customize a kit to cover your specific needs, including flares, treatments for frostbite or snake bites, and the like. In addition to standard materials, all kits should contain your council and emergency telephone numbers. Girl Scout Additional Activity Insurance forms, parent consent forms, and health histories may be included, as well. For swimming activities in public pools, hotel and cruise-ship pools, and backyard pools, ensure the lifeguards are at least 16 years old and have American Red Cross Lifeguard Training certification or the equivalent. For swimming activities in lakes, slow-moving streams, and rivers, ensure one adult lifeguard (certified in American Red Cross Lifeguard Training plus Waterfront Lifeguard course or the equivalent) is present for every 10 swimmers, plus one watcher. When girls are wading in water more than knee-deep, an adult with American Red Cross Basic Water Rescue certification or with documented experience is required. For swimming and wading activities, consult the “Swimming Lifeguards and Watchers Ratios” chart for standards. A watcher is a person trained in the use of basic water-rescue equipment and procedures who works under the direction of the lifeguard. Lifeguards and watchers are stationed at separate posts and stay out of the water, except in emergencies. Number of Swimmers Lifeguards Watchers 1–10 1 (see exception for pools above) 1* 11–25 1 (see exception for pools above) 2* 26–35 2 persons, at least 1 is an adult; others 3* may be 16 years of age or older. The ratio of lifeguards and watchers to swimmers may need to be increased depending on the number of girls in one area, swimming level and ability, girls with disabilities, age level and ability to follow instructions, type of swimming activity (instruction, recreation), type of swimming area, weather and water conditions, and rescue equipment available. If you are unsure whether your swimming lifeguards and watchers ratios are sufficient, be sure to contact our council. Participants’ swimming abilities are classified and clearly identified (for instance, with colored headbands to signify beginners, advanced swimmers, etc. In the absence of swimming-test certification, a swim test is conducted on the day of the activity. Guidelines for Hot Tubs: Ensure the presence of at least two adults no further than 10 feet from the water, when girls are in a hot tub; for Seniors/Ambassadors at least one adult must be present no further than 10 feet. Note: For backyard pools the homeowners’ liability insurance is primary in the event of an accident, and should therefore be notified before any other insurance company. At the scene of an accident, first provide all possible care for the sick or injured person. Your adherence to these procedures is critical, especially with regard to notifying parents or caregivers. If the media is involved, please say “I am not the council spokesperson” and for your protection do not discuss with the media. From pink card – in case of serious injury, accident, emergency or fatality involving Girl Scouts: 1. If a minor is injured, when available, have another adult contact the parent of the victim. State: “I am from Girl Scouts of Greater Los Angeles” and indicate your emergency. Additionally, an Accident/Incident Report should be completed either via eform. Follow these procedures when emergency response or immediate action by authorities is required: 1. If there has been an automobile accident, a death or a suspected crime, call the police. Do not move the person unless her/his life is in danger by being left at the scene of the accident. The staff emergency contact person will arrange for additional help and provide guidance for the next steps. Make a record of the following, indicating the time and what procedures were followed: a) How the accident or emergency happened. Your Girl Scout troop/group will plan and finance its own activities, with your guidance. At the same time, the girls learn many valuable skills that serve them throughout their lives. This is in addition to the $25 annual membership dues that go to the national organization. This chapter gives you the ins and outs of establishing a group account and helping girls manage their group’s finances, practice successful product-sales techniques, review the safety requirements around product programs, and understand how to collaborate with sponsors and causes. The troop treasurer is the volunteer responsible for the troop’s bank account which includes: coordinating deposits, expenditures, and financial reporting to the troop. This is a wonderful troop committee position for a detailed oriented parent or the troop leader with an interest and/or skill in finance. Girl Scout volunteers provide invaluable services to our most precious clients – the girls. However, the ultimate responsibility for budgeting and record keeping belongs to the adults. At the Cadette level and above, an adult mentors the girls as they keep the troop’s financial records and give reports to parents and troop volunteers. Since the money belongs to the troop, it is important that the management of funds is transparent for the girls, parents, and volunteers as well as for the Council. The troop treasurers will be trained and will receive ongoing support from their service unit treasurer. Any volunteer with an outstanding debt to Council may not be appointed to a troop treasurer position. Volunteers who serve in this role must complete the required background screening process and be a registered volunteer. Each service unit and Girl Scout troop or other pathway group (as approved by a Support Manager) is required, to set up a bank account. If you are taking over an existing troop, you may inherit a checking account, but all previous signers must be removed and new signers must be added. With a new troop, you will need to open a new account within 120 days of receiving your troop number. Please do not use your personal social security number when opening your Girl Scout account. All troop accounts are opened as Girl Scouts of Greater Los Angeles, a non-profit business account. This is a standard procedure for all banks and credit unions when opening a business account and is for their purposes only. Banks and credit unions will inform you of this requirement and will ask for your authorization to run a report. After selecting a bank, the troop leader should complete a Bank Letter Request e-form All signers must be unrelated adults not living in the same household, be currently registered adult members, hold a role in the troop, and be approved volunteers* ➢ Troops may open the bank account with a minimum of two signers but must add the third signer within 120 days of receiving their troop number. The troop leader is always responsible for the accounting regardless of designation. Volunteers who have debit cards issued in their name for any troop/group account are responsible for all purchases/charges made in use of the card in addition to: ➢ Any service fees, non-sufficient funds charges, closed account fee charges, etc. The Cheddar Up account may be used to collect dues and fees for events, equipment, and supplies. All troop payments must be made via Troop Debit card or Troop check with two signatures of approved signers as stated in above sections. Girl Scout troops may not open an independent PayPal account to collect dues or activity fees. Girl Scout troops may not utilize a Venmo account to collect dues or activity fees. Because money is held for the troop/group in trust, accurate records must be maintained. When the leadership of a troop/group changes, a Troop/Group Financial Report must be submitted electronically within 30 days of the change. All record keeping of the troop and group’s finances becomes part of the permanent record of the troop/group. When managing troop/group accounts the following must be adhered to: ➢ Savings accounts, or other interest-bearing accounts are not allowed. The troop/group leader is responsible, in partnership with the girls in the group (Juniors and older), to prepare a finance report and distribute it to each family in the troop/group a minimum of one time per year due the first Friday in June, June 5, 2020. Full disclosure of the troop finances annually ensures transparency and that all family members of the troop are informed of the troop’s income and expenses. A copy should be given to the service unit manager only if the troop was unable to submit the report electronically. As income and expenses are entered into the ledger, leaders will see an automatically generated financial summary. New Troops that have formed any time during January through May of the current membership year that have not yet opened a bank account do not need to submit a Year-End financial report.
