Dr Matthew A Butkus
A good asthma management plan should be able to reduce the severity and frequency of asthma symptoms 7 medications that can cause incontinence generic 250mg chloromycetin with visa, as well as prevent unscheduled visits to the doctor or hospital medications knowledge chloromycetin 250 mg low cost. During an asthma } Appropriate medications for preventing and episode treatment jammed finger purchase chloromycetin 500 mg line, the peak fow is slowed because the airways are controlling asthma episodes constricted and partially blocked 97140 treatment code chloromycetin 250mg amex. The when to take medications and help you identify your peak fow meter can detect this drop so that you can asthma triggers and ways to avoid them. But not everyone who has self-care techniques, including when and how to use asthma needs to use a peak fow meter. Early detection of an asthma episode can also make it easier to identify your asthma triggers. A routine peak fow Steps for using the peak fow meter measurement taken on Saturday, however, may make it easier to identify the real trigger. Hold the peak fow meter, being careful not to block either the mouthpiece or the air exit. Your doctor can help you determine the (The device measures the maximum best testing times for you. Write down the number indicated by the in the green zone mean you are doing fne, while pointer. Repeat steps 1 through 7 two more times well controlled and you should take medications as (unless the test has provoked a coughing prescribed in your asthma action plan. Record the highest of the three numbers and you should call your health care provider or seek achieved. Height and age are factors, and the best possible peak fow readings vary somewhat between men and women and among diferent ethnic groups. Green (all clear) represents 80-100 percent of your personal best reading; yellow (caution) indicates 50-80 percent of your personal best; and red (danger) shows below 50 percent of your personal best. Once these zones are established, your doctor can recommend an asthma action plan specially tailored to your needs. However, until your or asthma diary, that shows peak fow meter readings, child is old enough to accurately keep an asthma diary medications taken, asthma symptoms and and follow an asthma action plan unassisted, you will possible triggers. Your doctor may also use the information recorded in Increased amounts of mucus production in the airways your asthma diary along with peak fow readings taken may produce coughing and wheezing in a sleeping in the ofce to determine whether your medications are child. When asthma is properly The information you record in your asthma diary is managed, however, there should be no nighttime important for developing an asthma action plan that asthma symptoms. Also be sure your child has a separate supply of medications that is kept in a readily accessible place at A sample asthma diary is shown on page 40. The most common is mild Most people with asthma need to be seen by intermittent asthma. Ten it keeps control Some over-the-counter drugs can cause bad with the minimum efective dose. Check with your doctor or pharmacist before taking Learning about your medications will help you to use other drugs. Work with your health care provider to tailor The best way to control an asthma episode is to prevent a program to your needs. Many types of medications are used for long-term How asthma medications work control. They do help mild intermittent asthma can manage well with a control asthma with regular use. They increase breathing montelukast (Singulair) are oral drugs that block test results. They can be used alone or with inhaled It can take fve to seven days before they begin to work. Long-acting beta agonists Long-acting beta agonists Long-acting beta agonists can be inhaled or oral. Inhaled salmeterol and formoterol fumarate (Foradil) can help you breathe better for about 12 hours. It is taken Taking more than the prescribed dose can lead to through an inhaler or nebulizer. Anti-IgE therapy Cromolyn sodium also helps control asthma set of Anti-IgE therapy [with omalixumab (Xolair)] has by exercise or cold air. For these cases, it is taken just been approved by the Food and Drug Administration. It has been Nedocromil (Tilade) is a non-steroidal drug like shown to reduce asthma fares and the need for other cromolyn sodium. Quick-relief medications Epinephrine is often used in emergency rooms for Theophylline asthma attacks. Tese may include headache, nausea, vomiting, stomach cramps, diarrhea, insomnia, fast heartbeat and restlessness. They also work by relaxing short-acting beta agonists the muscles to let the airways open up and make it easier to breathe. Albuterol (Proventil Ventolin, ) Inhaled short-acting beta agonists are the most Levalbuterol (Xopenex) common family of bronchodilators. They are used to give fast relief Pirbuterol acetate (Maxair) during an asthma episode. When used with an inhaler, the beta agonist goes right into the airways to ease the spasm. They block signals in the nervous system that tell the body to should not be used for relief from an episode. It begins to work within tablet and nebulizer forms can be used with young 30 minutes after it is taken. DuoNeb nebulizing solution are combined beta agonist and anticholinergic products. Infammation and mucus in the sinuses, nasal passages They are mainly used for those with severe asthma. They are also used to give fast relief from severe So drugs to relieve these symptoms can also help your episodes. Mild cases can be They manage asthma very well for short periods when treated with antihistamines and decongestants. Diseases
Relatively few cases are caused in this way medications to treat bipolar chloromycetin 500 mg generic, dracunculiasis is generally limited to the rainy season from because there must be an index case in the household to May to August with a peak in June and July (73) medications band chloromycetin 250mg sale. Steib and contaminate the reservoir medicine 0552 purchase chloromycetin 250mg without prescription, but when they do occur medicine keppra order chloromycetin 500 mg with mastercard, transmis Mayer (147) attributed this pattern to the presence of T. More fundamentally, many water sources involved dry up and Villages of Endemicity hand pumps are repaired in the dry season, so that the popu the fact that dracunculiasis transmission depends on the lation turns to safer groundwater sources (48). It has also been suggested (41) that transmis sion does not occur when there is less than one susceptible cyclopoid per liter in the pond and that this accounts for seasonal variations in incidence. The duration and intensity of transmission in particular villages often de pend on whether and when the local dams or ponds dried up the previous year (152), and some villages have very different seasonal peaks from those of the surrounding area because of local circumstances. For example, in some villages along the banks of the Niger and Volta rivers the incidence peaks when the river level falls and water is taken from holes dug in the riverbed. Age prevalence curves for 4 high-endemicity and 23 lower sonal patterns, which can be explained in terms of seasonal endemicity villages in South Kordofan, Sudan. The curves were plotted variations in water source use, the incidence of the disease has from data in reference 31. The disease ioral risk factors (such as work in the elds or collection of often occurs or continues towards the end of the dry season water) are taken into account, the difference between the sexes (January to May) in Ghana (13, 25, 112, 138), southern Benin is not signi cant (153). This dry season transmission is often associated the graph for four high-prevalence villages, each with an in fected water source, shows similar prevalences in children and in adults. Characteristics of past and present eradication candidatesa lower prevalence in all ages but signi cantly less in children than in adults. The former is characteristic of communities Presence of characteristic for disease:b where the water carried home is infected, while the latter is Characteristic Small Dracun indicative of an association with mobility, where infection is Malaria Polio pox culiasis acquired from water sources outside the community. Agent Other individual risk factors are important, particularly No animal reservoir those associated with mobility (160); however, the strongest of No mobile vector all is infection in the previous year. The cyclops is Intervention not a mobile vector like a mosquito, and the carrier state in Existence of effective drugs both the cyclops and human hosts is of limited duration. Di Cheapness and completeness agnosis is easy and unambiguous; cheap and effective measures of prevention are available to prevent transmission. The disease has a limited No behavioral change needed for prevention geographical distribution, and even within this area it is found a only in certain communities of endemicity. The poor performances of Sudan, due to the civil war, and of Ghana and Nigeria in the late 1990s can be seen. This advocacy effort needed to be replicated in each country Choosing a target is easy, however, compared with the task to get a national program established (64). By 1990, for that achievement goes to members and former members of four other countries had followed: Pakistan, Ghana, Nigeria, the staff of the Centers for Disease Control and Prevention, and Cameroon. High-level advocacy was also supported by the continuing in volvement of Jimmy Carter and two African former heads of state whom he persuaded to play a similar role, A. Other major support ers, such as the Bill and Melinda Gates Foundation and the British and Japanese bilateral aid programs, have usually chan neled their funding through these agencies. The major players liaise periodically to identify major gaps in the funding of national programs, and in most countries of endemicity, one or another of them has, by consensus, taken the leading role. The outcome of all this effort has been a remarkable 98% reduction in the number of cases, from an estimated 3. As a result, mis takes are made along the way, and there is a need to learn from experience (108). On one hand, this was to kindle and sustain the agement of cases, (iv) ensuring that patients avoid contact with interest of donor agencies which supported water supply pro ponds, and (v) killing or removing cyclops in ponds. These are grams, technical assistance, vehicles, lter cloth, temephos, considered in turn. On the other, it aimed to keep up the commitment of governments of Safe Water Supply countries of endemicity and the enthusiasm of program staff, an essential function since the bulk of the staff engaged in the In the early discussion of strategies for eradication of dra initiative were health workers whose salaries were supported cunculiasis, provision of a safe water supply was generally seen from the budgets of national ministries of health. The eradication goal was dinators, together with program review meetings at which each originally proposed as a target for the International Water national coordinator would give a presentation on her or his Decade (79, 80). Early eradication efforts in Nigeria (61, 62, program and then answer a barrage of penetrating questions 91) and Benin (139) invested the major part of their budgets in from her or his skeptical colleagues from neighboring coun water supply construction. Table 5 ease in villages of endemicity with fewer than 150 inhabitants provides a summary; all the impacts reported there were as was four times that in the largest villages (154), but they were sessed after at least a year and in one case (62) after 3 years. In the countries However, there are also some important limitations to the of endemicity of the Sahel, a hand pump may be the only effectiveness of water supply as a preventive intervention. Many water systems in Africa have fallen into are often infected from the many ephemeral ponds which are disuse for this reason within a few years of construction, and in within a few hundred yards of their houses. In southern San some cases the resulting reversion to unprotected water matenga Province, one of the major foci of guinea worm dis sources has allowed the disease to persist (15, 147) or, in ease in Burkina Faso, there is a working hand pump for every periurban settings, to develop in epidemic form (21, 57). The 600 people, but for more than 1 household in 10 that pump is experience of the Ivory Coast is a salutary reminder of this. In the 1970s, the Ivory Coast was in the vanguard of African Fourth, much of the population in the rural Sahel migrates. Between 1973 and In addition to the movement of the nomadic pastoral popula 1985, a total of 12, 500 new boreholes were installed in rural tion, it is common practice in countries such as Burkina Faso areas, at a cost of many millions of dollars. As a result, the and Niger for a village to disperse during the growing season annual number of cases of guinea worm disease fell from (which is also the peak dracunculiasis transmission season) to 67, 123 in 1966 to only 1, 889 in 1985 (165). In 1991, however the a number of small and seasonally occupied hamlets, some of national case search found an estimated 12, 690 cases (134). Since then, hand pump main acquired through casual use of unprotected sources when peo tenance has much improved, and the incidence of dracuncu ple are away from home, especially when they are working in liasis has fallen sharply, with only 467 cases reported during the elds. Studies of the impact of water supply on dracunculiasisa Country and reference % Reduction in annual incidenceb Comment Ghana (112) 37% reduction for boreholes, deep wells, and dams, Less risky sources were generally not used exclusively; often compared to ponds, rivers, and shallow wells. India (133) 78% reduction for village with decreased use of Prevalence in 4 villages increased with proportion of the unprotected step wells. India (15) 84% of affected families used pond water, 65% Majority of families using wells and tube wells switched to used well water, and 38% used tube wells. Nigeria (62) 81% reduction in 20 villages provided with Less reduction in villages where boreholes were not boreholes and pumps, along with health convenient or had unpalatable water; no change in education. Nigeria (156) 72% reduction 18 mo after provision of water Not clear how postprevalence was determined; prevalence supply. Uganda (77) 90% reduction for borehole use in rainy season; Boreholes, on average, were closer than other sources; 60% reduction in dry season. Sudan (31) 63% reduction for well or borehole use compared Many hand pump users sometimes used other sources to surface sources because of breakdown, queuing, and inadequate yield. More recently, a comparable with the recurrent costs of delivering other inter somewhat cheaper polyester fabric has been found to be ventions, the capital cost is an order of magnitude greater. These lters have this does not mean that water supply has no role to play; in proved so popular that many households have bought them some cases, particularly in the few urban foci of dracunculiasis, and ltered their water with them whether or not they have it has been decisive. However, its impact must be assessed heard that it can prevent guinea worm disease. It can be seen as transforming a high-prevalence Several hundred thousand square meters of this cloth were community where all water is contaminated (like the four vil donated during the 1990s; at the sale price of the fabric, this lages in Fig. A study in those who use unprotected sources are at risk (like the 23 Pakistan (93) found the lters in satisfactory condition after 12 villages in Fig. Unfortunately, it gradually became clear that in Africa the cloth could not be expected to last for more than a year, particularly when people washed it regularly, with Filtration of Drinking Water the vigor that they customarily used on other items of domestic Since an adult cyclopoid is over 1 mm long, it can easily be laundry. The Since the ending of the fabric donation program in 1998, the ltration may be easy, but that does not mean people will do it. The cost of the cloth has encouraged national and speaking hundreds of different languages, to change their programs to nd more economical ways of using it, such as behavior in this way is by any standard a major challenge to stitching a patch of it into a hole in a larger piece of ordinary health education planning. First introduced with success by the Mau ment of health educators has been largely con ned to the ritanian program, it has also been used in Niger and in south production of visual aids and a walk-on part in the training ern Sudan. Buy 500 mg chloromycetin fast delivery. No Excuse / Useless Id.
The Previews button opens a tool in the browser window that shows what the app will look like on several common mobile devices symptoms for bronchitis purchase chloromycetin 500mg without a prescription. Supporting Data Layers Pre-existing data layers required for this research design include international and first level administrative unit administrative boundary datasets (polygons) medicine x ed order generic chloromycetin line, and primary schools (points) medicine kit generic chloromycetin 500mg on-line. Water access points are mapped at a very fine scale medications medicare covers effective chloromycetin 250mg, but are not available for the entire study extent. Point datasets of towns, cities, and urban centers 134 are accompanied by medical facilities/health centers. Malaria endemicity zones, a 2009 livestock census, and a 1999 Poverty Map complete the supporting datasets. Because rural areas are often not incorporated due to low population density, schools can be considered an analog for the centroid of communities when no other administrative boundaries exist. It is the theoretical likelihood of finding this data, combined with the larger issue of data conflation between differing administrative boundaries, that makes a school dataset ideal for this project. The dataset is entitled Kenya Primary Schools and includes 26, 197 primary schools. Reduction of the number of fields was considered if the dataset proved to be too cumbersome to run in an online environment, but the author decided to keep all datasets as unmodified as possible for ease of update in the future and to not remove attributes that users might find relevant during statistical analysis. This produced a point event layer, which was exported as a feature class to the Tungiasis file geodatabase. As an example, one tungiasis research study surveyed residents of one typical endemic area in Brazil for the presence of embedded sand fleas to better illustrate transmission dynamics of T. The study found a statistically significant peak in parasite burden during the dry season, a conclusion important for 136 developing control measures (Heukelbach et al. It shows the towns and urban centers in Kenya derived from the Kenya topographic sheets of scale 1:250, 000 for northern Kenya and 1:50, 000 for the rest of Kenya. The towns have been classified into six categories: Municipality, Township/Town, Trading centre, Market centre, Lodges/camps, and (one) City (Nairobi). To improve draw time and create more specific selection sets, the overall dataset was divided into two for cartographic display. Spatial analysis can still be performed using this dataset without clogging the mapped area with town names in duplicate or triplicate. The point dataset plots the relative location of health service providers for Kenya and categorizes each location by type and supporting agency. One potential use of this dataset is to construct buffers around each point, revealing areas that may lack basic medical services and thus might require greater attention for tungiasis treatment and prevention measures. This layer utilizes population data from 1989, 1997, and 1999 along with malaria infection rates to determine endemicity of districts within the country. Attributes of the Poverty Map included data about location (rural or urban), population per the 1999 population and housing census, an individual headcount of people living in poverty, poverty density, poverty rate (the proportion of people living below the poverty line), and the percentage gap to bridge for the poor to exceed the poverty line. One, this dataset provides an excellent example of the fluctuating boundary problem discussed in Chapter 7. Because the tabular dataset only contains data for districts as drawn when the data was collected (pre-2009), maps created by joining this table to a boundary spatial dataset cannot be accurately displayed. The northeastern portion of the country is desert and camels vastly outnumber other livestock. Bright green dots represent commercial chicken farms and are concentrated mostly around the capital city, Nairobi. Donkeys, beehives, and goats are represented by dark green, yellow, and orange dots, respectively. The dataset was produced in 2009, but no boundary dataset could be located for this time frame, so the boundary feature class used to perform a join to the census data was from 2013, after many districts had been consolidated. Figure 28 also helps to illustrate the problem of comparing some types of data visually; a dot density map has been used here but there are areas of no data on the map, which indicates that care should be taken when drawing conclusions formed based on the census data. As previously stated, one of the biggest risk factors to persistent tungiasis is sharing living quarters with livestock. Of great interest is the data about swine, as the 141 possession of pigs has been found to be the single greatest risk factor to tungiasis in Uganda (Ugbomoiko et al. Ultimately, it was understanding the potential real-world impact of the project that informed the decision to create the Tungiasis eLibrary. The two apps together are meant to attack the problem of tungiasis from both political and practical ends, and in doing so ultimately fulfill the thesis project goals. And with the rapidly-improving Collector App now available on both iOs and Android mobile devices, this dream could easily become a reality. Several fields and domains were considered, built, re-considered, and re-built using ArcMap. As mentioned in earlier sections, the patient demographic data is intended to assist researchers in pinning down which societal risk factors are the best indicators of perpetual tungiasis. Table 11 Form Fields in Individual Demographics Table Gender Has s/he had jiggers before Home Visit the Home Visit table is similar to the Individual Demographics table in terms of the data it contains but the data is being recorded about a homesite or sleeping shelter instead of a person. Pesticides are applied inside and outside shelters where tungiasis is persistent, so fields recording pesticide application and persistence were added to the database. Reminders based on the amount of time elapsed since application could alert aid workers to return to the area or be used for scheduling and routing purposes. Coded domain drop-downs for the questions asked were covered in detail in Chapter 3. Fields for a contact name, address, telephone, email, and website can be filled out to desired levels of completeness. The author populated this dataset with contact information available on websites found during research for this project, including Rise Up Society and Ahadi Kenya Trust, but drew in fictional service area boundaries. The website and app both state that these boundaries are fictional and used only to illustrate the feature class. Figure 29 illustrates a feature from the Service Area feature class volunteered by Dr. The following sections discuss supporting data and data derived from volunteering an article to the eLibrary. Since this project intends to classify literature by country, an authoritative international boundary dataset was needed. The dataset not only includes boundary data; it also includes country names in multiple languages and alphabets. This will be handy for future work of expanding beyond English as the sole application language. Additional fields, if not null, indicate membership in a particular classification, trade agreement, international body, or geography type. Sallaki Guggul (Indian Frankincense). Chloromycetin.
Source: http://www.rxlist.com/script/main/art.asp?articlekey=96109 |
