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By E. Hector. East Texas Baptist University.

If medical and other interventions are seen as disrespect- ing the tradition of a particular community buy tadapox 80 mg erectile dysfunction treatment in delhi, the result may be that the old customs are even more strongly defended and the care needed is rejected as ‘foreign’ inXuence discount tadapox 80 mg on-line erectile dysfunction treatment penile implants. Since talking about sex is still taboo in many communities, the information on the virus is not passed on properly and the real causes of the disease are misunderstood or merely disregarded (McFadden, 1992: pp. While it is often understood that too early, too late and, in general, too frequent pregnancies can cause serious health problems to mothers, many of whom often are children themselves (under 18 years), old habits die hard. Medical professionals who have to work with these issues may face a dilemma about how to approach the matter and how to educate not only women but also their husbands and/or male partners. In Musoma Rural District in Tanzania, for instance, 25 per cent of the young girls admitted having been forced or raped in their Wrst sexual intercourse. Globally, between 20 to 30 per cent of all women report having been physically assaulted by an intimate partner at least once in their life, accord- ing to the Washington-based Health and Development Policy Project. In 1993 the World Development Report of the World Bank estimated that gender violence causes more deaths and disability among women aged 15 to 44 than cancer, malaria, heart disease, traYc accidents or even war. These women may want to have children and/or carry their pregnancies to term, regardless how short or painful their own or their children’s lives might be. Since in many cases they do not want others to know about their pregnancy, unsafe Multicultural issues in maternal–fetal medicine 49 abortions and self-abortions are typical. A study conducted at the Muhimbili Medical Center in Dar es Salaam, for instance, has shown that 50 per cent of women between 15 and 24 years of age have been hospitalized because of abortion related complications. A further challenge for maternal–fetal medicine is the vicious circle that follows when young girls with unplanned pregnancies drop out of school, and thus miss out on the information they would need in order to improve their own and their children’s health and to plan the size of their family. After all, those who have the least access to information, to health services, to the right to make critical decisions and choices, are the easiest victims of any serious disease. At the same time, however, we need to acknowledge that the advice given or the methods of care suggested can sometimes lead the patient and her family to reject essential medical help, turning instead to self-help or the less professional and sometimes straight- forwardly harmful advice and treatment of traditional healers. In Mara Region in Tanzania, for instance, a high number of women seek help from traditional healers rather than professionals with modern (often Western) medical training. The result has been that many of them die annually from complications, such as prolonged labour pains, excessive bleeding and burst- ing of the womb when giving birth, because of the use of untested traditional medicine during labour (Howard, 1995: pp. Sometimes this rejec- tion of modern medicine occurs because the patient and/or her family and community feel oVended by the physician’s interference in their value or belief systems. Sometimes the cause lies in the particular treatment (family planning, abortion, Caesarean delivery, prenatal testing or blood transfusion) which in itself oVends against particular cultural norms. Feminist bioethics and respect for difference From a universalist point of view in maternal–fetal medicine and reproduc- tive health care, the immensity of women’s health problems in many socie- ties, particularly in the developing world, is related to the social constraints on women’s lives. In order to improve women’s health we not only need more health care and medical resources, we also need to improve women’s social position and promote women’s rights within their communities. However, controversial as it may sound, attempts to respect an individual’s rights and autonomy within some traditional and mainly patriarchal cultures 50 S. Let us take an example of how liberal promotion of the same standards everywhere and insensitivity to social inXuence can reinforce existing struc- tural discrimination and injustice. However, in order for this proposal to succeed, the society has to have already adopted the liberal concept of justice and to be committed to enhancing women’s rights. While the idea in itself promises more equality to women, importing it and applying it directly to a male-dominated culture may create serious problems in practice.

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Whereas national standards for the provision of addiction private payers (including private insurers and treatment and instead considerable inconsistency self-payers) are responsible for 55 cheap 80 mg tadapox otc impotence jokes. The concentration of spending for addiction The Profound Disconnect between treatment in public programs suggests that Evidence and Practice insurance across the board does not adequately cover costs of intervention and treatment generic 80mg tadapox free shipping drugs for erectile dysfunction in nigeria, The prevention and reduction of risky substance resulting in costly health and social use and the treatment of addiction, in practice, consequences that stem from untreated addiction bear little resemblance to the significant body of and that fall disproportionately to government evidence-based practices that have been programs. National data indicate that developed and tested; indeed only a small individuals with private insurance are three to fraction of individuals receive interventions or six times less likely than those with public treatment consistent with scientific knowledge 83 insurance to receive specialty addiction about what works. Providing quality care to identify and reduce The Education, Training and risky substance use and diagnose, treat and Accountability Gap manage addiction requires a critical shift to science-based interventions and treatment by Compounding the profound gap between the health care professionals--both primary care need for addiction treatment and the receipt of providers and specialists. In spite of the evidence that operating outside the medical profession and addiction is a disease: lacking capacity to provide the full range of evidence-based practices including necessary  Most medical professionals who should be medical care; a health professional that should providing addiction treatment are not be responsible for providing addiction screening, sufficiently trained to diagnose or treat it; interventions, treatment and management but does not implement evidence-based addiction  Most of those who are providing addiction care practices; inadequate oversight and quality treatment are not medical professionals and assurance of treatment providers and are not equipped with the knowledge, skills intervention practices; limited advances in the or credentials necessary to provide the full * range of evidence-based services to address With the notable exception of the regulation of 81 medication-assisted therapy for addiction involving addiction effectively; and opioids. All these challenges to closing the evidence-practice physicians should be educated and trained in gap, but are simply insufficient. It also signals widespread system failure in health care service delivery, financing,  Require non-physician health professional education and quality assurance. Develop core clinical competencies in addressing risky use and It is time for health care practice to catch up preventing and treating addiction for each with the science. There is no silver bullet to type of non-physician health professional making this happen; instead, a broad set of including, physician assistants, nurses and comprehensive reforms must be put in place. Assure that these core clinical Reform Health Care Practice competencies and specialized training are required components of all professional  Incorporate screening and intervention health care program curricula, graduate for risky substance use, and diagnosis, fellowship training programs, professional treatment and disease management for licensing exams and continuing education addiction into routine medical practice. Require all non- As essential components of routine medical physician health professionals providing care, all physicians and other medical psychosocial addiction treatment services to professionals should provide their patients have graduate-level clinical training in with addiction-related screening and, as delivering these services. Require that all needed: brief interventions; comprehensive pharmaceutical treatments for addiction be assessment to determine disease stage, provided only by a physician or in severity and the presence of co-occurring accordance with a treatment plan managed health conditions; stabilization; acute by a physician. Screening instruments should be adjusted or developed -14- to coincide with appropriate definitions of Use the Leverage of Public Policy to Speed risky substance use, and assessment Reform in Health Care Practice instruments should be adjusted or developed to mirror diagnostic criteria for addiction. As a condition of approaches, including pharmaceutical accreditation, accrediting organizations therapies (provided or managed by a should stipulate requirements for all physician demonstrating the core facilities and programs providing addiction competencies of addiction medicine or treatment with regard to professional addiction psychiatry) and psychosocial staffing (e. Recognize addiction as a individuals who engage in risky substance primary medical disease and standardize the use or who may have addiction. These language related to the spectrum of include, but are not limited to law substance use severity in current and enforcement and other criminal justice forthcoming diagnostic instruments. Public payers and connected with a trained health professional private health insurance companies should for intervention, diagnosis, treatment and encourage participating providers and disease management. Pursue and gain to the same mandatory licensing processes recognition of addiction medicine by the as other health care facilities. As a condition of Through these actions, assure that addiction licensure, federal, state and local medicine training programs are available to governments should stipulate that all physicians, that training opportunities within facilities and programs providing addiction addiction psychiatry are expanded, and that treatment adhere to established national such specialty care is formally recognized minimum standards for accreditation. Require that all health insurers--  Implement a national public health public and private--provide coverage for all campaign. Implement a nationwide public insured individuals for patient education, health campaign through federal agencies screening and intervention for risky charged with protecting the public health to substance use and treatment and educate the public about all forms of risky management of addiction (involving all substance use and addiction. As a Invest in research designed to improve and condition of reimbursement, public payers track progress in addiction prevention, and private insurance companies should be treatment and disease management and to find a cure for addiction. Create a unified national institute focused on substance use and addiction, recognizing the overarching disease of addiction rather than continuing the focus on different manifestations of the disease--tobacco, alcohol, other drug use-- and including the risky use of all addictive substances. Include in the research portfolio addiction involving behaviors other than substance use, and focus on the causes, correlates, consequences, interventions, policies and possible cures for all manifestations of the disease. The portfolio of the institute also should include health conditions resulting from risky use and addiction and other conditions which increase the risk of developing addiction. In many but not all cases, it involves the use of nicotine, † alcohol and other drugs.

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Delusions of persecution involve the false belief that people are out to do one harm - they are often quite bizarre in content order 80 mg tadapox amex erectile dysfunction vacuum therapy. Analytically speaking buy tadapox 80mg erectile dysfunction for women, a delusion of persecution occurs when someone denies hostile feelings in themselves and attributes them to others; he is using denial and projection. Partition delusion Belief that a person, animal, object or radiation can pass through normally impenetrable barriers such as walls Patient, classically suffering from schizophrenia, is usually convinced that the source is the house of a neighbour 141 Described by Jacob Kasanin in 1933. Paraphrenia, a relatively redundant term,(Hart, 1990) refers to a state of late onset, paranoid delusions, hallucinations, well preserved personality, and often auditory, or less commonly, visual defects. It has been argued by others that paranoid psychosis is a variant of schizophrenia (e. Schneider, 1959), an affective illness (Specht, 1901), or a separate nosological entity, distinct from both schizophrenia and affective illness(e. The belief that some unrelated event or object has special meaning for the individual is called a delusion of reference, e. With ideas of reference (or ideas of self-reference) insight is retained but the feeling of being noticed cannot be ignored; the subject knows that he is the origin of the feelings that others are taking undue notice of him or discussing him; anxiety may spawn ideas of reference. Delusions of control (or passivity) are present if a patient believes that external forces (radio waves, telepathy, etc) can control his thoughts, words, movements or feelings. The phenomenon of hearing ones thoughts spoken aloud may be classified as follows: if heard at the time of thinking them the term used is Gedankenlautwerden, and if they are heard just after thinking them they care called écho de la pensé. However, the patient may also hear his thoughts spoken aloud just 148 before he thinks them. Disorders of the possession of thought include thought insertion, withdrawal and broadcasting. In thought insertion and withdrawal some foreign agency puts their thoughts into ones mind 149 or removes ones own thoughts. In thought broadcasting (thought diffusion) people can hear one think because ones thoughts are broadcast. This is different from the delusion of mind reading wherein the patient believes others can read their mind/thoughts, i. Telepathy refers to the deliberate beaming of thoughts from one person to another. If the temporal lobe is stimulated during surgery, patients may experience similar ‘made’ thoughts and feelings as are found in both the temporal lobe epileptic aura and in the psychoses. Delusions of Passivity: one is forced by outsiders to experience bodily sensations. Delusional perception is present when a delusional interpretation of a real perception is made; the perception is mundane and logically unconnected, e. The term delusional mood (or atmosphere; Wahnstimmung) refers to the state of perplexity (usually unpleasant emotional state akin to bewilderment), foreboding, dread or anxiety occurring early during a psychotic breakdown, consisting of a variety of paranoid delusions which are transient and changing; the patient tries to make sense out of what seem to be 150 unusual changes going on about him; he may recover or develop a stable delusional system. During the early formative or recovery stages of a delusion we can speak of a partial delusion, when the belief is held with less intensity. Delusional memory (retrospective delusion) refers to a delusional interpretation of an 151 apparently real memory or a false memory arising in the context of psychosis, e. Somatization can be a primary personality trait, or secondary and transient when under stress or depressed. Alexithymia, or alternatively somatothymic,(Yates ea, 1998) refers to a constricted ability to recognise and express feelings or emotional states. Alexithymia may be mimicked by certain cultural expression styles and may be a state- dependent phenomenon, e. A dominant individual within a tight social grouping usually starts epidemic hysteria. Treatment involves quick recognition, isolation of affected individuals, psychological explanation and reassurance, use of local traditional healing methods (Skuse, 2007), and the delivery of mental health education programmes to the community.

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