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It provides a set of templates for different sections of a typical summary record arthritis special diet discount medrol 4mg, for example rheumatoid arthritis gifts order 16mg medrol free shipping, vital signs, family history and care plan, to facilitate reusability and interoperability [Health Level Seven International, 2010a, 2013g]. A History and Physical Note is a two-part medical report that documents the current and past conditions of the patient. Provides framework for the content and structure of common objects used to construct or referenced by other data-object data held on patient healthcare data cards. Provides a common framework for the content and the structure of identification data held on healthcare data cards. Specification for the basic structure of the data held within the medication data object without specifying or mandating the particular data-sets for storage on devices. Defines the basic concepts which underlie the use of digital certificates in healthcare. It the interoperability requirements for establishing a digital certificate-enabled secure communication of health information. It also identifies the major stakeholders who are communicating health-related information, and the main security services required for health communication where digital certificates may be required [International Organisation for Standardisation, 2008c]. Specification for the certificate profiles that is essential for the exchange of healthcare information within a single organization, between different organizations and across jurisdictional boundaries. It provides typical usage of digital certificates in the healthcare domain, with special focus on the specific healthcare issues relating to certificate profiles [International Organisation for Standardisation, 2008d]. Guidelines for management of certificate issue that are related to the distribution of digital certificates in healthcare. It specifies a structure and minimum requirements for certificate policies, and provides a structure for associated certification practice statements [International Organisation for 41. It gives the common directory information and services required for secure exchange of healthcare information over public networks. The standard is forward looking in that it addresses the requirements for the communication of healthcare information within and across healthcare institutions, as well as beyond country boundaries. It also supports directory for identification of care givers, health institutions and patients/consumers of health services. Specification for the basic principles required for long-term, secure preservation of health records in any format. This standard is specifically focused on document management and related privacy protection issues that are related to document archiving. Specification to support requirements for sharing healthcare information among independent healthcare providers, institutions, health insurers companies, patients, staff members and trading partners. It supports collaboration between several authorization managers that may operate over organizational and policy borders [International Organisation for Standardisation, 2006f]. It introduces the Domain Model, the Document Model, the Policy Model, the Role Model, the Authorization Model, the Delegation Model, the Control Model and the Access Control Model [International Organisation for Standardisation, 2006g]. Guidelines on data protection requirements to support the transfer of personal health data across national borders. While the standard is primarily concerned with international exchange of personal health data, it is nevertheless still applicable to the protection of health information transmitted within the borders of a country [International Organisation for Standardisation, 2004d]. Specifications on the principles and requirements for privacy protection through the use of pseudonym services in order to protect personal health information. It defines the basis concept for pseudonymization; provides an overview of different use cases for pseudonymization (reversible and irreversible); defines a basic methodology for pseudonymization services; provides a guide to risk assessment for re-identification; specifies a policy framework and minimal requirements for trustworthy practices for the operations of a pseudonymization service; specifies policy framework and minimal requirements for controlled re-identification; and the interfaces for the interoperability of services interfaces. The scope of the standard is limited to healthcare information systems using only passwords for user authentication before accessing sensitive, person identifiable health information. Guidelines on mechanisms for authenticating users of healthcare information systems and authorise specific actions by users. The standard is applicable to both centralised and distributed environments; it defines the requirements that a single system shall meet and the types of information which shall be transmitted between systems to provide distributed authentication and authorisation services. It also addresses the technical specifications for how to perform user authentication and authorisation. It covers the requirements to keep as confidential personal, provider, and organisational data in the healthcare domain. It also addresses a wide range of data and data elements that are not traditionally defined as healthcare data, but which are essential in the provision of data management, data services, and administrative and clinical healthcare services.

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I come to school on a bicycle but I had to walk home pushing my bicycle because I was afraid I would hurt the bleeding area arthritis in feet and running cheap medrol 16mg with visa. When I got home my aunt was not there chronic arthritis definition cheap medrol 16 mg amex, only my uncle, so I had no choice but to tell him that I was bleeding. They have overcome additional barriers to discuss and promote solutions to the challenges facing women and girls relating to menstrual hygiene. This section introduces a few of the increasing numbers of male champions around the world working on this issue. As a member of the Teens Watch Club, he heard how girls in the group could not afford to buy sanitary towels and were therefore embarrassed to stay in school. He proposed a fundraising football tournament, attracting people from different villages. With the money, the group bought 1,000 sets of sanitary towels and over a month gave them to 500 girls in more than ten schools in slums across Nairobi. He said nothing and went to his bedroom and came out with a lot of cloth and told me that I should put them in my pants and wait for my aunt to come back. My aunt came back and told me that I had grown from a child to an adult and that I should now act responsible and be careful with boys and she taught me how to use the cloths and that I was going to bleed every month until I become too old. Consequently, community hygiene promoter Nurul Islam was uncomfortable discussing menstruation hygiene, although it was a part of his role to educate the women and girls in his village about the dangers of using dirty rags. With their advice, he came up with a plan, "After our meeting, I invited Amina Khatum from Char Bramgacha to come to my village to speak about menstrual hygiene. Because Amina is from a village that is very close to ours, some of the women knew her. Amina tries to involve men and boys in her menstrual hygiene sessions whenever possible. At school sessions in her own village, she includes the boys in some of the menstrual hygiene discussions. Om Prasad WaterAid in Nepal Om Prasad supports menstrual hygiene advocacy efforts in Nepal, engages in international debates, and trains community leaders. Syed Shah Nasir Executive Director, Integrated Regional Support Programme, Pakistan Syed Shah Nasir introduced the issue of menstrual hygiene in Pakistan after attending a workshop in Bangladesh. He supported his team to assess issues for schoolgirls, undertake training and introduce low-cost menstrual materials into schools. He also supported an assessment of menstrual hygiene needs during the 2010 flood emergency, and is planning to advocate menstrual hygiene in national and international forums in the future. Gender budgeting means showing awareness that some problems are more relevant or particular to boys/men and some to girls/women. This includes budgeting relating to improving the menstrual hygiene situation for women and girls. Budgeting for menstrual hygiene In any menstrual hygiene programme, both one-off and ongoing running costs need to be considered. Where gender disparities are stark this will be even more crucial if women and girls are to be able to engage with the programme design, implementation, review and feedback. If there is a need for female staff or respondents to travel, in some cases, additional budget may be needed to cover the cost of an accompanying male family member. Resourcing for sanitary products in the household, at school and in emergency contexts There have been a number of programmes where schoolgirls have been provided with sanitary pads free of charge to help them continue attending school during menstruation. In a fast-onset emergency situation the provision of menstrual materials needs to be undertaken free of charge (refer to Module 6. Even in emergency situations the provision of free disposable sanitary materials is likely to pose challenges if the emergency or refugee situation is ongoing.

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Low testosterone is also associated with medical conditions oligoarticular arthritis definition discount medrol 4mg with mastercard, such as diabetes arthritis flare up diet buy 4mg medrol, obesity, high blood pressure, and testicular cancer. Most men with low testosterone do not have related problems (Berkeley Wellness, 2011). Source 327 Despite these percentages indicating that middle adults are sexually active, age-related physical changes can affect sexual functioning. For women, decreased sexual desire and pain during vaginal intercourse because of menopausal changes have been identified (Schick et al. A woman may also notice less vaginal lubrication during arousal which can affect overall pleasure (Carroll, 2016). Men may require more direct stimulation for an erection and the erection may be delayed or less firm (Carroll, 2016). As previously discussed men may experience erectile dysfunction or experience a medical conditions (such as diabetes or heart disease) that impact sexual functioning. Couples can continue to enjoy physical intimacy and may engage in more foreplay, oral sex, and other forms of sexual expression rather than focusing as much on sexual intercourse. Risk of pregnancy continues until a woman has been without menstruation for at least 12 months, however, and couples should continue to use contraception. People continue to be at risk of contracting sexually transmitted infections, such as genital herpes, chlamydia, and genital warts. Practicing safe sex is important at any age, but unfortunately adults over the age of 40 have the lowest rates of condom use (Center for Sexual Health Promotion, 2010). Hopefully, when partners understand how aging affects sexual expression, they will be less likely to misinterpret these changes as a lack of sexual interest or displeasure in the partner and more able to continue to have satisfying and safe sexual relationships. Brain Functioning the brain at midlife has been shown to not only maintain many of the abilities of young adults, but also gain new ones. Some individuals in middle age actually have improved cognitive functioning (Phillips, 2011). The brain continues to demonstrate plasticity and rewires itself in middle age based on experiences. Research has demonstrated that older adults use more of their brains than younger adults. In fact, older adults who perform the best on tasks are more likely to demonstrate bilateralization than those who perform worst. Additionally, the amount of white matter in the brain, which is responsible for forming connections among neurons, increases into the 50s before it declines. Emotionally, the middle aged brain is calmer, less neurotic, more capable of managing emotions, and better able to negotiate social situations (Phillips, 2011). Older adults tend to focus more on positive information and less on negative information than those younger. Lastly, adults in middle adulthood make better financial decisions, which seems to peak at age 53, and show better economic understanding. Although greater cognitive variability occurs among middle adults when compared to those both younger and older, those in midlife with cognitive improvements tend to be more physically, cognitively, and socially active. One distinction in specific intelligences noted in adulthood, is between fluid intelligence, which refers to the capacity to learn new ways of solving problems and performing activities quickly and abstractly, and crystallized intelligence, which refers to the accumulated knowledge of the world we have acquired throughout our lives (Salthouse, 2004). These intelligences are distinct, and crystallized intelligence increases with age, while fluid intelligence tends to decrease with age (Horn, Donaldson, & Engstrom, 1981; Salthouse, 2004). Research demonstrates that older adults have more crystallized intelligence as reflected in semantic knowledge, vocabulary, and language. As a result, adults generally outperform younger people on measures of history, geography, and even on crossword puzzles, where this information is useful (Salthouse, 2004). It is this superior knowledge, combined with a slower and more complete processing style, along with a more sophisticated understanding of the workings Figure 8. The differential changes in crystallized versus fluid intelligence help explain why older adults do not necessarily show poorer performance on tasks that also require experience. A young chess player may think more quickly, for instance, but a more experienced chess player has more knowledge to draw on. Seattle Longitudinal Study: the Seattle Longitudinal Study has tracked the cognitive abilities of adults since 1956. Every seven years the current participants are evaluated, and new individuals are also added. Approximately 6000 people have participated thus far, and 26 people from the original group are still in the study today.

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Mesele Bezabih (Jimma University) for their intensive and meticulouse review of this lecture note arthritis in rabbits back legs generic 16 mg medrol free shipping. Biftu Geda from Haramaya University Faculty of Health Sciences for their invaluable comments in reviewing the lecture note arthritis in fingers symptoms cheap medrol 4mg on line. Alemayohu Bayray (Mekelle University), Wezam Tesfay (Defence College of Health Sciences) and Mr. Adaptation is a normal life cycle adjustment like in growth during puberty; changes during pregnancy or aging and stressful life style produce physiologic changes that may lead to adaptation or disease. The cell constantly makes adjustments to a changing, hostile environment to keep the organism functioning in normal steady state which is necessary to ensure the survival of the 1 Pathophysiology organism. Prevention of disease by the body depends on the capacity of the affected cells to undergo self-repair and regeneration i. When cells are confronted to one of the following stimulus, they may undergo adaptive changes. The common stimuli are:a) Physical agents o o d) Hypoxia Is the most common stimuli (cause) Is because of inadequate oxygen in the blood or decreased tissue Perfusion. Bacteria Virus Fungus Parasites b) Chemical agents c) Micro organisms f) Nutritional imbalances 2 Pathophysiology Under nutrition or over nutrition causes cellular injury or changes. As a result common changes include:- - Cellular swelling 3 Pathophysiology Lipid accumulation (Fatty change process in the cytoplasm of cells). Calcification (precipitation of calcium in dead or Chronic inflammation area) Hyaline infiltration(characteristic alteration within cells or in the Extra-cellular spaces that appear as inclusion on stained histology). Changes to cellular size or numbers Changes in size and numbers of the cells are usually as a result of response to adapt to harmful agents. Causes: - Decreased work load (Disuse atrophy) Loss of nerve supply Decreased blood supply Inadequate nutrition Loss of hormonal stimulation Eg. It is controlled reproduction of cells, but closely related to malignancy in that it may transform into uncontrolled, rapid reproduction. It is complete loss of normal architectural orientation of one cell with the next both in shape and size. Types of Hyperplasia 5 Pathophysiology a) Physiologic Hyperplasia: occurs when there hormonal stimulation - Occurs in puberty and pregnancy b) Compensatory-Hyperplasia - Occurs in organs that are capable of regenerating lost tissues. It is an adaptive substitution of one cell type more suitable to the hostile environment for another. The changes caused by this type of injury are potentially reversible if the injuring stimuli are removed. Causes of cell injury:Causes of cell injury are the same causes of cellular adaptive changes as mentioned above. Classification of cell injury:Cellular injury can be reversible or it may progress to irreversible change (Lethal change). Reversible cell injury:Is cell injury which can be reversed when the stimulus or the cause of injury is removed. Example -Ischemia: o o Ischemia refers to a critical lack of blood supply to a localized area. It is reversible in that tissues are restored to normal function when oxygen is again supplied to them, but if late progress to ischemic infraction 9 Pathophysiology o o It usually occurs in the presence of atherosclerosis in the major arteries. Irreversible Cell injury It is cellular injury that can not be corrected (reversed) after the stimulus or cause has been removed. Necrosis:- 10 Pathophysiology o the term necrosis refers to cell or tissue death characterized by structural evidence of this death. It is common in tuberculosis and is characterized by central area of necrosis which is soft, friable and surrounded by an area with a cheesy, crumbly appearance. Colliquative- Necrosis (liquefactiveNecrosis) 11 Pathophysiology It frequently occurs in brain tissues and results from break down of neurons by released lysosomal enzymes resulting in formation of pockets of liquid, debris and cyst like structures in the brain tissue.

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