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By: Pierre Kory, MPA, MD
- Associate Professor of Medicine, Fellowship Program Director, Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai Beth Israel Medical Center Icahn School of Medicine at Mount Sinai, New York, New York
https://www.medicine.wisc.edu/people-search/people/staff/5057/Kory_Pierre
This package focuses specifcally on the provision of such services integrated within clinical and non-clinical contexts and follows a gender-transformative approach arrhythmia prognosis norvasc 5 mg on line. Existing gender inequalities pulse pressure wave velocity order 5mg norvasc otc, in large part due to arrhythmia long term effects effective 5mg norvasc rigid gender norms and harmful perceptions of what it means to be a man, have far-reaching consequences on health and well-being. Where men and adolescent boys are engaged in tackling gender inequality and promoting womens choices, the resulting outcomes are positive and men and women are able to enjoy equitable, healthy and happy relationships. These policies also highlight the need to create conditions for equitable relationships for individual health and the development of communities. Importantly, the implementation and use of this service package should not lead to a reduction in the quality and quantity of services provided to women and girls. A key consideration in this work, explored further below, is that womens sexual and reproductive health and rights and their access to services, continues to be at the forefront of our efforts. This service package recognizes that men and adolescent boys are not a single, homogenous group but have diverse experiences and identities. In this service package, specifc health and service delivery considerations are outlined in relation to adolescence, sexual orientation and gender identity. For ease of communication, while this service package includes men in all their diversity, throughout the document the overall term men and adolescent boys is used. Global Sexual and Reproductive Health Service Package for Men and Adolescent Boys Introduction, rationale and overview 5 Who is this service package written for Programme managers, policy makers and advocates working in this area will also fnd it useful. The contents are applicable to organizations across the globe, but will need to be adapted to local contexts (see section 6). Section Five looks at specifc health and service delivery considerations related to adolescence, sexual orientation and gender identity. Section Six provides key steps for operationalizing the framework, including assessing the current situation, building capacity and commitment, programme design, implementation, and monitoring and evaluation. The Annex provide a set of checklists, templates and further resources, linked to different sections within this publication. Men are husbands, partners, father, brothers and sons, and their lives are intertwined with women, children and other men. These norms lead to gender inequalities that dramatically impact lives and choices and act as barriers to optimal health for women and men, adolescents, girls and boys. As a result, not only do men get sick unnecessarily, but their sexual partners, their families, their communities, and the health systems that serve them are also harmed. It is imperative for everyones health and well-being to deconstruct harmful gender norms. Challenging and transforming harmful male gender norms and promoting gender equality 4. A working defnition of sexual health is: a state of physical, emotional, mental and social wellbeing in relation to sexuality; it is not merely the absence of disease, dysfunction or infrmity. Innovative service delivery methods are needed, for example, at workplaces, places of worship, sports gatherings and other community venues. The socially constructed expectations and norms regarding appropriate roles, responsibilities and behaviours among men and women, known as masculinities and femininities;18 and 2. The power relations between women and men, and structural contexts that reinforce and create these power relations. Socio-cultural norms that hold family planning and childcare as womens responsibility limit mens willingness to get involved and provide support. This can be seen in the promotion of gender equitable fatherhood; advocacy against discriminatory laws and policies; and changing attitudes and behaviours that are causes and consequences of sexual and gender-based violence. Since the policys launch, an understanding has developed within the Brazilian Ministry of Health that when men are healthier, women and children probably will be healthier and that mens presence at health services can also be a golden opportunity to strengthen gender equity.
As reviewed above blood pressure medication that doesn't cause cough buy norvasc 5mg on-line, several aphasia syndromes present with rapid hypertension and obesity norvasc 5 mg with visa, effortless speech that is not understandable arrhythmia with normal heart rate effective 10 mg norvasc. Semantic paraphasias include speaking (or writing) an incorrect word that is semantically related to the target word. Phonemic paraphasia involves speaking a word with an 12 Aphasia Syndromes 285 error in a letter sound. Circumlocution can involve thematic circumlo cution and provide a description of the term by general synonyms. Assess for Comprehension Comprehension is most easily assessed during the initial conversation. However, a careful step-by-step assessment will assure adequate evaluation of this domain. Assessment should include asking the patient to respond to increasingly complex instructions/requests. Comprehension can be assessed with single-step (point to the ceiling), two-step (point to the door and then the ceil ing), and three-step (point to the door and then the floor, but first point to the ceil ing) instructions. For example, a simple comprehension task can be asking a patient to state what got hit Finally, ask the patient to repeat grammatically dependent sentences (The cat was eaten by the mouse) and grammatically incorrect sentences (This pink circle heavier than red box). Assess for Naming Assess patients ability to name visual objects by pointing (what do you call this Scott Assess for Reading and Writing Have the patient write a sentence and have the patient read a sentence silently to his/herself and do what it says. One might have the patient read a sentence (s)he writes as well as a unique sentence (s) he has not had previous exposure to. Have the most familiarity and clinical experience, but should not be construed to indicate the tests in Table 12. Ethnic, Age, Diversity and Psychiatric Considerations the astute clinician will appreciate the need to be sensitive to, and appreciate the potential for, ethnic, age, and sociocultural impacts on the assessment of language. While a detailed analysis of these issues are beyond the scope of this text, we high light some ethical and practical considerations below. Cultural Considerations First, and foremost, it is essential that assessment of language occur in the patients primary language. If this is not possible due to some limiting factor, the clinician must weigh the relative merits of completing an evaluation that will underestimate language abilities and potentially result in an incorrect diagnosis or determination for the extent of language impairment. Clinical neuropsychologists are sensitive to cultural and eth nicity variables that may adversely affect the reliability and validity of assessment (see American Psychological Association 2002). It may be that the assessment of language functions occurs in the patients second or third language that was acquired later in life and/or not as frequently used. Considerable work has identified that supplementary language areas can develop and/or the fluency or comprehension of the patient in the second or third language may have been reduced at baseline, thereby potentially leading the assessor to believe more language impairment exists than is actually present. In addition to cultural/ethnicity variables of evaluating or treating an individual not having the same language as the assessor, one must also consider cultural factors with respect to the potential for differences in language dialects and customs for introducing the assessment and assessment procedures. Pediatric Considerations the assessment of language functions is particularly difficult in children to differenti ate the presence of an acquired language deficit versus a developmental language 12 Aphasia Syndromes 287 Table 12. Scott problem, such as dyslexia or as a component of another neurodevelopmental process such as Autism or Aspergers disorder. It is essential to obtain a detailed history for the presence of developmental language problems prior to the onset of known or suspected neurological injury. In the case of early childhood trauma before onset of language functions, intra-hemispheric and/or inter-hemispheric language re-organiza tion has been well documented. In particular, the assess ment of language in older adults can be complicated by comorbid medical disorders that can adversely affect a patients mental status, such as encephalopathies, sepsis, infections. Psychiatric Considerations Distinguish aphasia from psychosis, schizophrenia, other psychiatric illness, or delirium may not seem important or difficult, but in clinical settings can be more difficult than is often readily appreciated. Perhaps this is the reason why articles and chapters reviewing the symptoms and signs of aphasia often do not include a discussion on differentiating psychiatric disorders from aphasias. It may also be the reason for some unfortunate patients with aphasia being diagnosed (and treated for) psychiatric disorders. We believe this is an important skill to develop and to provide an overview for distinguishing aphasia syndromes from psychiatric disorders.
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Maccoby and Jacklins study (1987) of individual childrens choice of playmates in a preschool setting shows four and a half year olds playing in same-sex groups 47 percent of the time blood pressure medication joint pain norvasc 2.5mg, mixed groups 35 percent of the time and other-sex groups heart attack 51 buy 10mg norvasc with amex. While these figures show a good deal of mixing blood pressure hypertension discount norvasc 2.5 mg with amex, the same-sex groups are far greater than random playmate selection would produce. And at age six and a half, children in the Maccoby and Jacklin study were playing in same-sex groups 67 percent of the time. This presupposes different play styles to begin with, presenting a complicated chicken-and-egg problem. For if sex-segregated play groups fill a need for predictable play and interaction styles, they are also a potential site for the production and reproduction of this differentiation. It has been overwhelmingly established that small boys engage in more physically aggressive behavior than small girls. However, experimental and observational evidence puts this differentiation at precisely the same time that same-sex group preference emerges. This play style reaches its peak among boys at about the age of four and that it is restricted to same-sex groups, suggesting that there is a complex relation between the emergence of gendered play styles and of same-sex play groups. In their same-sex friendship groups, they develop different behavior, different norms, and even different understandings of the world. They argue, further, that this can result in cross-cultural miscommunication between males and females. Certainly, if girls and boys are segregated on a regular basis, we can expect that they will develop different practices and different understandings of the world. This miscommunication model draws on John Gumperzs work with ethnically distinct subcultures. It hypothesizes both that male and female understandings of interaction are in fact different, and, critically, that they are unaware of these differences, and believe that they are operating from the same understanding. It is the unawareness that may be the most problematic assumption for this approach to gender-based miscommunication (or conflict), since the gender beliefs that most kids are industriously acquiring in their peer groups and outside them emphasize difference, to the point sometimes of absurd exaggeration. Gender segregation in childhood almost certainly plays some role in the development of gendered verbal practice. Gender segregation in western societies is virtually always embedded in practices that bring the sexes together and that impose difference in interpretations even where there are great similarities in those actions or people being interpreted. As we move farther along in development, the complexity of explaining gender differences increases exponentially. As kids spend more time with their peers, and as they enter into more kinds of situations with peers, not only does the balance between adult and peer influence change, but the nature of peer influence also changes. Peer society becomes increasingly complex, and at some point quite early on, explicit ideas about gender enter into childrens choices, preferences, and opportunities. Whatever the initial factors that give rise to increasing gender separation, separation itself becomes an activity, and a primary social issue. Barrie Thorne (1993) notes that public choosing of teams in school activities constrains gender segregation, hence that games that involve choosing teams are more likely to be same gender, while games that simply involve lining up or being there are more likely to be gender-mixed. Separation can carry over to competitions and rivalries between boys groups and girls groups, as in elementary school activities such as girls chase the boys (Thorne 1993). These activities can be an important site for the construction of difference with claims that girls or boys are better at whatever activity is in question. In this way, beliefs about differences in males and females natural abilities may be learned so young and so indirectly that they appear to be common sense. It is not at all clear, therefore, to what extent differences in behaviors and activities result from boys and girls personal preference, or from social constraint.
Heterosexuality is the metaphor around which the peer social order organizes itself blood pressure juice generic norvasc 10mg online, and a heterosexual market (Thorne 1993; Eckert 1996) becomes the center of the emerging peer social order blood pressure chart for 60 year old discount 10 mg norvasc. While up until now arrhythmia jokes buy norvasc 5mg amex, boys and girls may have seen themselves as simply different, and perhaps as incompatible, in the context of the heterosexual market, boys and girls emerge as complementary and cooperating factions. The market metaphor is not frivolous, for the heterosexual market is the first of a series of social markets that the age cohort will engage in on the way to, for example, the academic market and the job market. It is here that both girls and boys will come to see themselves as having a place in a structured system of social evaluation. It is the rapidity of trades on the market that establishes a system of social value. The rapt attention that the market attracts from those participating in it and from nonparticipating observers is part of the establishment of gender norms, as peoples worth is recalibrated within the context of heterosexual attractiveness. The activities establish a system and hierarchy of desirability prior to the actual onset of overt heterosexual desire and activity. The new and enduring status system that forms around this market constitutes the core of the emerging adolescent social order. What was appropriate for boys and girls simply as male and female individuals now defines them with respect to a social order. Their value as human beings and their relations to others are based in their adherence to gender norms. And the differentiation of these norms intensifies as differentiation of male and female merges with engagement between male and female. Not everyone is active in the heterosexual market, and not everyone who participates in this market is heterosexual. This market is the means by which the social order comes to presume heterosexuality, marginalizing and rendering deviant any who do not eventually participate. There are some cultural contexts where heterosexual coupling is not so early or so central a part of development. In almost all cultures though, eventual marriage is a central social goal that marks adulthood even in cases where the young people themselves do not play a very active role in forging heterosexual links. Most cultures have some kinds of institutions that focus on heterosexual desire among the young and are linked to plans for eventual marriage. Gender difference and separation have been commonly emphasized by such things as mock elections that have male and female counterparts for most popular, most likely to succeed, and similar categories. The classic pairing of the cheerleader and the football player emphasizes the role of the female supporting the male, as the latter upholds the honor of the institution. And the institutions of prom and homecoming king and queen emphasize the importance of heterosexual alliances, elevating such alliances to institutional status. In recent years, prom and homecoming have come to be sites for the legitimation of same sex desire in the adolescent social order. The American Civil Liberties Union successfully sued a Mississippi school district that denied a lesbian student the 5 opportunity to bring her girlfriend to prom. And in 2011, a lesbian couple were elected homecoming king and queen at Patrick Henry High School in San Diego. The heterosexual market brings an important change in the nature of dichotomous thinking, as suddenly, opposites are supposed to attract.
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