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It explains how to use the process and methods used in participatory action research medicine hat lodge generic 40mg atomoxetine overnight delivery, including recent innovations and developments in the field treatment kidney infection buy atomoxetine 25 mg lowest price. The reader also learns how the findings can be communicated medicine man aurora atomoxetine 40mg low cost, reported medications not to be crushed generic 18 mg atomoxetine otc, and applied to improve health systems. Although the resource is not specifically focused on gender analysis, it provides a good introduction to tools that are useful for conducting a gender analysis, as long as they are used to both engage men and women equitably in the research and to gather comparative information. It is also intended for community level and program implementing organizations, and policymakers. Part I provides an overview of the key concepts underlying participatory action research. In particular, it will allow users to measure the quality, efficiency, and accountability of their services. Communities using this tool are engaged through focus groups that are highly interactive. It uses participatory methods to help health workers themselves identify causes for the way they relate to clients and ways to improve their interaction and support for clients, both through improving their own job satisfaction and the quality of services. Researchers may also use the manual to gather information about how health workers and clients relate. Part 1 gives an overview to allow one to decide whether it is appropriate to meet the needs of the user. It provides the tools, resources, and information needed to conduct each step of the gender audit. The tool provides the necessary instructions and data collection instruments to conduct a gender audit. The questions on the questionnaire and for the focus group discussions can be adapted for other types of gender analyses. It includes a series of score cards that organizations can use to assess if their organization falls into a non-gender-sensitive program, a somewhat gender-sensitive program, or an ideal gender-sensitive program. Through this tool, facilitators can provide greater clarity on how to incorporate a gender perspective into policies and maternal health program. The topics include Section 1: Overview of Maternal Health, Globally and in India (p. On page two, a schedule for the sessions outlines the learning objectives for each session, methodology outlining the learning objectives for each session, methodology, and the amount of time required. This tool can be used for training mid-level managers on ways to integrate gender into their programming. This manual can be used to identify the extent to which gender is integrated into the system and then develop a plan of action to better integrate gender into identified areas. The annexes of this manual includes six tools: 1) a client exit interview guide; 2) a service provider interview guide; 3) a service provider document review guide; and guides for 4) observation of physical aspects of the clinic; 5) client reception; and 6) consultation and counseling. Annex 8 includes a list of indicators that can be used to assess the quality of care in a reproductive health institution from a gender perspective. This tool can be used to evaluate the quality of care of a reproductive health institution from a gender perspective and identify resources and a plan of action to better integrate gender in the institution. The body of the report presents findings of a gender audit conducted at the Society for Family Health in Zambia. Appendix A includes the data collection instruments, including a questionnaire for a survey and guides for focus group discussions. It also includes instructions for the facilitators and note takers on how to conduct the focus groups, informed consent forms for the focus group discussion participants, and surveys. These tools, along with the InterAction Gender Audit Manual, can be used by anyone who is interested in conducting a gender audit of their organization. The body of the report provides an example of a completed audit and how to present the findings, analysis, and recommendations. The guide includes four different guides focused on the formal certification process. The self-training guide can be used by staff to build their capacity to understand definitions and concepts and comply with them (p. Lastly, the costing guide outlines a methodology for analyzing the costs of integrating a gender perspective into system standards (p. The appendices include useful tools assessment tools such as a survey guide, an interview guide, and costing guides.

Color flow Doppler utilizes the same concepts and technology as pulse wave Doppler and is medications ok for dogs order atomoxetine without prescription, therefore treatment xanthoma purchase genuine atomoxetine online, subject to the same limitations treatment algorithm generic atomoxetine 40 mg without prescription. The colors that we see in color flow Doppler are simply color encoded pixels that represent the velocity of blood flow at that particular spatial location medicine misuse definition purchase atomoxetine 25 mg visa. Colors that are pure red or blue in color flow Doppler represent velocities that are below the aliasing velocity of the Doppler signal (Fig. Colors that appear to be yellow-green or mosaic, depending on the color map utilized, suggest high velocity (higher than the aliasing velocity) or turbulent flow (Fig. The aliasing velocity, in centimeters per second, is usually listed on the scale present on the ultrasound image. Although we often estimate the volume of regurgitant lesions, including mitral and aortic regurgitation, from the color flow Doppler signal, we cannot do this directly because color flow Doppler provides limited assessment of the volumetric degree of regurgitation. Chapter 1 / Doppler Echocardiography Improvements in transducer design and imaging modalities have led to improved image quality. The addition of Doppler ultrasound to 2D echocardiography provides reliable noninvasive determination of velocity shifts and pressure gradients within and across cardiac chambers. Echocardiographic data is influenced by limitations intrinsic to ultrasound and Doppler technology, patient characteristics, and operator skill. She has no significant medical problems and is in the third trimester of an uncomplicated pregnancy. The systolic murmur was noticed on a routine obstetrical examination; the patient has no complaints of dyspnea, chest discomfort, or palpitations. She has no history of rheumatic fever and has never been told of a heart murmur in the past. This chapter is an introduction to the echocardiographic examination, and a detailed description follows in Chapter 3. As discussed in Chapter 1, ultrasound waves generated from the ultrasound transducer travel to the heart and are then reflected back to the transducer. Returning ultrasound waves are analyzed for depth location (based on the time elapsed between signal emission and return), and density (denser structures will reflect a greater proportion of the ultrasound beam than less refractile objects). Most M-mode images are recorded in the parasternal long-axis view previously described (still frame of M-mode in parasternal long-axis). The ultrasound beam is maneuvered to slice through the structure of interest, producing a high-resolution image of this slice over time. The high resolution of M-mode images, and the ability to correlate them with a simultaneously recorded electrocardiogram, makes M-mode the image of choice for many measurements. From this view, measurements of left ventricular wall thickness, and end-diastolic and endsystolic diameter can be made. Note the typical M configuration of the mitral valve during early diastolic filling (E), and atrial filling (A). See Chapter 1 for an explanation of the differences between pulsed- and continuous-wave Doppler. Nonturbulent flow that is below the Nyquist limit (see Chapter 1) and directed toward the transducer appears in red and nonturbulent 22 Lee and Solomon Fig. The waveform demonstrates the velocity of blood (y-axis), with time on the x-axis. Example of color flow Doppler demonstrating tricuspid regurgitation (a normal finding in this patient). Color flow Doppler is a form of pulsed-wave Doppler in which blood velocities are color encoded and superimposed on top of the two-dimensional image. The scale on the upper right hand side of the image shows the velocity associated with each color gradation as described in the text. Turbulent flow, and flow in which the velocities are faster than the Nyquist limit, is seen as a multi-color mosaic signal. Multiple different viewing angles are needed to fully visualize all the cardiac 23 Fig. Illustration showing transducer placement for each of the major echocardiographic views: (A) parasternal location for parasternal long and short-axis; (B) apical location for apical four-, two-chamber and long-axis views; (C) subcostal location for subcostal views; (D) suprasternal location for suprasternal notch view. Lee and Solomon Doppler Color flow Doppler looking for mitral regurgitation and aortic insufficiency.

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Active discouragement of harmful practices treatment improvement protocol atomoxetine 18 mg overnight delivery, such as female genital mutilation symptoms 0f ms buy generic atomoxetine from india, should also be an integral component of primary health care medications not to be taken with grapefruit purchase 25 mg atomoxetine visa, including reproductive health-care programmes medications 2355 safe 18 mg atomoxetine. Governments and other organizations should take positive steps to include women at all levels of the health-care system. Such programmes must both educate and enable men to share more equally in family planning and in domestic and child-rearing responsibilities and to accept the major responsibility for the prevention of sexually transmitted diseases. Programmes must reach men in their workplaces, at home and where they gather for recreation. Boys and adolescents, with the support and guidance of their parents, and in line with the Convention on the Rights of the Child, should also be reached through schools, youth organizations and wherever they congregate. Most such schemes have had only marginal impact on fertility and in some cases have been counterproductive. Family-planning programmes have contributed considerably to the decline in average fertility rates for developing countries, from about six to seven children per woman in the 1960s to about three to four children at present. However, the full range of modern family-planning methods still remains unavailable to at least 350 million couples world wide, many of whom say they want to space or prevent another pregnancy. Survey data suggest that approximately 120 million additional women world wide would be currently using a modern family-planning method if more accurate information and affordable services were easily available, and if partners, extended families and the community were more supportive. These numbers do not include the substantial and growing numbers of sexually active unmarried individuals wanting and in need of information and services. During the decade of the 1990s, the number of couples of reproductive age will grow by about 18 million per annum. To meet their needs and close the existing large gaps in services, family planning and contraceptive supplies will need to expand very rapidly over the next several years. The quality of family-planning programmes is often directly related to the level and continuity of contraceptive use and to the growth in demand for services. Family-planning programmes work best when they are part of or linked to broader reproductive health programmes that address closely related health needs and when women are fully involved in the design, provision, management and evaluation of services. All countries should take steps to meet the family-planning needs of their populations as soon as possible and should, in all cases by the year 2015, seek to provide universal access to a full range of safe and reliable family-planning methods and to related reproductive health services which are not against the law. The aim should be to assist couples and individuals to achieve their reproductive goals and give them the full opportunity to exercise the right to have children by choice. To this end, Governments should secure conformity to human rights and to ethical and professional standards in the delivery of family planning and related reproductive health services aimed at ensuring responsible, voluntary and informed consent and also regarding service provision. In-vitro fertilization techniques should be provided in accordance with appropriate ethical guidelines and medical standards. Some of those barriers are related to the inadequacy, poor quality and cost of existing family-planning services. It should be the goal of public, private and non-governmental family-planning organizations to remove all programme-related barriers to family-planning use by the year 2005 through the redesign or expansion of information and services and other ways to increase the ability of couples and individuals to make free and informed decisions about the number, spacing and timing of births and protect themselves from sexually transmitted diseases. Governments at all levels are urged to provide a climate that is favourable to good-quality public and private family-planning and reproductive health information and services through all possible channels. Finally, leaders and legislators at all levels must translate their public support for reproductive health, including family planning, into adequate allocations of budgetary, human and administrative resources to help meet the needs of all those who cannot pay the full cost of services. Privacy and confidentiality should be ensured; (d) Expand and upgrade formal and informal training in sexual and reproductive health care and family planning for all healthcare providers, health educators and managers, including training in interpersonal communications and counselling; (e) Ensure appropriate follow-up care, including treatment for side effects of contraceptive use; (f) Ensure availability of related reproductive health services on site or through a strong referral mechanism; (g) In addition to quantitative measures of performance, give more emphasis to qualitative ones that take into account the perspectives of current and potential users of services through such means as effective management information systems and survey techniques for the timely evaluation of services; (h) Family-planning and reproductive health programmes should emphasize breast-feeding education and support services, which can simultaneously contribute to birth spacing, better maternal and child health and higher child survival. At the request of the countries concerned, the World Health Organization should continue to provide advice on the quality, safety and efficacy of family-planning methods. Special efforts should be made to improve accessibility through outreach services. Although the incidence of some sexually transmitted diseases has stabilized in parts of the world, there have been increasing cases in many regions. The risk of transmission from infected men to women is also greater than from infected women to men, and many women are powerless to take steps to protect themselves. Special outreach efforts should be made to those who do not have access to reproductive health- care programmes. All relevant international organizations, especially the World Health Organization, should significantly increase their procurement. Equal relationships between men and women in matters of sexual relations and reproduction, including full respect for the physical integrity of the human body, require mutual respect and willingness to accept responsibility for the consequences of sexual behaviour. Responsible sexual behaviour, sensitivity and equity in gender relations, particularly when instilled during the formative years, enhance and promote respectful and harmonious partnerships between men and women.

Our qualitative work suggests that their better knowledge grows out of better regional uptake medications online order atomoxetine with a mastercard. Contraception appears more openly discussed in Amhara symptoms your having a boy generic atomoxetine 40 mg line, with even fathers talking about how they have taken their daughters to health clinics to get injections medications dispensed in original container buy atomoxetine on line amex. This was largely driven by fears about family honour; contraception would ensure that should a girl be raped treatment 4 pimples buy atomoxetine 18mg on line, she would not become pregnant, as pregnancy before marriage is widely seen as a fate too terrible to contemplate (see companion report on bodily integrity). Girls were often married in early childhood, typically to create ties between families and demonstrate social status. Adults admitted that young married girls, while ostensibly still protected from sex by geyed, are often in reality quite vulnerable. Indeed, we found that very young married girls are often extremely worried about becoming pregnant. With no protection from sex, but an understanding of the risks that early pregnancy entails, several reported they had begun using contraception even though they had not yet begun menstruating. Key informants added that many young husbands also prefer to delay first births, so they can better provide for their families. However, key informants also made it clear that girls can only put off pregnancy for so long. As a key informant in Community F explained, `Those who married at 9 or 10 years old give birth to a child at age 15. A father in Community G (South Gondar) explained that he made his daughter begin using contraception: `We have to teach the young girls to use contraceptives in order to become safe. Girls are held almost solely to blame for shifting practices around pre-marital sex and are seen as at fault if they become pregnant. A man from Debre Tabor (South Gondar) explained, `The behaviours of girls are extremely changed. Previously, girls did not have sexual intercourse before marriage, but now, girls start sexual intercourse at an early age. Only 14% could correctly identify a contraceptive 19 Adolescent health, nutrition, and sexual and reproductive health in Ethiopia method (see Table 2 in Annex 2). This lack of knowledge was also evident in our qualitative work, which found that adolescents in Oromia not only had less information about contraception than their peers in Amhara, but they also tended to have more concerns about its safety. A key informant from Community L (East Hararghe) explained that it is not uncommon for girls to believe that if they use contraception, it will leave them permanently unable to have children. If you stay without a child for a longer time, they will tell you, you are barren. A 15-year-old married girl from Batu reported, `My motherin-law has awareness about the health risks of delivering at an early age and she told me to take contraceptive for one year. Now shegoye dancing has become commonplace in some communities and teachers in our research mentioned that students as young as 11 years are unable to pay attention in class because they are simply too tired following night after night of dancing. While some men in Community K believed that modern technology is changing the nature of shegoye, because adolescents now have access to tape players and therefore modern music, others blamed the drought, which has compelled families to pull their children out of school and thus shegoye has taken on added importance as one of the few spaces where adolescents can interact with peers. Indeed, a teacher in Community K explained that he had been told by local adolescents that `those of you who come from another area can do what you like and can get married when you like. Afar Our survey found that young adolescents living in rural Zone 5 (Afar) had very little knowledge of contraception, with only 7% able to correctly identify a method (compared to 40% in Amhara and 14% in Oromia) (see Table 2 in Annex 2). Adolescents in our research reported that while marriage patterns are not shifting, options for sexual partners are. A 10-yearold girl in Community B (Zone 5, Afar) emphasised that: `Small girls like us do not have sex.