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Feminist bioethics and respect for difference From a universalist point of view in maternal–fetal medicine and reproduc- tive health care buy pamelor 25 mg amex anxiety quiz, the immensity of women’s health problems in many socie- ties cheap pamelor 25 mg on line anxiety symptoms pregnancy, particularly in the developing world order pamelor without a prescription anxiety getting worse, 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. The practical conclusion might easily be that it is better not to promote women’s rights in these societies, but to take an alternative approach in order to improve women’s health. So-called universalism often fails to take into account how much inXuence our personal diVerences as well as social circumstances have on our health, health care and medical practices. In its attempt to treat everybody equally, universalism may in reality disregard the diVerences between people (whether we talk about race, ethnicity or gender) that should be taken into account when we have to decide on medical advice or treatment for a particular person (Wolf, 1999: pp. Since our concept of equality is based on an illusionary, idealistic standard of normality, we may discrimi- nate against those who do not Wt this norm. Treating everybody exactly the same may mean failing to under- stand the special problems which particular groups of people, for instance African women, may encounter in their social circumstances and in their medical care. In many cases individual patients beneWt more from medical treatments in which the particularities in their personal situation are taken into consideration. Multicultural issues in maternal–fetal medicine 51 Second, the feminist criticism of the Western abstract form of liberalism shows that the same is true when it comes to the promotion of universal human rights standards. Thus they either inadvertently or deliberately ignore many human rights violations particular- ly relevant to women (such as domestic violence, rape and other forms of sexual and reproductive violence and coercion). Since human rights standards were originally set by men and justiWed by the idea of social contract which, even in the West, historically excluded women from equal participation as less rational and less human, there still appear to be problems in including women within the scope of human rights. As Catharine MacKinnon (1998) has pointed out, there is always a way to Wnd jurisdictional, evidentiary, substantive, customary or habitual reasons to overlook these violations and to disregard women’s special needs. Thus, those human rights violations that are done to women are actually sometimes defended by the very human rights standards that should be there to prevent these violations. Appeals to cultural identities, autonomy and tolerance can be used to justify women’s global subordination by men, not only by traditional communities but also in apparently democratic societies which claim to promote equality (MacKinnon, 1998: pp. Many human rights violations escape the human rights net, because women in general as a group (and particularly not as individuals) are still not seen as naturally meeting the standard of the ideal of humanity. In other worlds, the demand that everyone should be treated the same may eVectively ignore the special needs of women and disregard sexually based violence towards women. Talking about collective rights makes ‘women’s rights issues’ appear to be some kind of deviation from ‘universal human rights issues’, as any minority or cultural rights demand is. Womanhood then remains a deviation from the ideal of our ‘common humanity’, and women cannot meet the traditional standards for human rights (MacKinnon, 1998: pp.

These of the patient’s use of other addictive substances measures improve communication and increase and deliberate counseling with regard to the trust and understanding cheap pamelor on line anxiety symptoms skipped heart beats, which in turn result in risks of physical dependence and the dangers of greater recognition of patients’ needs pamelor 25 mg on-line anxiety 6 months pregnant, increased combining addictive substances is necessary cheap 25 mg pamelor otc anxiety symptoms 8 months. Naltrexone Orientation has been tolerated well by older adults and there is some evidence of its effectiveness in this 97 Treatment goals for lesbian, gay, bisexual and population. For example, or auditory or visual impairments; to provide higher rates of discrimination against lesbian, psychosocial interventions that help patients gay and bisexual adults may be associated with cope with loneliness, loss or depression which higher rates of risky use and addiction in this are more common in this age group; and to help 104 98 population, compared with heterosexuals. In patient and command in order to review the addition, providers should be particularly careful treatment plan and goals. A to engage in any type of ongoing care with 2007 national study found that services provided any provider (e. Public Health initiate treatment and specifically states that Services’ Clinical Practice Guidelines for tobacco cessation services should be integrated 113 116 smoking cessation. Individuals Involved in the Justice For adolescents in the juvenile justice system, screening and comprehensive assessments are System critical for identifying an adolescent’s needs and for connecting the juvenile with effective In 2006, the National Institute on Drug Abuse interventions and treatments. These juvenile court (often conducted by an intake principles include providing comprehensive officer) where results may be used to refer the assessments of the extent and severity of adolescent to more appropriate community offenders’ substance involvement, addressing health services rather than incarceration. For both juveniles and adult offenders with addiction, the use of treatment-based alternatives Addiction treatment for juvenile offenders to incarceration represents an important step in should reflect the standards of evidence-based treating the disease. Drug courts, prosecutorial- care for adolescents in the general population, based diversion programs and intensive with a special focus on family-based treatment treatment-based probation are some of the models. These initiatives provide addiction treatment, assure collaboration between justice authorities and Adult Corrections treatment providers and hold the offender legally 122 Treatment tailored to criminal justice accountable for treatment compliance. Freedom from 127 problems related to substance use was reflected by a inmates, particularly in that they help train response of “never” to each of 15 problems in the patients to recognize errors in judgment that lead 128 areas of health, work, legal situation and finances. As is true in the general population, evidence-based pharmaceutical interventions should be provided to patients in the criminal justice population along with psychosocial 130 therapies. Individuals with addiction facing release and reentry should be assured appropriate post- release community-based treatment, disease 131 management and support services. Determining the exact size and shape of the addiction treatment gap in this country is impossible due to * significant data limitations; however, 89. Rather, existing data on addiction treatment exclude addiction involving nicotine, and data on the types of services offered and venues in which they are provided are available only for providers that receive public funds. Because some addiction treatment providers accept both public and private funding, the available data on providers serving publicly-funded patients also include an unidentifiable number of patients who receive private funding. Detoxification, services received in an emergency department or in prison or jail settings, mutual support programs, peer counseling and other support services (including religious-based counseling) are excluded from these analyses. Therefore, this chapter focuses exclusively on the treatment gap for individuals with addiction.

Brown pigmentation may be due to a holiday 2150 in the sun or to Addison’s disease but the latter is associated with greying of the oral lining buy pamelor 25 mg low cost anxiety bc. Vitiligo buy pamelor 25mg with visa anxiety 100 symptoms, an autoimmune-based depigmentation (especially affecting face purchase pamelor amex anxiety symptoms flushing, hands, and genitalia) with loss of melanocytes, may have severe psychological consequences, particularly in coloured patients. Hypomania and depression may be betrayed by excessive and diminished display of engagement respectively. Tremor of the lips may suggest dependence of alcohol and tongue protrusion and smacking of lips may point to tardive dyskinesia. A hairless face in hypopituitarism, puffy eyelids in hypothyroidism, a look of ‘surprise’ (prominent eyeballs and retracted eyelids) on the face in hyperthyroidism or the expressionless facies in Parkinson’s disease, the moon facies 2151 of Cushing’s syndrome is accompanied by hirsutism , the intended smile replaced by a sneer in myasthenia gravis, the long thin face of dystrophia myotonica or the tire en travers (transverse smile) of facioscapulohumeral dystrophy, and the head may move in synchrony with the pulse in cases of aortic incompetence. Incongruous affect or blunted emotions may prompt a search for other symptoms of schizophrenia. Facial palsy may spare emotional movements or, rarely, emotional movement may be 2152 lost with retained voluntary activity. Neuroendocrinology & psychoneuroendocrinology While neuroendocrine axes are abnormal in some patients with certain psychiatric disorders, (Arce ea, 2003) these often normalise on recovery from an illness episode, suggesting state rather than trait markers. Idiopathic/familial, polycystic ovaries, and the menopause are the most frequently encountered causes of hirsutism. Macroglossia and hypertrophic pharyngeal soft tissues lead to obstructive sleep apnoea. Patients may lack spontaneity and state this may alternate with periods of elation and impulsiveness. Surgical interventions involve removal of small tumours via the sphenoid sinus with the addition of radiotherapy and medical therapy for partially removed larger adenomas. About 15% of drug-naïve first-episode schizophrenic patients have impaired fasting glucose levels and hyperinsulinaemia. First episode schizophrenic patients have three times as much intra-abdominal fat as do matched control subjects. Meyer and Stahl (2008) reviewed the literature on metabolic syndrome in schizophrenia and found strong evidence for significant cardiometabolic risk differences among antipsychotic agents. The clinical relevance and predictive power of the metabolic syndrome per se has been questioned. With visual, auditory, and tactile deprivation for periods up to seven days there may develop Increased suggestibility, anxiety, tension Poor concentration and ability to organise thoughts Somatic illusions Physical complaints Intense subjective emotional distress Vivid (usually visual) sensory imagery Hallucinations and delusions (sometimes) Weaning from mechanical ventilation A minority of patients find this difficult to tolerate. Reasons include fear of dying, depression and other negative affects such as anger, and conflicts with others. Interventions include slow, gradual weaning, dealing with conflicts, and cautious use of medication.

Early intubation is preferable if the patient is unable to maintain oxygen saturation above 90% buy cheap pamelor on-line anxiety head pressure. If the patient is hypotensive and the veins are collapsed buy generic pamelor pills anxiety 30 minute therapy, a central venous line may be required pamelor 25mg amex anxiety scale 0-10. A mean blood pressure around 65-90mmHg or systolic blood pressure above 90mmHg is adequate for a start. Hypotension could be hypovolaemic, cardiogenic (narrow pulse pressure) or septic (wide pulse pressure). If the patient is hypotensive, quick and aggressive fluid resuscitation is vital; in hypovolaemic and septic shock, it is the single most important intervention which will improve survival. If cardiogenic shock or left ventricular failure is likely, appropriate immediate steps should be taken. If consciousness is reduced, is it due to a primary neurological problem such as stroke, encephalitis, seizure? Fluids: What fluids has the patient had over the past 24 hours and the past few days? Note that an ill looking patient is always ill, while a well looking patient also maybe quite ill. Examine the abdomen for distension, organomegaly, masses, distended bladder, and herniae. Adjust ventilatory parameters, and make sure that the endotracheal tube is positioned correctly. Make sure that secretions are sucked out, and sputum samples are collected for gram stain and culture. If the patient is breathing spontaneously, assess whether respiratory support is needed. Clinical approach 15 Ask yourself the following questions: x Is the patient in shock? Think of the ‘blind spots’ – pulmonary embolism, pancreatitis A more detailed history of the patient’s condition can now be obtained from the patient, relatives, and staff previously responsible for the patient’s care. Look through the hospital notes, taking care to identify trends in the results of investigations and patient parameters. The most essential drugs are x Antibiotics x Inotropes and vasoconstrictors x Sedatives and neuromuscular blocking agents x Antihypertensives Check interactions and possible adverse effects relevant to the patient’s condition. Are they likely to become deranged again, since only emergency treatment has been given so far? What steps should be taken to prevent them from becoming Clinical approach 16 deranged again? Clinicians sometimes make the mistake of simply attempting to correct a biochemical value to normal without identifying and treating the underlying condition which results in the deranged value. Every abnormal value has a reason, and it is vital that that reason is identified, and appropriate measures taken to both correct the abnormality, and to prevent it from occurring again. Trends are also important, and it is vital that the clinician identifies trends in homeostatic parameters, which though comparatively innocent at the start, may progress to life threatening derangement.

Within the framework of naturopathic thinking there Crown et al (1997) have observed: exists an appreciation that symptoms are frequently evidence of self-regulation in action – to be under- Both extrinsic and intrinsic factors can increase the stood discount pamelor master card anxiety 5 4 3-2-1, respected cheap pamelor 25 mg with visa anxiety symptoms peeing, assisted and possibly modulated if risk of injury pamelor 25 mg for sale anxiety hierarchy. Extrinsic factors include training errors, excessive (inflammation is a clear example) – and faulty technique, poor environmental conditions, ideally not to be suppressed (Lindlahr 1913). Intrinsic factors Pain, arguably the most common symptom of all, include biomechanical deficiencies including epitomizes the need to understand the sources and malalignment of limbs, muscular imbalances, mechanisms involved, and the processes associated degenerative processes, and other anatomical factors. Merely suppressing A fuller list of additional factors might also include pain without such understanding, and where possible nutritional imbalances, past and present pathological the taking of appropriate action to relieve symptoms processes, adaptive changes to previous injury or and remove causes, is a prescription for chronicity. Pain may represent: Specific examples will be offered in later chapters, • a warning (hand touches a flame) emphasizing the naturopathic approaches to such • a caution not to move the area (due to a tear, common features as restriction and pain, as well as a break or a process of degeneration) the wider range of conditions that are treated using naturopathic physical medicine approaches. Amongst the most widely beneficial manual methods Understanding the processes involved in the pro- of treatment commonly incorporated into naturo- duction and maintenance of pain (or other symptoms) pathic care is traditional massage therapy, which has Chapter 1 • Physical Medicine in a Naturopathic Context 15 been shown in numerous research studies to have chamomile infusions, or by taking mastic capsules or value in the care of conditions as diverse as preg- probiotics. The concept of tolle in Massage Therapy Research (2006) by Tiffany Field causum (identify and treat the cause, as discussed PhD, of the Touch Research Institute, University of earlier in this chapter) requires further evaluation if a Miami Medical School. Examination from a naturopathic physical medicine perspective may reveal facilitated mid-thoracic spinal Osteopathic and chiropractic treatment segments (see Box 2. McKenzie rehabilitation exercises and supportive It is worth emphasizing at this point that the (‘unloading’) taping methods, are all suitable for causes of disease and dysfunction, as perceived use in a naturopathic practice (see Chapter 7). The broad scope of ‘causes’ will be more fully outlined in relation to specific conditions in Chapter 10. Are all ‘natural’ modalities necessarily • An inclusive assessment should be made of, naturopathic? Non-naturopathic manual methods This points to the fact that the same modality may be used either allopathically or naturopathically – Examples of manual medicine approaches that offer depending largely on the context in which it is short-term gain, without consideration of the context employed, the intent behind its use and the condition out of which the symptoms have emerged, can be of the person to whom (as well as the tissues to which) described for almost all modalities. However, these statement as to what constitutes manipulative methods will not be being employed naturopathically therapy as viewed from a naturopathic unless the causes of the individual’s health problems perspective). This would be This suggests that much that is currently done in seen as offering a naturopathic solution to a massage therapy, chiropractic, osteopathic and physi- problem if used as part of a comprehensive cal therapy settings may fail to meet the basic naturo- approach to the needs of the tissues and the pathic requirements of dealing with the whole person person. If naturopaths mimic symptom-oriented approaches in dealing with mus- • The same thrust, utilized without recourse to culoskeletal dysfunction they are not living up to the prior soft tissue treatment (which may well core principles on which their profession is based. Medicine is: reduced self-regulatory potential) • the science of diagnosing, treating, or preventing • Leading to acute and chronic illnesses, toxicity. Practicing a system of medicine (as opposed to a • Diagnoses somatic dysfunction – circulatory/neural/ therapy, modality or technique) requires an established lymph effects. Treatment of Therapies and techniques are open for all practitioners immune and organ dysfunction. Australian States • Physiotherapy is concerned with human function and limit spinal manipulation to registered medical movement, maximizing potential. Traditional Chinese Medicine and Ayurvedic medicine Biomedicine • Identify constitutional types with imbalanced energy as Features of the biomedical profession: a feature of ill-health. Case example The use of many physical medicine techniques by a A 42-year-old male presented with mid-thoracic pain and practitioner of biomedicine may be limited by the stiffness following increased manual labor. Most of the uncertain answers to the questions: seven practitioners from the listed professions utilized • What is the condition?

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