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However, in cases where people were shackled close to each other in institutions and were unable to move to a private location, interviews were conducted in groups or within hearing range of others, with the informed consent of the person. Where the person felt uncomfortable speaking in front of other shackled residents, we did not conduct interviews. In certain cases, persons with disabilities have been assigned pseudonyms and identifying information, such as location or date of interview, has been withheld in order to respect confidentiality and protect them from reprisals from family or from staff in institutions. In a few cases, names of staff members working at mental health institutions or institutions run by faith healers have also been withheld to protect their identity. Mental Health in Indonesia According to the 2013 National Basic Health Riskesdas Survey conducted by the Indonesian Ministry of Health, 17 percent of Indonesians have a disability. Spending on mental health is negligible, which means there is a major and unmet gap in government services. According to the latest available data, Indonesia has 48 mental hospitals across 26 provinces but more than half of these are located across four provinces. Eight provinces do not have any mental hospitals, and three provinces do not have any psychiatrists. Human Rights Watch interview with Sri Idaiani, National Institute of Health Research and Development, Ministry of Health of Republic of Indonesia, Jakarta, November 4, 2014. Hervita Diatri, psychiatrist, member of the National Taskforce on Mental Health and lecturer at the Department of Psychiatry at the Faculty of Medicine at the University of Indonesia, Jakarta, October 31, 2014. This leaves much of the country lacking in trained mental health professionals, particularly smaller islands and rural areas. People are compelled to travel to tertiary facilities in provincial capitals to access mental health care as community-based services are scarce and under resourced. As per a ministerial decree regulating primary and community health centers, all centers are supposed to provide mental health services. These provinces are Riau, Banten, North Borneo, Gorontalo, East Nusa Tenggara, West Sulawesi, North Maluku, and West Papua. The government aims to reach universal coverage, making medical care, including mental health care, available to 247 million Indonesians by 2019. Eka Viora, former director of Mental Health, Ministry of Health Indonesia, Jakarta, August 14, 2015. However, despite subsidized or free access consultations, hospitalization and medication, the long distances to travel to a hospital with mental health services are a deterrent and the cost of transportation is prohibitive. Human Rights Watch interviews with at least 25 families and mental health professionals reaffirmed that distance and transport costs were a significant barrier to accessing mental health care. Fathoni, an 85-year-old father of two adult daughters with psychosocial disabilities, living in Brebes, told Human Rights Watch: We have no money to take [my daughter] to the hospital; it makes us scared.

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It also focuses on preparing standard operating procedures and ensuring that everyone is aware of the risks and how to manage them. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means (electronic, mechanical, photocopying, recording or otherwise) without the prior written permission of the copyright owner. But if you do follow the guidance you will normally be doing enough to comply with the law. Health and safety inspectors seek to secure compliance with the law and may refer to this guidance as illustrating good practice. This document develops the content of the two earlier books by setting the guidance in the context of the requirements of the Management of Health and Safety at Work Regulations 1 and the Control of Substances Hazardous to Health Regulations. It applies to diagnostic work in patient care areas, such as outpatients departments, intensive therapy or neonatal units and to work by general practitioners at their surgeries. They are of equivalent meaning, and are used where the guidance offers a way of complying with a legal duty, as distinct from recommendations on what constitutes good practice. Safe working and the prevention of infection in clinical laboratories and similar facilities Page 6 of 69 Health and Safety Executive Health and safety law Health and Safety at Work etc Act 1974 9 the Health and Safety at Work Act 5 places general duties on employers, employees and others. Health and Safety at Work Act key duties Employers must: protect the health and safety of their employees; protect the health and safety of others who might be affected by the way they go about their work (for example, cleaners, visitors or contractors working in the laboratory); prepare a statement of safety policy and the organisation and arrangements for carrying it out (if 5 or more people are employed, this statement must be written down). Employees must: take care of their own health and safety and that of others; co-operate with their employer. If any doubt exists about who is responsible for the health and safety of a worker this could be clarified and included in the terms of a contract. The Approved Code of Practice on the Management Regulations provides further guidance. Safe working and the prevention of infection in clinical laboratories and similar facilities Page 7 of 69 Health and Safety Executive the Management Regulations key duties Employers must: assess risks to staff and others, including visitors, young persons and new and expectant mothers; 6,7 make appropriate health and safety arrangements, which must be written down if five or more people are employed; appoint competent persons to help them comply with health and safety law; establish procedures to deal with imminent danger; co-operate and co-ordinate with other employers and self-employed persons who share the workplace. Employees must: work in accordance with training and instruction given by their employer; report situations which they believe to be unsafe. Schedule 3 to the Regulations has special requirements for work with biological agents. Detailed guidance is provided in Safety representatives and safety committees and A guide to the Health and Safety (Consultation with Employees) Regulations 1996. Arrangements for dealing with infection risks in laboratories are only fully effective if employers closely involve employees and their representatives. Duties to non-employees 15 Under the Health and Safety at Work Act 5, employers have general duties towards people who are not their employees, but who may be affected by their work activities. In a laboratory, these include cleaners, contract staff, patients and others who are not at work. In some cases, employers may owe the same duties towards agency staff under health and safety law as they do towards their own employees. Safe working and the prevention of infection in clinical laboratories and similar facilities Page 9 of 69 Health and Safety Executive 17 People employed by different organisations may share a workplace, or employees of one organisation may work in an area controlled by another. In such cases, the employers involved must co-operate and co-ordinate their activities, to enable everyone to comply with their legal duties. Employers need to ensure that everyone working in the laboratory has sufficient information, instruction and training to work safely. Lone workers 18 There may be situations where staff work alone in the laboratory, particularly outside normal working hours. Although there is no general legal prohibition on working alone, the broad duties of the Health and Safety at Work Act and the Management Regulations apply. The risk assessment will need to determine whether the work can be done safely by a lone worker, and any necessary special control measures. These may include periodic visits to the laboratory by supervisors and providing means of raising the alarm in the event of an emergency. Working alone in safety: Controlling the risks of solitary work provides guidance on working alone safely. This involves assessment of the risks, development of policies, putting arrangements in place to implement those policies and monitoring the way those arrangements work, ie employers must make arrangements to manage health and safety. Action to ensure that adequate precautions are in place is generally delegated down to line managers. The heads of department have a key role in managing health and safety in laboratories.

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Por todo esto, hay resaltar que el tratamiento con corticosteroides topicos requiere control del medico, aplicacion en zonas localizadas poco extensas y seleccionadas, y evitar zonas como la cara, pliegues y genitales, en las que la absorcion y los efectos secundarios locales, pueden tener consecuencias mas graves. En estas zonas tenemos la alternativa de los nuevos inhibidores de la calcineurina como el tacrolimus y el pimecrolimus topicos, con los que obtenemos buenos resultados sin esos efectos adversos. La estrategia se basa en efectuar tratamientos cortos y efectivos, para cambiar lo mas pronto posible a otros tratamientos. La sustancia es un derivado del alquitran, cuya aplicacion produce efectos beneficiosos en la psoriasis. Su ventaja radica en su bajo nivel de absorcion, en su efectividad, en la ausencia de fenomeno de rebote y en que es el tratamiento que produce periodos mas largos de remision. Por el contrario, sus desventajas se basan en que es un producto irritante, que produce dermatitis en las zonas en las que se aplica, que tiene una respuesta lenta (una media de 4 a 5 semanas de tratamiento para obtener resultados) y que cosmeticamente es muy mal aceptado, ya que mancha la piel, la ropa, el mobiliario, etc. Por todo lo anterior, su utilizacion debe reservarse para pacientes motivados y con un buen entorno familiar. Se puede formular en crema y en pomada, la primera se reserva para la aplicacion en cuero cabelludo, ya que aunque es menos efectiva, se puede retirar mediante lavado mucho mas facilmente. La pauta que se utiliza es la denominada terapia de contacto corta, en la que se utilizan concentraciones elevadas de antralina, entre un 1 y un 2%, aplicadas en la zona enferma durante un tiempo corto, aproximadamente una hora, con lo que se consiguen resultados similares a los obtenidos con concentraciones bajas y aplicaciones prolongadas en la piel enferma. Analogos de la vitamina D3 Los analogos de la vitamina D3 han demostrado su efectividad en el tratamiento de la psoriasis, con unos resultados superponibles a los corticosteroides topicos, pero sin los efectos adversos de estos, tanto locales como sistemicos. El problema fundamental que plantean es que su aplicacion continuada puede dar lugar a alteraciones en el metabolismo del calcio, por ese motivo su utilizacion solo esta indicada en adolescentes y no debe sobrepasar la cantidad de 100 g del producto por semana. Los psoralenos tienen efectos secundarios y su utilizacion en ninos esta contraindicada, solo pueden usarse en adolescentes. Asi pues, es un tratamiento largo, que requiere tiempo, por lo que hay que tener en cuenta la perdida de escolarizacion que supone y solo esta indicado para ninos mayores de 8 anos. Acitretina Pertenece al grupo de los retinoides, que son derivados de la vitamina A y tienen una toxicidad elevada. Es un medicamento efectivo para la psoriasis y para otros trastornos de la queratinizacion, como determinadas formas de ictiosis, por este motivo se tiene experiencia con tratamientos prolongados en ninos. El efecto secundario mas preocupante en su utilizacion durante periodos prolongados es la calcificacion de ligamentos, por lo que debe de hacerse un estricto seguimiento del paciente. Tambien puede producir un cuadro de pseudotumor cerebri, por lo que esta contraindicado asociar vitamina A y antibioticos derivados de las tetraciclinas. El medicamento es teratogenico y debe de transcurrir un periodo minimo de dos anos desde que se produce el cese de la toma del medicamento hasta empezar la gestacion, por este motivo la administracion de este farmaco en mujeres adolescentes debe de ser muy justificada. En la psoriasis se administra durante periodos cortos de dos a tres meses para blanquear psoriasis extensas. Metotrexato Este citostatico ha demostrado su utilidad para el control de la psoriasis a dosis bajas. El efecto secundario agudo mas importante es la mielosupresion, por este motivo es necesario efectuar dosis de prueba de la medicacion y monitorizacion cuidadosa del paciente, con controles hematicos periodicos. El efecto adverso cronico mas importante es la hepatotoxicidad, que depende de la dosis acumulativa y requiere para que se produzca la administracion del farmaco durante periodos prolongados, cosa que debe de evitarse, procurando no llegar nunca a una dosis total mayor de 1. La dosis inicial es de 0,2 mg/kg/semana y se aconseja incrementar segun la tolerancia hasta alcanzar 0,7 mg/kg/semana. El tratamiento produce el blanqueamiento de las lesiones en un tiempo medio de 6 a 10 semanas, pudiendose entonces retirar la medicacion progresivamente y efectuar mantenimiento con otras terapias. Tiene una elevada eficacia y una respuesta rapida, ya que en 30-60 dias consigue magnificos resultados. El problema mas importante es la nefrotoxicidad, que requiere un control de la funcion renal, con medicion de la creatinina. Tambien puede producir hipertension arterial, por lo que se requiere control periodico. Ademas, el medicamento presenta numerosas interacciones medicamentosas que deben de ser tenidas en cuenta. Childhood pustular psoriasis elicited by the streptococcal antigen: a case report and review of the literature.

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The overarching goal of the guidelines is to inform and support clinicians (specifcally primary care clinicians, who provide the majority of mental health care in the state) in making treatment decisions that are safe and evidence-based, and that maximize beneft and minimize harm to patients. In addition, a section on treating mood disorders in pregnancy was added to help clinicians who often face practice challenges in deciding how best to treat women with psychotherapeutic medications during pregnancy because the evidence to guide decision making is often contradictory and/or limited. The 2015 Florida Expert Panel met in Tampa, Florida on September 25-26, 2015 to review and update the adult guidelines last published in 2013. For each disorder, a psychiatrist who is a nationally recognized content expert reviewed the scientifc literature on treatment and made suggestions to the panel on revising the guidelines based on the state of the scientifc evidence. The panel then discussed the guidelines and proposed revisions, and reached a consensus about whether to revise and adopt a particular set of guideline recommendations. A description of the guideline process and assignment of levels of recommendations was recently published1 and are adapted here to explain the basis for each Level: n Level 1 is initial treatment for which there is established efficacy and relative safety for the treatment recommendations (based on replicated, large randomized controlled trials). It should be noted that the levels are not algorithms in which specifc treatment decisions are mandatory. Instead, the use of the adult guidelines should take into account the individuality of the patient and presenting symptoms. The inevitable changes in the state of scientifc information and technology mandate that periodic review, updating, and revisions will be needed. These guidelines may not apply to all patients; therefore, each guideline must be adapted and tailored to the individual patient. Clinicians should use rating scales to assess symptom severity during the initial evaluation/treatment, when medication changes are implemented, and/or when the patient reports a change in symptoms. Internet links to the following scales are available on the program website F If inadequate response, follow with systematic trial of monotherapy with one or more other antipsychotics at adequate dose and duration. F If inadequate response, follow with a trial of clozapine or a long-acting antipsychotic. F Repeated assessment of efcacy using reliably defned treatment targets (use standard rating scales. F Standard protocols customized to individual vulnerabilities/needs and specifc agent. Consider psychiatric consultation, if possible, prior to psychotherapeutic treatment. Longer-term efcacy data is limited for the following: divalproex monotherapy, carbamazepine (drug interaction risk), antidepressants, electroconvulsive therapy (inconvenience/expense). The 2015 iteration of the Florida Best Practice Psychotherapeutic Medication Guidelines for Adults (6th update) is a critical component of decision support that attempts to narrow the foregoing gap in health outcomes by fostering precision and consistency, as well as the appropriate selection and sequencing of treatments throughout each stage of the illness. Notwithstanding, there has been robust and accumulating evidence for greater attention given to clinical aspects of chronobiology, metabolic and physical health aspects, cognitive dysfunction, as well as premature mortality in this population. The timeliness of accurate diagnosis is underscored by convergent evidence in support of an integrated conceptual pathogenic framework indicating that bipolar disorder has both neurodevelopmental as well as neurodegenerative aspects. In 2015, the American Heart Association consensus statement identifed bipolar disorder (and major depressive disorder) as a Tier 2 risk factor for cardiovascular disease and accelerated atherosclerotic illness. The integrated care of bipolar disorder warrants systematic and routine screening for traditional and emerging risk factors for cardiovascular disease. The scientifc evidence is compelling that lithium and divalproex, as well as atypical agents ofer therapeutic beneft in mania. So far, no studies have primarily enrolled individuals meeting criteria for mania with mixed features specifer.

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Acupuncture for posttraumatic stress disorder: A randomized controlled pilot trial. Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship. The effect of aerobic exercise on obsessive-compulsive disorder, anxiety, and depression: A Kohli A et al. A clinical study of autogenic training-based behavioral treatment for panic disorder. The treatment of recalcitrant post-traumatic nightmares with autogenic training and autogenic analysis. Two cases of panic disorder treated with autogenic training and in vivo exposure Foods rich in tryptophan without medication. Ambulatory short-term therapy of anxiety patients with autogenic training and hypnosis. Psychotherapie, Psychosomatik, medizinische Psychologie disorder with anxious mood: A randomized, double-blind, placebo-controlled trial. Controlled programmed trial of Ocimum sanctum leaf on generalized anxiety Ayurveda disorders. Effects of a traditional herbal supplement on anxiety in patients with generalized anxiety disorder. Utilization of Ayurveda in health care: An approach for prevention, health promotion, and Pilkington K et al. Homeopathy for anxiety and anxiety disorders: A systematic review of the research. Double-blind, placebo-controlled, crossover trial of inositol treatment for panic disorder. Anxiolytic effect of Rescue Remedy for psychiatric patients: A double-blind, placebo 153:1219-1221. Effcacy of self-examination therapy in the treatment of generalized anxiety disorder. Understanding Your Reactions to Trauma: A Booklet for Survivors of Trauma and Their Families. A randomized controlled trial of self-directed versus therapist-directed cognitive-behavioral Mantani N et al. Four cases of panic disorder successfully treated with Kampo (Japanese herbal) medicines: therapy for obsessive-compulsive disorder patients with prior medication trials. A critical review of caffeine withdrawal: empirical validation of symptoms and signs, Carcinogenesis & Ecotoxicology Reviews 2008; 26:89-112. Double-blind, randomised, placebo-controlled study to evaluate the effcacy and safety of a Clinical Practice 2009; 15:96-101. Effect of valepotriates (valerian extract) in generalized anxiety disorder: a randomized Krisanaprakornkit T et al. Randomized trial of a meditation-based stress reduction program and cognitive behavior Art no. Broad spectrum of cytokine abnormalities in panic disorder and posttraumatic stress Biological Psychiatry 2008; 32:1093-1105. Public beliefs about the helpfulness of interventions for depression: effects on actions taken Kirkwood G et al. Relaxation training for anxiety: a ten-years systematic review with meta-analysis. Smoking and panic attacks, panic disorder, and agoraphobia: a review of the empirical literature.

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Looking at the group as a whole (Brazilian and French Guianan children), mercury concentrations in hair were found to correlate with deficits in drawing tasks designed to measure cognitive function, this deficit was found to be worse in younger children (Chevrier et al. A similar correlation was found in a study comparing children from high exposure (Upper Maroni), medium exposure (Camopi on the Oyapock River) and low exposure (Awala on the Atlantic coast) areas (exposure assessed by level of fish consumption). It should be noted that this was a retrospective study with maternal hair being sampled up to 12 years after childbirth so levels in hair may be very different to that seen during gestation. Studies in French Guiana demonstrate significant exposure of indigenous communities to mercury contamination, principally via the consumption of contaminated fish. The presence of significant neurological deficits, including developmental delay, in some children and a possible link to maternal exposure is of great concern and suggests that action to mitigate exposure is long overdue in some communities. Researcher led studies have been conducted in maroon and indigenous communities while the community-led assessments of mercury exposure have been conducted by the Wayana community of southeast Suriname, in conjunction with scientific and medical professionals. The maroon community of Kwakoegron was recently revisited in a survey conducted in conjunction with a study on the indigenous population of Pikin Saron. The study focused on women and children due to the increased risk of toxicity in these groups. In a 6-day survey in Kwakoegron, 50% of families ate fish less than twice per week. The locally caught fish consumed by the surveyed households were a mix of herbivorous, omnivorous and carnivorous species. As in Kwakoegron a mix of herbivorous, omnivorous and carnivorous fish were consumed. Sampling revealed the very high levels of contamination in the aquatic ecosystems relied on by both communities (75% of fish had a mercury concentration > 0. Adapted from Ouboter, in press 43 In Kwakoegron, 33 people (13 women and 20 children) provided samples of their hair while in Pikin Saron 22 people took part (9 women and 13 children). Another study was conducted at the Brownsweg villages in the heavily mined district of Brokopondo (Figure 5. Piscivorous fish caught in the Brokopondo reservoir showed high mean concentrations of mercury (S. However, mercury concentration in hair was low during surveys carried out in both the wet (women 2. Surveys on diet indicated that consumption of locally caught piscivorous fish was low (4. These data further underline the importance of diet and specifically the role of fish consumption for exposure to mercury even in highly mined regions (Ouboter and Landburg, 2010). The importance of diet over location was further emphasised in a small study conducted in two Maroon villages, Poesoegroenoe and Njoeng Jacobkondre (Figure 5. Notably, the mean mercury concentrations were higher in participants from Poesoegroenoe 6. The higher mercury concentrations in Poesoegroenoe are likely driven by the higher fish consumption in this community, where there is a preference for predatory fish. In addition this area showed high levels of mercury contamination, likely driven by atmospheric deposition (see section 3. The study was conducted in the communities of Puleowime (n = 158) and Kawemhakan (n = 106), close to the Wayana communities studied in French Guiana (Figure 5. There appeared to be a relationship between mercury contamination and fish consumption. All participants in Puleowime reported eating fish at least 3 times per day while in Kawemhakan, although fish consumption was also high, 25% of participants reported consuming fish less than 3 times per day. The two most common fish species eaten in both communities were piscivorous, Hoplias spp. Neurological signs of mercury toxicity were inconclusive, however, a small number of self-selected participants who accessed medical examination showed neurological deficits (n = 3) (Peplow and Augustine, 2012).


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That could be a symptom of an enlarged prostate, a common condition among men as they get older. Most of the time, erectile problems are caused by an underlying health problem, such as diabetes, clogged arteries, or high blood pressure. So if you want to make love and your husband says he has a headache, pay attention: it might be something far more serious. Although women may be more likely to attempt suicide, men are four times more likely to succeed. Because men are reluctant to ask for help and may try to hide their depression, you may recognize the symptoms sooner than he does. As with most things, the results of specific exams are important, but often are not nearly as important as changes over time. Somewhere along the line we got the idea that "self-exams" have to be done, well, by ourselves. First, it will dou ble the chances that his (and your) exams get done regularly and thoroughly. Women get most of their skin cancers in places where they can more easily be spotted on their hands and face and below the dress line. If you recognize any unusual symptoms in your loved one do whatever it takes to get him the help he needs, it may save his life. Besides encouraging the men in your life to exercise, eat a high-fiber/low-fat diet, quit smoking, and do monthly self exams, the most important step you can take is to get them into the habit of getting regular medical checkups. U l t i m a t e l y, the goal of all this is to get your husband to take better care of him self and to get the next generation of men to start building good habits. Ask your employer, fraternal organization, or place of worship to establish a yearly health fair or screening event. Excluding pregnancy-related office visits, women make twice as many preventative care visits as men.

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In addition, during tooth tiate amalgam tattoo from other lesions of the oral extraction, fragments of amalgam restorations are mucosa with dark discoloration. Amalgam tattoo appears as a well defined flat area with a bluish-black or brownish discoloration of varying size (Fig. Amalgam deposits usually occur in the gingiva, the alveolar mucosa, and the buccal mucosa. Metal and Other Deposits Bismuth Deposition Materia Alba of the Attached Gingiva Bismuth compounds were formerly used in the Materia alba is the result of accumulation of bac treatment of syphilis. It is antibiotics have replaced these compounds in the usually found at the dentogingival margins of per treatment of syphilis. However, materia bismuth are now rarely encountered except in alba presenting as a white plaque along the ves patients who have been treated for syphilis in the tibular surface of the gingiva and the alveolar preantibiotic era and have poor oral hygiene. Less detached after slight pressure, leaving a red sur frequently, bismuth may be deposited in other face. Phleboliths Phleboliths are calcified thrombi that occur in veins and blood vessels. It is accepted that thrombi are produced by a slowing of the peripheral blood flow, and become secondarily organized and mineralized. Clinically, it appears as a hard, pain less swelling of the oral soft tissues typically associated with hemangiomas, although in some cases there are no signs of hemangiomas (Fig. The differential diagnosis includes salivary gland calculi, calcified lymph nodes, and soft-tissue tumors. White plaques on the attached gingiva and the alveolar mucosa caused by materia alba accumulation. If the salivary glands are irradiated, xero treatment of oral and other head and neck can stomia is one of the earliest and most common cers. Spontaneous remission of oral lesions ionizing radiation, delivered by an external may occur gradually after termination of the radi source, or radioactive implants (gold, iridium, ation treatment. Late manifestations are usu Ionizing radiation, in addition to its therapeutic ally irreversible and result in extremely sensitive effect, can also affect normal tissues. The teeth, in the absence of mucosal side effects after radiation are mainly salivary protection, rapidly develop caries and dependent on the dose and the duration of treat finally are destroyed (Fig. These radiation-induced mucosal reactions crosis is a serious complication and occurs in cases may be classified as early and late. Early reactions of high-dose radiation, especially if inadequate appear at the end of the first week of therapy and measures are taken to reduce the radiation dosage consist of erythema and edema of the oral delivered to the bones. During the second week, erosions and osteomyelitis with bone necrosis and sequestra ulcers may appear, which are covered by a whit tion and, rarely, formation of extraoral fistulas ish-yellow exudate (Figs. The mandible is more frequently complaints include malaise, xerostomia, loss of affected than the maxilla. The risk of this compli taste, burning, and pain during mastication, cation is increased particularly if teeth within the speech, and swallowing. Diagnosis of oral lesions due to radiation de Treatment should include preventive measures, pends on the medical history and the clinical fea cessation of the, radiation therapy, analgesics, tures. Allergy to Chemical Agents Applied Locally Allergic Stomatitis due to Acrylic the differential diagnosis includes denture Resin stomatitis and reactions to other allergens. Treatment consists of oral antihistamines and con True allergy of the oral mucosa to denture base struction of new dentures with fully polymerized material is very rare. Alternatively, traces of other allergenic substances absorbed within the denture base may be the cause of the allergic reactions. Allergic acrylic stomatitis is characterized by diffuse erythema, edema, and occasionally small vesicles and erosions, especially in areas of contact with the dentures (Figs. The patient complains of intense burning of the mouth and this reaction may extend to areas of the oral mucosa that are not in direct contact with the dentures. In localized reactions there is redness, edema, Allergic Stomatitis due to Eugenol and erosions that are covered with whitish Eugenol has many uses in dentistry as an antisep pseudomembranes (Fig. The skin patch test is usually sitized patients it may cause generalized allergic positive. Periodontal Diseases Gingivitis An early and common feature is gingival bleeding, even after mild local stimulation. Inflammation is Gingivitis is an inflammatory disease of the gin mainly located at the marginal gingiva and the giva caused by dental microbial plaque.

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Saya berasa sungguh sedih Kebanyakan masa/Yes, most of the time sehingga saya mengalami Kadang-kadang/Yes, sometimes kesukaran untuk tidur Jarang-jarang sekali/Not very often I have been so unhappy that I Tidak pernah/No, not at all have had difficulty sleeping 8. Saya berasa sangat sedih Ya, kebanyakan masa/Yes, most of the time sehingga saya menangis Ya, agak kerap/Yes, quite often I have been so unhappy that I Hanya sekali sekala/Only occasionally have been crying Tidak pernah/No, never 10. B Animal reproduction studies have failed to demonstrate a risk to the foetus and there are no adequate and well-controlled studies in pregnant women. C Animal reproduction studies have shown an adverse effect on the foetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Whilst this document may be printed, the electronic version posted on the intranet is the controlled copy. As a controlled document, this document should not be saved onto local or network drives but should always be accessed from the intranet. Throughout the development of the policies and processes cited in this document, we have: Given due regard to the need to eliminate discrimination, harassment and victimisation, to advance equality of opportunity, and to foster good relations between people who share a relevant protected characteristic (as cited under the Equality Act 2010) and those who do not share it; and Given regard to the need to reduce inequalities between patients in access to, and outcomes from healthcare services and to ensure services are provided in an integrated way where this might reduce health inequalities. Although the proportion of those affected is broadly in line with other age groups, older people have not been able to access the same level of support. Later life is a time when getting the right support is extremely important for wellbeing due to the complex challenges older people often face. We are also running a number of pilots and services across the country, including in partnership with Mind, to enhance psychological coping strategies, wellbeing and social connections among older people. Introduction Mental health problems are as common in older adults as they are in younger adults and are associated with considerable individual suffering, suicide, higher use of health and social care services and poorer outcomes for physical illness. We are not considering dementia in this document because it has been dealt with 1 elsewhere, however delirium is covered briefly. When evaluating an older person with a mental health problem, it can be helpful to bear in mind whether it is a longstanding condition in a person who is growing old. We see this as work in progress and any comments and suggestions would be appreciated to Alistair. Less than one in ten people present with bipolar disorder in older age, and even less common are older people presenting with psychotic symptoms (one in twenty). Older people more frequently have symptoms of depression or dementia than late-onset schizophrenia. A symptom or complaint that started in old age, compared to one which is life-long, is more likely to be due to an underlying mischief. Bitter complaints of loss of memory over months are likely to be due to depression and a sudden onset is most often vascular in origin. Enquire about drugs with particular reference to the temporal relation between starting or stopping a medication and the onset of symptoms. Delusional ideas will usually be volunteered, however, they can be missed if you are too rushed in your interview. Press people as to whether they really believe something and you can detect hesitation indicative of an overvalued idea. Physical examination Physical illness, whether above or below the neck, and medication side effects are particularly common in older people (Appendix 1 has an exhaustive list of these). For example, if someone is breathless, listen to their heart and chest; if someone coughs, listen to their chest; if someone looks to be in pain, examine their joints; if there is unexplained weight loss, examine the abdomen; if someone looks parkinsonian, look at their gait, examine their wrists for cogwheel rigidity and do a glabellar tap. Thinking about it another way, what would something look like if it went wrong and was publicised in the media Indications for referral to specialist and older adult mental health services Psychotic symptoms.