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By N. Ines. Rasmussen College.

Oral cancer is among biting generic verapamil 120 mg with visa, chewing safe verapamil 80mg, smiling 120mg verapamil for sale, speaking discount 120mg verapamil with mastercard, and psy- the 10 most common cancers in the world, chosocial wellbeing. Tens Declaration of Human Rights of thousands of children are still af- adopted by all nations. Moreover, one in every 500 A healthy mouth and a healthy body go hand to 700 children is born with a cleft lip and/or in hand. And oral and facial trauma, associated detrimental consequences on physical and with unsafe environments, sports and violence, psychological wellbeing. Oral diseases are often oral diseases that affict humankind and which hidden and invisible, or they are accepted as require population-wide prevention and access an unavoidable consequence of life and age- to appropriate care. However, there is clear evidence that oral general and oral health, particularly in terms of diseases are not inevitable, but can be reduced shared risk factors and other determinants, pro- or prevented through simple and effective vide the basis for closer integration of oral and measures at all stages of the life course, both at general health for the beneft of overall human the individual and population levels. The mouth is a pattern of inequalities in oral and general The extensive or general health are complete loss of teeth closely related and mirror of the body, often reflecting signs of sys- disease burden between different population Organ infections: may negatively impact Oral bacteria are should be considered temic diseases. With the global improvement in life expectancy, infections of the heart, habits such as tobacco or alcohol use. Different ages in life and changes in tooth appearance can indicate Noma: have different oral health needs, and the specific serious eating disorders. Acute necrotizing problems of older people, who are often also Saliva: Can be used to gingivitis/periodontitis Many general conditions increase the risk suffering from other diseases, are becoming identify specific is an important risk of oral diseases, such as an increased risk of more prevalent. Tooth decay shares the same social determinants and resulting inequalities as many other oral diseases. Separate national oral health surveys epidemiologic information constrains the 2000 or latest available data studies. It records the number of decayed (D), missing (M) and filled (F) are complex and costly to conduct, and development of appropriate approaches to decayed (D) missing (M) filled (F) teeth (T). However, a wide range of other factors the tooth surface, the bacterial biofilm (dental disease. These factors act over time at the level of reducing sugar Reducing acid attacks on the tooth enamel can food. Biofilm bacteria metabolize sugars and the community, the family and the affected intake, appropriate be achieved by reducing the total amount and individual. Action on the microbial biofilm can can be arrested and even reversed, but in the be taken by ensuring good oral hygiene later stages a cavity forms. E becomes necessary to restore tooth function, In addition, a range of external factors, such as lt involving the removal of decayed tissue or the where and how people live, also influence the placement of a filling or crown. This means that untreated, decay can lead to extensive destruc- although the decay process starts at the surface tion of the tooth, pain, and infection. The latter F of the tooth the problem cannot be solved by can result in abscess formation or septicaemia. It also neces- At this stage, root canal treatment or extraction sitates action on the community level to becomes necessary. Several of the bacterial species have been associated with causing tooth decay including Streptococcus mutans. I decided to take some Universal access to affordable and effective simple and cost-effective interventions. I spent about four The highest levels of tooth decay are found Exposure to fluoride is among the most when it hurt and that would do the minimizing the risk of tooth decay. During in middle-income countries, where sugar cost-effective measures to prevent tooth trick. Then one day, the pain got so So we started taking our son for this time, though, I developed the consumption is on the rise and health decay and improve oral health. Regular use acute that I started having a fever regular dental checkups and we habit of snacking and drinking soda. I rushed to the dentist who knowing that we are taking the right impact on my life. I decided to go consequences of untreated tooth decay, Universal access to primary oral healthcare told me that my tooth was in such preventive measures to keep our son back to work, only my employer said particularly for children, are negative Existing inequalities in disease burden can bad shape that I needed a root canal in good health. Luckily our health he wouldn’t take me because I had impacts on nutrition and growth, loss of only be reduced with universal access to treatment. I didn’t realize days in school and at work, reduced overall primary oral healthcare, covering at least could have been quickly cured ended so we can do what is necessary for this had become so visible, but my productivity and significant impacts on relief of pain, promotion of oral health and up costing me numerous working our son’s wellbeing and overall bad eating habits had caused a lot of quality of life and social interactions. This was a mistake I will devastated to learn I couldn’t Teacher, Vancouver, Canada, to address the global tooth decay burden, not make again. This was a wake-up call to Full integration of oral health into popula- demiological surveillance. Inadequate oral hygiene leads to The defence of the local immune Because of the shared risk factors and its accumulation of dental plaque containing system breaks down and the two-way relationship with some systemic harmful bacteria and bacterial products that inflammation process advances. However, the global attention from healthcare professionals, cells of the immune system counter these pocket formation, with loss of governments, and insurance and pharmaceuti- damaging effects and the inflammation supporting bone. For many patients, the affected teeth may become loose disease never progresses beyond this point and be lost. Specialized periodontal care is not generally Links with general health available; when it is, it is unaffordable for Products from inflammation around the tooth and the bacteria in dental plaque enter the bloodstream and may cause systemic many. Diseases with an impact on the immune system, such as diabetes, increase the risk of more serious forms of periodontal severity data on a global level are scarce. Periodontal disease is a major public health regular check-ups, are important elements problem that challenges health systems in prevention of periodontal disease. It largely goes unnoticed is a strong social gradient in the prevalence by patients until it reaches an advanced of periodontal disease, which requires inter- “I was scared of stage. Public awareness of the disease and ventions addressing the wider determinants what that meant: the importance of proper oral hygiene is of health. Could I Periodontal disease shares common risk dontal disease can be detected at early “I started smoking in my early 20s. In about 10 to university, I was meeting people and going my gums were swollen and often bleeding collaboration 15 percent of patients, common gingivitis out… I was enjoying life. Then, some of my A holistic approach to managing periodontal may progress to severe periodontal disease, husband to-be when I started working. My told me I had suffered major bone loss and stronger collaboration between oral health disease has progressed to the stage where pregnancy was a joyful time in my life, which had severe periodontal disease. As with all chronic was sadly shadowed by some complications tioners and other appropriate health profes- I was scared of what that meant: Would I lose diseases, effective lifelong self-care, together linked to my baby’s premature birth. Could I afford key to preventing disease progression and warning me already about smoking and the that require care. I address severe periodontitis are required: myself I would smoke less and quit Integrated disease surveillance wish I had taken my doctor’s advice to stop eventually, but never really managed to. Healthy living and prevention Integrating indicators for periodontal dis- smoking when it could have made a I was around 40 when I started noticing gaps difference. I wish I knew back then what I The promotion of a generally healthy life- ease, together with other oral diseases, into between my teeth.

These six diseases were prior to administering a vaccine is good practice diphtheria 240 mg verapamil with mastercard, measles discount verapamil 120 mg with visa, pertussis discount verapamil 120mg on line, poliomyelitis order 240 mg verapamil visa, tetanus and will identify possible contraindications. The Correct storage of vaccines increase in immunization uptake was higher in usually means maintaining developed areas and lower in less developed areas. A the world had adopted the principle of a national protocol document about vaccine storage can help immunization programme. An became clear that disease incidence was not example of such a document is found in Appendix 1. Problem areas were targeted and on Immunization) strategies set up to ensure that vaccines were readily Following the success of smallpox eradication, the available to those areas with poor coverage. World Health Organization was keen to attempt eradication of other infectious diseases. The term “expanded” was used to indicate the increase in the Module 2 Page 45 The six targeted diseases The following information covers vaccines used Boosters: Usually none. Malaise, transient fever and headache immunization schedules vary between and within may also occur. Contraindications: Acute febrile illness or severe adverse event to previous dose of same vaccine Diphtheria (severe local or prolonged high-pitched screaming Type of vaccine: Active immunization with diphtheria more than four hours; convulsion). Notes: The risk of vaccine related neurological problems Primary course: Usually 3 doses. Malaise, transient fever and headache Type of vaccine: Active vaccination with live may occur. Notes: A lower dose of vaccine is usually given to Primary course: Usually 3 doses. Tetanus Contraindications: Acute febrile illness, untreated Type of vaccine: Active vaccination with tetanus malignant disease, immunocompromised status, toxoid (often given with diphtheria and pertussis). Notes: There is an exceptionally small risk of Adverse reactions: Swelling and redness at the encephalitis or encephalopathy related to injection site, malaise, transient fever and headaches vaccination. Contraindications: Acute febrile illness, severe Pertussis adverse event to previous dose of same vaccine. Type of vaccine: Active vaccination with inactivated Notes: Tetanus toxoid and/or tetanus organisms, usually with diphtheria and tetanus. Heaf test (or multiple puncture test) at a later date: yellow fever (for those living in 2. Using a firm pressure, press the Heaf gun head down on to the arm and six needles from the Heaf head will be released and protrude 2mm into Page 47 the skin. Results of a Heaf test Heaf grades 3 or 4 and Mantoux tests of 15 mm Heaf grade Result Appearance induration or more, are considered to be strongly No induration at the puncture sites. Discrete induration of three or positive and should be referred for further 0 fewer needle sites is acceptable. Induration around each needle site merging with the next, forming a ring of induration but with 2 a clear centre. The test should be read 48–72 thumb and forefinger of one hand; the other hand hours later. A bleb typically of 7 mm diameter follows 4mm induration are regarded as negative. National immunization days have been carried out in 82 countries, and over 140 countries now conduct surveillance for cases of acute flaccid paralysis in children. The incidence of polio has followed a downward trend, and an increasing number of areas in the world are becoming free of the disease. Whilst success is in (For further information on skin testing and sight, zones and countries where there is armed screening of high-risk groups such as contacts with conflict remain difficult to implement effective tuberculosis and new immigrants, see Module 5). In 1994 it was estimated that the actual control or elimination of major around 733 000 deaths due to neonatal tetanus childhood diseases is now the focus. A key component countries in South America, the Middle East, of this strategy is the routine immunization of all Southeast Asia and the Pacific Islands, have included women in antenatal clinics. Routine programmes are still needed Clean delivery practices (a complementary strategy) in sub-Saharan Africa, the Indian subcontinent and have improved in recent years although most babies the Newly Independent States. The reduction in neonatal tetanus deaths is the result of impressive progress in certain high-risk counties. A reduction in cases of and deaths from measles In 1998 it was estimated that the global coverage of the measles vaccine had reached 75%, and the number of reported cases fell from 4 billion (4 thousand million) in 1980 to fewer than 1 billion in 1998 and is now 900 000 deaths per year. For many countries where the measles vaccine was not introduced until 1985, however, the disease reduction goals will be hard to reach. Since then, although the global numbers of reported measles cases have fallen, high transmission rates are still found in densely populated areas. This means that uniform measles vaccine coverage is necessary, especially when the one dose schedule is used. Mass campaigns in the Americas have resulted in the virtual disappearance of measles from the continents. Accelerated introduction of new vaccines One of the current priority areas of work for the immunization programme is to introduce new vaccines into the world’s poorest countries with a special emphasis on introducing Hepatitis B vaccine. Module 2 Page 51 Page 52 Appendix 1 The immunization centre safe vaccine storage protocol Aims and objectives 1. All vaccines delivered to the Immunization Centre are accepted in the knowledge that they have been transported safely. All vaccines accepted are stored within the recommended manufacturer guidelines (usually between 2–8° C). All equipment used for vaccine storage should be of an acceptable standard and regularly maintained. Procedures for vaccine administration should maintain the cold chain at all times thus offering maximum efficacy. Staff involved All staff at the immunization centre should be aware of the importance of the safe storage of vaccines and the maintenance of the cold chain. One person is designated to be the overall responsible person for this and in her/his absence the deputy is responsible. Module 2 Page 53 Appendix 1 (continued) Responsibilities of the vaccine coordinator 1. Vaccine delivery: • Ensure that the delivery has taken no more than 48 hours • Place the vaccines in the refrigerator immediately • Ensure the delivery contents are correct 2. Vaccine storage: • Ensure the vaccine storage refrigerator is used for storage of vaccines only • Ensure the refrigerator is maintained regularly • The refrigerator should ideally be a self defrosting model • The maximum/minimum thermometer should be placed in the centre of the middle shelf so that it can measure the core temperature • The thermometer should be read and recorded daily • The temperature should usually be maintained between 2–8° C. Vaccine stocks: • The refrigerator should be stocked so that air can easily circulate internally, care should be taken to prevent over stocking • Ensure that sufficient stock is available to meet the demand • Vaccines should not be stored in the refrigerator door Staff Training All staff should be aware of the importance of maintaining the cold chain. The vaccine coordinator should ensure that all staff have access to information on the safe and effective storage of vaccines. Diarrhoea is the most common and the resultant dehydration is responsible for serious morbidity and mortality. Increased knowledge and awareness will lead to: • greater awareness of prevention measures; • early recognition of clinical signs and symptoms; • prompt and effective intervention, treatment and nursing care, and • improved public health measures. Dehydration is the main cause • Failing to continue breastfeeding until at least of death from acute diarrhoea although other one year of age: prolonged breastfeeding reduces important causes are septic shock, peritonitis and the incidence or severity malnutrition. The patient with diarrhoea not only of certain types of eats less, but also has an inability to absorb nutrients diseases causing at a time when nutrients are more in demand as a diarrhoea, such as result of the infection.

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Wheezes and rhonchi are more continuous sounds which last notably longer than crackles and have more of a musical quality to them discount 80 mg verapamil visa. Wheezes are relatively high pitched with a hissing proven 80 mg verapamil, shrill-like quality trusted verapamil 80 mg, whereas purchase verapamil 240 mg on line, rhonchi are more relatively low pitched with a snoring quality. When these continuous sounds are heard, it suggests a narrowing of the air passageways which can be due to a tumor, foreign body, or more generalized situations such as bronchospasm, accumulated secretions or edema of the bronchial mucosa. A stethoscope with both a diaphragm and bell piece will be needed for this examination. Inspection and palpation are performed to determine the presence and extent of normal and abnormal pulsations over the precordium (area of the chest directly over the heart). They may be manifested as the apex beat over the heart area on the chest or as heaves or lifts of the chest as the heart beats. Five prominent areas to become familiar with in describing the heart assessment findings are: right 2nd interspace, left 2nd interspace, left sternal border or right ventricular area, apex or left ventricular area, and the epigastric area. Auscultation is done at the five areas just mentioned as well as in other areas as well. The stethoscope diaphragm is used to detect the high-pitched sounds, like the first and second heart sounds, or S1 and S2, murmurs, and pericardial friction rubs. The bell piece is more likely to detect the more low pitched sounds like the third and fourth heart sounds, or S3 and S4, and other murmurs. The examiner should listen at each of the five areas, paying particular attention to the location and intensity of each sound, and for the presence of any "splitting" of the sounds. Sounds that are heard in between the regular heart sounds may be accentuated by having the patient sit up, lean forward, exhale completely and stop breathing momentarily in expiration. Allow the patient to breathe normally, periodically catching his breath throughout the exam. Abdomen: The abdomen is best assessed with the patient in the supine position (lying on the back) with an empty bladder. Taking the time to make the patient as relaxed as possible will facilitate the examination. Examination for symmetry, distention, masses, skin condition (striae or stretch marks, color, scars, venous patterns, condition of the umbilicus), effect of respirations on abdominal movement, and visible peristalsis is included. Auscultation is employed next before palpation or percussion which may stimulate peristalsis. The examiner should listen with the diaphragm piece in all four quadrants of the abdomen. The examiner should listen for the presence or absence of peristaltic sounds, and, vascular sounds. The sounds of air and fluid moving through the gastrointestinal tract are easily audible and produce high pitched, gurgling noises about every five to 15 seconds. First, light palpation is used to identify muscle resistance, abdominal tenderness and some superficial organs and masses. Percussion is employed to detect fluid, gaseous distention, and to assess the more solid structures in the abdominal cavity, such as the liver and spleen. Tympany (a low-pitched, drum like sound) is the characteristic sound of abdominal percussion. Musculoskeletal system: The musculoskeletal assessment is an evaluation of the function and structure of the human body. The ability of the body to move is dependent upon the joints and muscles being able to execute the full range of motion for each particular joint. The examiner should note the coordination, speed, strength of motion, and any clumsy, awkward, or involuntary motions. Inspection includes noting symmetry, contour, size, gross deformities, any swelling or edema, painful areas, ecchymoses (bruises), and general posture and body alignment. Beginning with the head and neck area, the temporomandibular joint and the cervical spine can be assessed with the patient sitting up. The hands, fingers, elbows, shoulders and related structures are assessed by putting each joint through a full range of motion. One side of the patient is compared with the other to note asymmetry and to identify abnormalities. The ankles and feet, knees and hips are also assessed for full range 1-12 of motion. The assessment includes palpation of the joints; if pain is present, the painful and tender joints are palpated lightly. The usual sequence for performing the assessment of the joints is inspection, palpation, range of active and passive motion, and muscle strength testing. Also, some portions of the neurological assessment can be included in the assessment of other systems, such as the musculoskeletal system. Generally, the neurological assessment can be organized into the following: mental status and speech, cranial nerves, motor system, sensory system, and reflexes. A tool used is the Glasgow coma scale, which describes the state of consciousness during or following coma. The examiner can observe the patient during portions preceding the actual examination for assessment of some of the cranial nerves. The motor system can be screened by observing for involuntary movements or abnormal positions, observing for muscle bulk, assessing the muscle tone, and testing for rapid alternating movements in the hands. The sensory assessment includes checking for pain and temperature in the hands and feet, position and vibration in the hands and feet, and comparing light touch in both arms and both legs. Reflexes are assessed by striking over the tendon briskly and observing the response elicited. The commonly tested deep tendon reflexes include: biceps, triceps, abdominal, knee, ankle, and plantar. Reflexes can be graded on a 0 to 4+ scale; 4+ indicating a very brisk hyperactive response, 3+ indicating a brisker than average response, 2+ indicating an average or normal response, 1+ indicating a diminished, low normal response, and 0 is the absence of any response. Genitalia: Except when specifically related to the chief complaint, the genitalia exam would usually not be expected to be done at sea aboard a vessel. If rape or sexual assault is reported, forensic, as well as medical, issues must be considered. Assessment Summary: Once the health care provider completes the history and physical assessment, it is necessary to review all notations and to devise a list of all significant problems identified during this process. This final problem list or summary of problems are known as the assessment summary and usually is written as the final section of the health assessment. The assessment summary assists the health care provider in determining what the health care problems are, and what actions to take to resolve them. However, the availability of adequate fluids is essential to maintain normal body functioning.

At this stage verapamil 80mg low price, individuals may: » Need round-the-clock assistance with daily activities and personal care 120 mg verapamil mastercard. But drugs and non-drug treatments may help with both cognitive and behavioral symptoms order verapamil 120mg fast delivery. A comprehensive care plan for Alzheimer’s disease: » Considers appropriate treatment options generic 240 mg verapamil. By keeping levels of acetylcholine high, these drugs support communication among nerve cells. Three cholinesterase inhibitors are commonly prescribed: » Donepezil (Aricept®), approved in 1996 to treat mild-to-moderate Alzheimer’s and in 2006 for the severe stage. The second type of drug works by regulating the activity of glutamate, a different messenger chemical involved in information processing: » Memantine (Namenda®), approved in 2003 for moderate-to-severe stages, is the only drug in this class currently available. The third type is a combination of cholinesterase inhibitor and a glutamate regulator: » Donepezil and memantine (Namzaric®), approved in 2014 for moderate-to-severe stages. While they may temporarily help symptoms, they do not slow or stop the brain changes that cause Alzheimer’s to become more severe over time. Behavioral symptoms Many find behavioral changes, like anxiety, agitation, aggression and sleep disturbances, to be the most challenging and distressing effect of Alzheimer’s disease. Other possible causes of behavioral symptoms include: » Drug side effects Side effects from prescription medications may be at work. Drug interactions may occur when taking multiple medications for several conditions. There are two types of treatments for behavioral symptoms: non-drug treatments and prescription medications. Non-drug treatments Steps to developing non-drug treatments include: » Identifying the symptom. Often the trigger is a change in the person’s environment, such as: » New caregivers. Because people with Alzheimer’s gradually lose the ability to communicate, it is important to regularly monitor their comfort and anticipate their needs. Prescription medications Medications can be effective in managing some behavioral symptoms, but they must be used carefully and are most effective when combined with non-drug treatments. Medications should target specific symptoms so that response to treatment can be monitored. Use of drugs for behavioral and psychiatric symptoms should be closely supervised. Some medications, called psychotropic medications (antipsychotics, antidepressants, anti-convulsants and others), are associated with an increased risk of serious side effects. These drugs should only be considered when non-pharmacological approaches are unsuccessful in reducing dementia-related behaviors that are causing physical harm to the person with dementia or his or her caregivers. Behavioral: A group of additional symptoms that occur — at least to some degree — in many individuals with Alzheimer’s. Early on, people may experience personality changes such as irritability, anxiety or depression. In later stages, individuals may develop sleep disturbances; agitation (physical or verbal aggression, general emotional distress, restlessness, pacing, shredding paper or tissues, yelling); delusions (firmly held belief in things that are not real); or hallucinations (seeing, hearing or feeling things that are not there). Non-drug: A treatment other than medication that helps relieve symptoms of Alzheimer’s disease. Since 1982, we have awarded over $350 million to more than 2,300 research investigations worldwide. Alois Alzheimer first described the disease in 1906, a person in the United States lived an average of about 50 years. As a result, the disease was considered rare and attracted little scientific interest. That attitude changed as the average life span increased and scientists began to realize how often Alzheimer’s strikes people in their 70s and 80s. The Centers for Disease Control and Prevention recently estimated the average life expectancy to be 78. Today, Alzheimer’s is at the forefront of biomedical research, with 90 percent of what we know discovered in the last 20 years. Some of the most remarkable progress has shed light on how Alzheimer’s affects the brain. Clinical studies drive progress Scientists are constantly working to advance our understanding of Alzheimer’s. But without clinical research and the help of human volunteers, we cannot treat, prevent or cure Alzheimer’s. Clinical trials test new interventions or drugs to prevent, detect or treat disease for safety and effectiveness. Clinical studies are any type of clinical research involving people and those that look at other aspects of care, such as improving quality of life. Every clinical trial or study contributes valuable knowledge, regardless if favorable results are achieved. This protein fragment builds up into the plaques considered to be one hallmark of Alzheimer’s disease. Researchers have developed several ways to clear beta-amyloid from the brain or prevent it from clumping together into plaques. We don’t yet know which of these strategies may work, but scientists say that with the necessary funding, the outlook is good for developing treatments that slow or stop Alzheimer’s. This connection makes sense, because the brain is nourished by one of the body’s richest networks of blood vessels, and the heart is responsible for pumping blood through these blood vessels to the brain. It’s especially important for people to do everything they can to keep weight, blood pressure, cholesterol and blood sugar within recommended ranges to reduce the risk of heart disease, stroke and diabetes. Eating a diet low in saturated fats and rich in fruits and vegetables, exercising regularly, and staying mentally and socially active may all help protect the brain. Our mission is to eliminate Alzheimer’s disease through the advancement of research; to provide and enhance care and support for all afected; and to reduce the risk of dementia through the promotion of brain health. Such distribution does not constitute an endorsement of these parties or their activities by the Alzheimer’s Association. All Nature of the disease process 22 reasonable precautions have been taken to ensure accuracy of all information in this publication. Oral cancer The designations employed and the presentation of the material in this publication do not imply the expression of any Burden of the disease 26 Patient testimonies / What can be done? The terms ‘low-, middle- and high-income Noma 32 country’ used in this publication follow the defnitions of the World Bank Group. Impact of oral diseases 54 Access to oral healthcare 56 Suggested citation: The Challenge of Oral Disease – A call for global action. Prevention of tooth decay A prerequisite of progress towards optimal oral health is to understand where we stand today.

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