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By K. Karlen. Pacific Lutheran University. 2018.

The recommendation for a higher than normal folic acid supplement is based upon the higher incidence of neural tube defects in infants born to women with diabetes buy 20 mg cialis soft mastercard erectile dysfunction pills nz. In gestational diabetes there is evidence to suggest that dietary strategies focusing on low glycaemic index carbohydrates may offer improved glycaemic control [193] cheap cialis soft 20 mg line erectile dysfunction hiv. Although it has been suggested that nutritional supplements might reduce this risk, there is no evidence to support this viewpoint [194, 195]. Recommendations for postnatal care • Women who are breastfeeding and managing their diabetes with insulin should decrease their insulin dose, consume additional carbohydrate, test more frequently and have hypoglycaemia treatment close to hand. Breastfeeding may precipitate hypoglycaemia and requires increased frequency of glucose testing, an increased carbohydrate intake and a reduced insulin dose. However, the protective effects of breastfeeding on the infant and mother, both initially and in terms of chronic disease risk reduction, suggest that where possible it should be encouraged. Gestational diabetes is a strong predictor of future gestational diabetes and Type 2 diabetes, and women should be encouraged to follow a healthy lifestyle and consider weight management if appropriate after giving birth [193]. Therefore, expert opinion suggests lifestyle intervention, as advised for the general diabetes population, should be the primary treatment [202]. Evidence-based nutrition guidelines for the prevention and management of diabetes 29 Additional considerations • Meals and snacks should be made available around appropriate timing of medications. Practitioners should be aware that many people with diabetes may choose to fast for their own personal, spiritual or religious reasons despite being exempt. Little evidence is available on which to make recommendations about fasting and most of it usually focuses on Ramadan [209], so consensus guidelines have been formulated: • Fasting can be safe if a specifc individual care plan is put in place that considers adjustments to timing and dosing of medication, frequent blood glucose monitoring and food and drink choices that are made when breaking the fast. The deliberate omission of insulin to aid weight loss has serious consequences [214] and is referred to as diabulimia in the media. Eating disorders also co-exist with Type 2 diabetes, where binge eating seems to be most prevalent among younger women [215]. Most eating disorder guidelines support a multidisciplinary approach and if healthcare professionals involved with diabetes care feel ill-equipped to deal with patients who have eating disorders [217] they should refer the patient to eating disorder units (see signpost). However, there is no clear evidence of beneft from vitamin or mineral supplementation in people with diabetes (compared with the general population), who do not have underlying defciencies. There are varying degrees of evidence from a range of studies looking into other supplements and functional foods. More robust research is required into micronutrients, supplements and functional foods before further recommendations about safety and effectiveness can be made. Individuals choosing to or considering using supplements or functional foods should be encouraged to discuss their individual needs with a registered dietitian or medical practitioner taking into account safety and risks. Consensus Recommendations for Diabetic Foods • People with diabetes are not advised to purchase ‘diabetic’ foods. Some confectionery, biscuits and bakery products are labelled as ‘diabetic’ and usually contain polyols as a substitute for sucrose. They are available in a variety of high street outlets including supermarkets, pharmacies,health food shops and from the internet. In 2008 a report from the Commission on ‘diabetic’ foods [218] concluded • people with diabetes should be able to meet their dietary needs by appropriate selection from everyday foods. They tend to cost more than standard products and this is an issue for those people who are affected by deprivation whom are at a greater risk of developing Type 2 diabetes. There is no evidence that the small amount used in these products benefts blood glucose control or weight. It is not exactly clear how polyols should be ‘counted’ by people who are adjusting their insulin dose according to the amount of carbohydrate they consume, as not all the carbohydrate from polyols is absorbed. The evidence was reviewed and the recommendations were linked to the evidence supporting them and graded according to the level of evidence upon which they were based, using the grading system below. Recommendations for nutrition management and models of education • Nutrition therapy is effective in people with diabetes and those at high risk of diabetes when it is an integrated component of education and clinical care. Recommendations for prevention of Type 2 diabetes in high risk groups • Weight loss is the most important predictor of risk reduction for Type 2 diabetes.

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La causa principal de la trombosis arterial periférica es por tanto la ateroesclerosis obliterante order 20mg cialis soft amex erectile dysfunction wife, pero también puede ser la trombosis de un aneurisma order 20 mg cialis soft fast delivery impotence guide, ya sea de la aorta abdominal, o de la arteria poplítea, por mencionar sus localizaciones más frecuentes. El cuadro clínico no es tan florido como el de la embolia, por cuanto durante el tiempo de la enfermedad arterial periférica, se han ido formando colaterales que no existen en el cuadro de embolia. Aquí también se ponen de manifiesto el dolor, la palidez, la frialdad, la impotencia funcional, pero más atenuados. Traumatismos arteriales y ligaduras Las arterias también sufren de traumatismos, contusos y cerrados, o que rompen la continuidad de su pared. Existe un grupo producido por iatrogenias al realizar punciones arteriales para estudios angiográficos o al lesionar o ligar alguna arteria importante en el curso de intervenciones quirúrgicas. En estos casos los síntomas se parecen mucho a la embolia, es decir, el dolor es intenso, la palidez y le frialdad, cadavéricas; la impotencia funcional y la ausencia de pulsos distales a la lesión. En los traumatismos se evidencia fácilmente el antecedente y en general no están enfermos ni el corazón, ni las arterias. Cuando hay rotura de la pared arterial y hemorragia importante, el cuadro de estado de choque es prioritario al estado local de la extremidad. Las prioridades son de forma escalonada: salvar la vida, salvar la anatomía de la extremidad y salvar su función (Capítulo 14). Hematoma disecante de la aorta Este cuadro clínico se presenta en pacientes con antecedentes de hipertensión severa, principalmente en hombres de la raza negra. Es un grave cuadro clínico que semeja simultáneamente un infarto cardíaco, pues casi siempre la disección se inicia por encima de las válvulas sigmoideas, en la propia raíz de la aorta, y una isquemia aguda de una o más localizaciones. La isquemia aguda en la extremidad suele ser: - Fugaz (ahora es evidente y en unos minutos desaparece) - Migratriz (ahora en una extremidad, luego en otra) - Incompleta (falta alguno de los signos o síntomas) - Múltiple (dos localizaciones o más: cerebral y extremidad, dos extremidades, tres, etc. Es fácil cuando se realiza una buena anamnesis y se examina integralmente al paciente. Diagnóstico diferencial El diagnóstico diferencial debe realizarse primero entre las diferentes causas. En la embolia generalmente hay antecedentes de enfermedad cardíaca conocida, principalmente la fibrilación auricular y el cuadro clínico es muy florido. El paciente suele demorar la búsqueda de atención médica, lo que no ocurre en la embolia. Ante un traumatismo arterial el cuadro es evidente por el antecedente: accidente de tránsito, del hogar, quirúrgico o de ligaduras. Si ha habido sangramiento el cuadro general de hipotensión, pulso filiforme, hasta el estado de choque dominan el cuadro clínico y no puede precisarse la intensidad de la insuficiencia arterial regional, en la extremidad, hasta tanto el enfermo no se estabilice su hemodinamia. En el hematoma disecante de la aorta, el paciente es un hipertenso, una embarazada, o portador de enfermedad de Marfán. Cursa con dolor retroesternal, sensación de muerte inminente, como el de un infarto cardíaco y el cuadro de isquemia que provoca se caracteriza por ser: fugaz, migratriz, incompleta o múltiple. También debe hacerse el diagnóstico diferencial con otras enfermedades en las extremidades: 1. En ella existe el antecedente de estrés trombógeno, el enfermo tiene intranquilidad, edema de la extremidad, dolor a la compresión de las masas musculares y a la palpación de los trayectos vasculares. Dado el dolor intenso que produce en la extremidad deben descartarse de igual manera la ciática y la sepsis por clostridios, mal llamada gangrena gaseosa. Electroencefalograma: Buscar enfermedad cardíaca, arritmias, infartos antiguos, en particular fibrilación auricular. Conocer el estado de la raíz de la aorta y del área cardíaca permiten apoyar o descartar el hematoma disecante de la aorta. Definirá eventuales áreas de hipoquinesia cardíaca, disfunciones valvulares, vegetaciones, presencia de trombos en el interior del corazón, tumores cardíacos como el mixoma, disección en la raíz de la aorta con imagen de doble luz. Estudio invasivo con introducción de catéteres e inyección de sustancia yodada de contraste, obtenido por cine o video, que permite definiciones extraordinarias de qué está sucediendo y cómo planificar el tratamiento, eventualmente quirúrgico. Registro de la imagen del vaso y del sonido y la dirección del flujo sanguíneo en su interior. Gasometría Evolución Cuando se realiza el diagnóstico tempranamente y se impone el tratamiento sin demoras, antes de las 6 horas de haberse iniciado el cuadro clínico, la evolución es favorable.

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These are the ‘micronutrients’ that are necessary to help the body in all its functions order cialis soft 20mg with mastercard erectile dysfunction pills cost, including reproduction purchase cialis soft 20mg overnight delivery erectile dysfunction blogs, and to make sure that it can fight infection. People need micronutrients so they can use their brains and have the energy to keep their body working as well as possible. Your job as a Health Extension Practitioner will involve helping people to understand the importance of these components in a diverse diet. Among these micronutrients, three have obtained worldwide attention due to their high public health significance. If people don’tgetsufficient vitamin A, iodine and iron, this can lead to grave health as well as social and economic consequences. In this session you will learn more about these micronutrients, as well as the extent and consequences of their deficiency. You will also learn how to prevent and treat the major micronutrient deficiencies in your community. Learning Outcomes for Study Session 7 When you have studied this session, you should be able to: 7. Vitamins are necessary in small amounts in our diet to facilitate growth, maintenance of health and reproduction. Although minerals make up only a small portion of body tissues, they are essential for normal growth and functioning. Because only very minute quantities of vitamins and minerals are needed for health, they are called micronutrients. These elements are essential; they cannot be manufactured by the human body and must be obtained through 79 dietary means. Among these micronutrients, three have obtained worldwide attention and are the focus of this study session due to their high public health significance. Vitamin A, iodine and iron deficiencies lead to grave health, social and economic consequences; but the good news is that there are cost- effective strategies to overcome these deficiencies. You can also work with the women in your village to help identify potential problems and families who need support. The overall goals and objectives of the prevention and treatment of micronutrient deficiencies in Ethiopian are shown in Box 7. To increase coverage of the programmes that improve the micronutrient status of the population. In Ethiopia, one out of every 1000 people is affected and about 50,000 prenatal deaths occur yearly due to iodine deficiency disorder. This is in part because of the marked decrease in the amount of iodised salt being consumed in Ethiopian households compared with a decade ago. Anaemia is a widespread health problem affecting more than two billion people worldwide — one third of the world’s population. More than half 80 Study Session 7 Preventing Micronutrient Problems in Ethiopia (54%) of Ethiopian children age 6-9 months and 27 % of Ethiopian women aged 15-49 are anaemic (mainly due to low blood iron status). Iron deficiency can delay muscular and nervous system development and mental performance, especially in preschool age children. In adults, anaemia reduces work capacity, mental performance and reduces tolerance to infections. Iron deficiency anaemia can also cause increased maternal mortality due to bleeding problems. Maternal anaemia can lead to prenatal infant loss, low birth weight, and pre-term births. Ask teachers if there are children who miss school (children with anaemia may be too tired to attend). Ask family members if there are mothers and children who find it difficult to see after dusk and if children frequently get sick (possible signs of vitamin A deficiency). Ask community leaders/families if there are any children/adolescents who have swelling in front neck area (goitre: a sign of iodine deficiency).

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Important Guidelines for Printing and Photocopying Limited permission is granted free of charge to print or photocopy all pages of this publication for educational cialis soft 20mg fast delivery erectile dysfunction cures over the counter, not-for-profit use by health care workers cialis soft 20mg sale tobacco causes erectile dysfunction, students or faculty. Under no circumstances is it permissible to sell or distribute on a commercial basis, or to claim authorship of, copies of material reproduced from this publication. Except as expressly provided above, no part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission of the author or authors. This material is intended for educational use only by practicing health care workers or students and faculty in a health care field. Nuclear family is defined as ‘’ a family consisting of a married couples and their children; the children can be born or adopted’’. For practical reasons, it may be sound to distinguish: ♦ The childbearing unit, nuclear or one parent family, where the genetic factors are prominent. It could be defined as: A quality of life, which involves social, mental and biological fitness on the part of the individual, which results from adaptations to the environment. The summary of different views conceptualises health to be multidimensional and inclusive of many components and many different aspects of one’s life. We can consider health as a quality of life that is a function of at least social, mental, emotional, spiritual and physical health. Justification Knowledge acquired in the past few decades has clarified the biological and social bases underlying the health and health care of families. This represents the image of a healthy family – the only real basis for the self-realization of all its members. This approach also takes account of the patterns of intra-family relationships in regard to disease prevention, health education and health care. The cause and factors to maternal morbidity and mortality could be: Medical Factors ♦ Anaemia of pregnancy ♦ Obstructed labour ♦ Infections ♦ Hypertension 9 Family Health Health delivery system factors ♦ Inadequate action taken by health personnel ♦ Lack of essential supply and trained staff. The fertilized ovum gradually grows and develops in the uterus of the woman and transforms itself into a foetus. Antenatal service is the provision of counselling and health service to a pregnant woman by a health professional from the time of conception to delivery. The medical check up made during pregnancy helps mothers to get advices during pregnancy and post delivery periods. The following are the activities that would be undertaken during first antenatal visit: Registration of age, height, weight, last day of menstruation. Other information that would be collected from the mother are, number of children born, where they were born, previous health problems, information whether she ever taken vaccination or not. After these and other information are collected, and when there are some indications for risks during pregnancy and delivery, the mother should be educated about the need for her to go to the next higher 13 Family Health level of health facility. Unless these illnesses are known on time and the necessary care is taken, the illnesses can lead to life threatening risks. The signs of such illness are the following: - Puffiness/ oedema of the face especially around the eye. When the following signs are observed, the woman should be immediately referred to a health facility since this will lead her to dangerous situations. She needs to regularly and attentively feed herself with cereals, vegetables, fruits, milk, meat, pulses, butter, and cereals with fat contents. If she cannot get these food items, she should be educated on the use of other food items that replace those ones. Regular antenatal follow up It is proposed that there should be: ♦ Nine visits for the healthy nulliparous ♦ Seven visits for the healthy parous Actual visit is – Once per month up to 28 weeks (that is four times) • Twice per week up to 32 weeks (four times) • Then once per week till delivery. Health care providers can also help to detect and manage any warning signs that might occur during pregnancy. Personal hygiene A pregnant woman must keep her personal hygiene more than ever since the body easily gets dirty at this period than at other times; because much waste is disposed as sweat through the body skin. Nevertheless, she should not lift heavy material, should not travel long distance by foot and perform heavy duties. Vaccination against tetanus Tetanus vaccination, given to the pregnant women, will help to prevent the new born from acquiring tetanus. The importance of this vaccine has to be explained to pregnant women and to all women of childbearing age. Pregnant women should eat foods rich in protein (eggs, milk and milk products, Soya bean, beans and lean meats), Calcium (dairy products, green leafy vegetables, fish), iron and folic acid (lean meat, legumes, green leafy vegetables, egg yolk). However, women with certain medical conditions, high-risk pregnancies, or other complications may need to decrease working hours or discontinue working altogether.

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