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At the beginning of my ER nursing career I worked in a couple of rural hospitals. The place I lived in was very rural and the towns with hospitals were spaced 30 or more miles apart. There was no such thing as diversion, you just dealt with what you got. Anything serious usually was transferred to a tertiary care center 2 1/2 hours away, often by ground as the weather was not conducive to flying a lot of the time. It was the 3 - 11 shift in our ten-bed ER. We were staffed with three RN's. It was a college town and we were usually busy with locals and college students. The ER was packed that night. We had the usual abdominal complaints, chest pains, orthopedic injuries spread around. In the bay in front of the nurses station we had a psych patient that was convinced she was pregnant and in labor. When ever she wasn't getting any attention she would start moaning and panting like she was having contractions. Never a dull moment. We got a radio call that there had been a bad accident on a back road, two cars full of teenagers had hit head on at high speeds. Two were dead at the scene and they were bringing us the other 5. Five traumas in an ER staffed with one doc and three nurses! Yikes! Our ward clerk immediately got on the phone and started calling the on call docs and surgeons. It was bad, all five had serious injuries. Two of them obviously had bad head injuries. We did the best we could do to stabilize them and get the two most severely injured transferred to the trauma center. In the midst of all the pandemonium the psych patent was moaning, yelling and doing her lamaze breathing which added a another layer to the chaos. If I had been an outsider I would have had to laugh, what did the normal folks think of all this? Only in the ER. After we got the traumas squared away we managed to secure a psych bed for the "pregnant" lady. By then the shift was over. No breaks, no dinner, not even time to pee. Ah....the life of an ER nurse.

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10 26 05 Hello: This will be a light post. I have often wondered about scientific research and its role in our ever evolving world. Should the government sponsor scientific research? Or should it all be profit driven? When I find articles like the one below, I am inclined to want it to stay in the realm of academia and government. Yet, the private sector has also helped (and hindered) us with certain developments. Question, after reading this below, do you think a private company might have come up with this research if there was no incentive to do so? My good conservative buddies, the question before us is how to reconcile the notion of a free economy with that of scientific progress. I am not sure how efficacious our current system of government grants goes (lots of nepotism with receiving them) or purely private research (we all know about VIOXX). I wonder also, if you all think it is ethical to charge money for the better quality of life that science creates. And lastly, whatdya think of this stuff? Cool huh! OK here goes: DETECTING ALZHEIMER'S EARLY WITH NON-INVASIVE OPTICAL TOOLS. Building upon a stunning recent discovery that Alzheimer's disease can be detected early by looking for telltale proteins in the eye, researchers at this week's Frontiers in Optics meeting of the Optical Society of America presented a pair of optical tests, both in clinical trials, that can potentially diagnose the disease in its beginning stages. Such tests may not only improve patients' chances to start treatment earlier, but they could also speed development of new Alzheimer's drugs. Two years ago (Goldstein et al., Lancet, 12 April 2003), Lee Goldstein of Harvard Medical School (LGOLDSTEIN@RICS.BWH.HARVARD.EDU) and his colleagues showed that the exact same amyloid beta proteins which are a hallmark of Alzheimer's disease are also found in the lens and its surrounding fluid. In those portions of the eye, the proteins form amyloid deposits similar to those in the brain. Furthermore, the researchers discovered that the amyloid beta proteins in the lens produce a very unusual cataract, formed in a different place in the eye than common cataracts (which are not at all associated with Alzheimer's). Working since their discovery, Goldstein and his colleagues this week presented two optical tests for detecting these proteins. Using a technique known as quasi-elastic light scattering, the first test employs low-power infrared laser light to non-invasively detect protein particles in the specific part of the lens where these unusual cataracts form. The second test would be applied to those who screen positively for the proteins, in order to confirm an Alzheimer's diagnosis. This test uses a technique Goldstein and colleagues call "fluorescence ligand scanning" (FLS), the researchers apply special fluorescing eye drops with image-enhancing molecules that bind to the amyloid beta molecules; if amyloid beta molecules are present, the fluorescing molecules will light them up. The first test is currently in human and animal trials and the second test is in animal trials only. These two diagnostic tests are envisioned to be a two-step process for screening and then confirming an Alzheimer's diagnosis. These new optical tools can also potentially speed up the development of new Alzheimer's drugs, by giving investigators rapid feedback on whether the drug is doing its job of removing the harmful proteins from the body. Moreover, the researchers are using the same technologies to develop new tests for rapidly detecting amyloid plaques resulting from prion diseases, including mad cow, scrapie in sheep, and Creutzfeldt-Jacob disease in humans. ( http://www.osa.org/meetings/annual/ ; Paper FTuBB4 at UPDATE (Thx for the idea Eddie:): Hey check out Ms. Chatterbox on www.chatterboxchronicles.blogspot.com. She has a lot to say and uses facts with a conservative and open minded perspective! I guarantee you will enjoy the visit! :) You guys oughta see this leftist radical feminist site. Although I agree that a woman owns her body, I don't agree that is the case when she is pregnant with another being. http://the-goddess.org/wam/blog.html . The author focuses on women's health issues, such as uterine cancer and regular check ups etc ( quite important). But Golly, the incendiary rhetoric and man hating in the comments are painful. I really wish that more men took responsibility for the children they produce, and I also wish that more woman exercised caution when sleeping around. Let's be honest; it takes two to tango! Oh, I usually was a guest poster on Wednesdays on www.dellgines.com. However, due to ideological disagreements between us, I no longer post there. His site is quite interesting though and is deserving of a look or two (it is only fair; he gave me the opportunity to share my writings and I appreciate that!) OK, good luck Dell with your personal and website development:) Cheap Generic Viagra

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Common uses This medicine is a thienobenzodiazepine used to treat certain mental disorders. Before using Some medicines or medical conditions may interact with this medicine. Inform your doctor or pharmacist of all prescription and over-the-counter medicine that you are taking. Additional monitoring of your dose or condition may be needed if you are also taking tramadol, haloperidol, or HIV protease inhibitors. Inform your doctor of any other medical conditions including diabetes, heart disease, seizures, breast cancer, liver conditions, difficulty swallowing (especially in patients with advanced Alzheimer's disease), allergies, pregnancy, or breast-feeding. Contact your doctor or pharmacist if you have any questions or concerns about using this medicine. Directions Follow the directions for using this medicine provided by your doctor. This medicine may be taken on an empty stomach or with food. If you miss a dose of this medicine, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once. Store this medicine at room temperature in a tightly-closed container, away from heat and light. Cautions Do not take this medicine if you have had an allergic reaction to it or are allergic to any ingredient in this product. Do not stop using this medicine without first checking with your doctor. Do not exceed the recommended dose without checking with your doctor. Keep all doctor and laboratory appointments while you are taking this medicine. Laboratory and/or medical tests, such as fasting blood sugar levels, may be done to monitor your progress or to check for side effects. This medicine may cause dizziness. Using this medicine alone, with other medicines, or with alcohol may lessen your ability to drive or to perform other potentially dangerous tasks. Ask your doctor or pharmacist if you have questions about which medicines cause dizziness. Alcohol, hot weather, exercise, and fever can increase dizziness. To prevent dizziness or fainting, sit up or stand slowly, especially in the morning. Also, sit or lie down at the first sign of dizziness or weakness. Do not become overheated in hot weather or during exercise or other activities since risk of heatstroke may be increased. This medicine may increase your risk of developing diabetes, or increase blood sugar levels. High blood sugar levels can cause serious problems if left untreated. Contact your doctor for more information. Before you begin taking any new medicine, either prescription or over-the-counter, check with your doctor or pharmacist. For women: if you plan on becoming pregnant, discuss with your doctor the benefits and risks of using this medicine during pregnancy. It is unknown if this medicine is excreted in breast milk. Do not breast-feed while taking this medicine. Diabetics: this medicine may affect your blood sugar. Check blood sugar levels closely and ask your doctor before adjusting the dose of your diabetes medicine. Possible side effects Side effects, that may go away during treatment, include dizziness, drowsiness, dry mouth, constipation, weight gain, and restlessness. If they continue or are bothersome, check with your doctor. Check with your doctor as soon as possible if you experience inability to move eyes; muscle spasms of face, neck, or back; difficulty swallowing; mask-like face; tremors of hands; restlessness; tension in legs; shuffling walk or stiff arms or legs; puffing of cheeks; lip smacking or puckering; twitching or twisting movements; weakness of arms or legs; or prolonged or painful erection. Contact your doctor immediately if you develop symptoms of high blood sugar such as increased thirst, increased urination, or vision changes. An allergic reaction to this medicine is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include rash, itching, swelling, dizziness, or trouble breathing. If you notice other effects not listed above, contact your doctor, nurse, or pharmacist. If you take too much If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include fast/irregular heartbeat, agitation, severe drowsiness, difficulty speaking or slurred speech, muscle stiffness, and unconsciousness. Additional information Do not share this medicine with others for whom it was not prescribed. Do not use this medicine for other health conditions. Keep this medicine out of the reach of children. If using this medicine for an extended period of time, obtain refills before your supply runs out. Drug interactions Drug interactions can result in unwanted side effects or prevent a medicine from doing its job. Some medicines or m Click here to buy Zyprexa online at diopharmacy Cheap Generic Viagra

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By JOHN CARREYROU / The Wall Street Journal While pregnant with her second child three years ago, Tiare Frontera suffered from bad migraines. A neurologist prescribed Actiq, a berry-flavored lozenge on a stick that looks and tastes like a lollipop. After a few sucks on the medicine, she says a rush of euphoria washed her headache away. Soon, Mrs. Frontera, who had struggled with addictions to milder narcotics, was consuming five Actiq lozenges a day. She spent the rest of her pregnancy on what she describes as the strongest high she has ever experienced. When she gave birth, her baby son was cranky and wouldn’t sleep. Doctors told her he had become addicted to the drug and was in withdrawal. Mrs. Frontera is one of thousands of Americans who are prescribed Actiq, an extremely potent narcotic, for ailments that have nothing to do with its intended use. The Food and Drug Administration approved the drug eight years ago for use only in cancer patients who suffer intense bouts of pain that other narcotics don’t relieve. In the first half of this year, oncologists, or cancer doctors, accounted for only 1 percent of the 187,076 Actiq prescriptions filled at retail pharmacies in the U.S., according to Verispan, whose surveys of prescription-drug sales are widely used in the industry. Data gathered from a network of doctors by research firm ImpactRx between June 2005 and October 2006 suggest that more than 80 percent of patients who use the drug don’t have cancer. Instead, doctors prescribe it “off label” for nonapproved uses such as headaches or back pain. Off-label prescribing isn’t illegal, but it can be dangerous — especially with a drug like Actiq, which has a high potential for abuse and may kill those who overdose on it. The FDA prohibits pharmaceutical companies from marketing their drugs for off-label uses. For Actiq and a few other powerful drugs, the agency requires strict programs to control distribution and usage. Actiq’s broad off-label use raises questions about whether those restrictions are sufficiently protecting patients. “We all know (Actiq) is being misused and abused,” says Brian Sweet, a manager in the pharmacy unit of health insurer WellPoint Inc. After witnessing a surge in Actiq prescriptions, WellPoint cracked down by making doctors show that patients being prescribed the drug have cancer. Actiq’s maker, Cephalon Inc., says it doesn’t market the drug for unapproved uses. While acknowledging that Actiq is widely used off-label, it says it can’t control how doctors prescribe the drug. Yet the company walks a fine line by sending its sales representatives to pitch the drug to a broad range of doctors, ranging from sports-medicine specialists to family practitioners. It gives these doctors coupons for free samples. Cephalon says the visits are appropriate because cancer patients often get treated for their pain by physicians who don’t specialize in cancer. Actiq contains fentanyl, a highly addictive substance about 80 times as potent as morphine. Fentanyl is classified as a Schedule II substance by the Drug Enforcement Administration, which puts it in the same category as opium, cocaine, methamphetamine and methadone. Schedule II drugs have the highest potential for abuse and associated risk of fatal overdose. Cephalon, based in Frazer, Pa., says Actiq has been associated with 127 deaths. Two of them involved children who confused the drug for candy. Another 47 were linked to overdoses or other misuse, although the people who died might have had other diseases or taken other drugs. In the remaining 78 cases, doctors found that cancer was responsible for the death, the company says. Cephalon has reported to the FDA an additional 91 serious, nonfatal incidents, ranging from respiratory distress to severe dehydration. The U.S. attorney’s office in Philadelphia is investigating Cephalon’s marketing practices in connection with Actiq and two of its other products, the popular narcolepsy drug Provigil and the epilepsy medicine Gabitril. No charges have been filed. Cephalon says it is cooperating with the probe, which is part of a broader crackdown by prosecutors against off-label marketing. In August, the Justice Department fined Schering-Plough Corp. $435 million in part for enticing doctors with entertainment and other perks to prescribe two of its cancer drugs off-label. Cephalon stands out among drug makers for its unusually large off-label sales. Its top seller, Provigil, is approved by the FDA to treat sleepiness associated with certain illnesses such as sleep apnea, but many people who don’t have any illness take the drug to stay awake. Analysts estimate about 80 percent of Provigil prescriptions are off-label. Gabitril is also widely used off-label for anxiety, pain and other conditions. Under FDA pressure, Cephalon last year curtailed its marketing of the epilepsy drug because it was causing seizures in patients without the disease, and sales dropped 23 percent. Founded in 1987 by a former DuPont Co. scientist named Frank Baldino Jr., Cephalon expects revenue to exceed $1.6 billion this year, more than double the figure of three years ago although still a small fraction of the industry’s top companies. Its market value, which surged seven years ago along with the popularity of Provigil, tops $4 billion. Dr. Baldino earned $2.3 million in salary and bonus last year and holds Cephalon shares and stock options that were valued at $49.6 million as of the end of last year. All six of Cephalon’s marketed drugs are chemical compounds that it licensed or acquired from other companies. Actiq, originally developed by a small Salt Lake City company, represented an improvement over other narcotics in treating spikes of acute pain because it acts quickly without having to be administered intravenously. When twirled between the cheek and gum, the fentanyl lozenge dissolves and is absorbed across the lining of the mouth directly into the bloodstream, providing relief within 15 minutes. Actiq had sales of $15 million in 2000, when Cephalon acquired it. By last year, sales had grown to $412 million, making it Cephalon’s No. 2 drug. In the first nine months of this year, sales jumped to $471 million. Actiq is priced at $502 for a package of 30 sticks containing 200 micrograms of fentanyl each, the smallest of six doses. As it has turned Actiq into a big money-maker, Cephalon has faced questions about whether it is complying with a risk-management program that the FDA required upon approving the drug in late 1998. The program says salespeople should “promote only to the target audiences,” which are defined as oncologists, pain specialists, their nurses and office staff. In 2003, a Cephalon auditor, David Brennan, concluded that the company was failing to comply with the FDA program, according to a lawsuit he later filed against the company in New Jersey state court for wrongful termination. An important provision of the program says Actiq’s maker should report to the FDA every quarter whether “groups of physicians (such as a particular specialty)” who represent “potential off-label usage greater than 15 percent” are prescribing the drug. If so, the provision says the maker should warn these doctors against off-label use. Mr. Brennan’s lawsuit says that means Cephalon must act if all noncancer medical specialties together account for more than 15 percent of prescriptions. Cephalon interprets the provision differently. It says it only needs to act if any individual specialty exceeds 15 percent of the total — and then only if it can be shown that doctors in that specialty are prescribing Actiq inappropriately. Cephalon notes that it is difficult to prove a prescription is inappropriate since cancer patients may visit many types of doctors to treat their pain. It believes the 15 percent clause has yet to be triggered. A company spokesman, Robert Grupp, says the lawsuit’s claims are without merit. The FDA declined to comment. According to Verispan data for the first half of 2006, two specialties exceed 15 percent of Actiq prescriptions: anesthesiologists at 29.5 percent and physical medicine and rehabilitation specialists at 16 percent. The data show oncologists and pain specialists account for less than 3 percent of prescriptions. Cephalon doesn’t dispute the data. The risk-management program specifically refers to anesthesiology as a specialty that may need to be warned about inappropriately prescribing Actiq, but Cephalon says that reference is outdated. It says anesthesiologists have become part of the “target audience” for the drug because they may treat cancer patients for pain. Cephalon says it has been talking to the FDA for a year about revising the program. After Mr. Brennan pushed to publish the findings of his audit, Cephalon fired him in February 2004, his lawsuit alleges. Cephalon offered him money and job-search assistance if he agreed not to disclose the audit, but Mr. Brennan refused, the suit says. Mr. Grupp declined to discuss Mr. Brennan’s dismissal but noted that he is “a former disgruntled employee.” Mr. Brennan has been interviewed twice by investigators working for the U.S. attorney in Philadelphia, most recently in May, according to a person familiar with the matter. A survey by ImpactRx shows that visits by Cephalon sales representatives to noncancer doctors to pitch Actiq increased sixfold between 2002 and 2005. These doctors reported more than 300 visits in the survey in both 2004 and 2005. Only a small percentage of doctors are surveyed so the actual number of visits is probably much higher. Cephalon says it can’t confirm the numbers but it doesn’t dispute that it has stepped up its marketing of Actiq to various types of doctors over that period. Stephen Leighton, a general practitioner in Winston-Salem, N.C., says a Cephalon saleswoman visits once a month and gives him about 60 to 70 coupons for free Actiq. Patients can trade each coupon for six Actiq sticks. Dr. Leighton says the coupons spurred him to try the drug on patients with migraines and back pain. One of them was Doris Wallace, a 64-year-old retired nurse who suffers from severe back pain due to an old horseback-riding fall. Ms. Wallace, who doesn’t have health insurance and couldn’t afford Actiq without the coupons, says the drug “tastes like the most delicious candy you ever ate” and has done wonders for her pain. At the height of her use, she was consuming 24 Actiq sticks a month. The positive experience of patients like Ms. Wallace has led Dr. Leighton to prescribe Actiq more widely for different types of pain. Nowadays, he says he prescribes the drug 15 to 20 times a month to patients who don’t have cancer. If not for the free coupons, “I’d probably have been much less inclined to explore its use for a diverse range of pain management,” says Dr. Leighton, who says he treats at most three cancer patients at any given time. Dr. Leighton says he thinks the FDA-approved usage of Actiq is too narrow. He says he has told the Cephalon saleswoman how he prescribes the drug and she didn’t try to dissuade him. Mr. Grupp of Cephalon says Dr. Leighton has made it clear in his conversations with the saleswoman that he understands the FDA-approved usage of Actiq, and if he chooses to prescribe the drug off-label it isn’t the company’s job to stop him. Mr. Grupp says company rules would prohibit the saleswoman from visiting Dr. Leighton only if he never prescribed the drug for cancer pain. “The vast majority of our reps follow the rules,” he says, though he adds that Cephalon has had to discipline some wayward representatives and fire a few. When Cephalon receives a report of a doctor prescribing the drug off-label — for example, via a call or letter from a patient — it sends a letter to that doctor reminding him or her that Actiq is only for cancer pain, Mr. Grupp says. The company has sent more than 3,300 such letters, he says. Earlier this year, Dr. Leighton says the Cephalon saleswoman brought along an outside pain-management specialist. Over lunch, Dr. Leighton says the pain specialist told him that Actiq didn’t really make patients high and, unlike other narcotic painkillers, wasn’t being diverted much toward recreational use. Cephalon declined to comment on the conversation. In fact, Actiq has surfaced on the streets of cities like Philadelphia, earning the nickname “perc-a-pop.” Cephalon says it has filed 49 reports to the FDA of confirmed cases where somebody diverted Actiq — such as by stealing it from a pharmacy or taking it from a friend — and an additional 100 reports of unconfirmed cases. Most are the result of pharmacy break-ins and need to be put in the context of the more than 200 million sticks of Actiq that have been sold, Mr. Grupp says. Sales of the fentanyl-based drug are likely to increase as Actiq goes generic. In late September, Barr Pharmaceuticals Inc. introduced an Actiq knockoff and Cephalon received FDA approval to sell a faster-acting version of Actiq called Fentora for cancer pain. Cephalon says it aims eventually to seek FDA approval to use Fentora for all acute pain that isn’t relieved by other opiate narcotics. Mrs. Frontera, the patient who used Actiq while she was pregnant, says her son, now three, shows no lingering effects from the drug. Mrs. Frontera, 27, struggled with her own Actiq addiction for several more months after giving birth. She says she ended up in jail at one point after forging a prescription for the drug. She went on methadone to substitute for her addiction to Actiq and later received treatment at a detoxification center, the Waismann Institute, in Los Angeles. Now she lives in San Luis Obispo, Calif. “It makes me angry that it was prescribed to me,” she says of Actiq. “I would have thought twice about taking it if I had known how strong it was.” Philip Delio, the neurologist who prescribed Actiq to Mrs. Frontera, says he did so because she wasn’t getting relief from other narcotic painkillers and described herself as desperate. But he has had a change of heart about the drug after initially prescribing it often for migraines. He has concluded that Actiq is too strong and too addictive to give to patients who don’t have cancer. Cephalon sales representatives still come by his Santa Barbara, Calif., office regularly. But Dr. Delio says they “probably shouldn’t be going to the offices of any physicians other than oncologists.” Sphere: Related Content Cheap Generic Viagra

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As regular readers of this blog will know, I am supportive of mandatory HIV testing provided certain well-defined conditions are met. Stuart Rennie seems to disagree. Here I reproduce his take on the issue. It's well worth reading. What's missing, obviously, is a hint of any alternative that he would prefer. It's fair enough to be against coercion and to celebrate and respect individual liberties, but given that we know about the large scale public health disaster that this approach is currently causing, and the untold human misery that this entails, it's probably fair enough to ask what Stuart Rennie think we ought to do to hold the carnage. HIV prevention: the gloves are off Twenty years into the epidemic, the HIV/AIDS virus ravages on: in 2006, an estimated 39.5 million people in the world were living with HIV, 4.3 million were newly infected, and 2.9 million AIDS-related deaths. Of the deaths, 2.1 million occurred in sub-Saharan Africa. As for new HIV infections, South Africa alone is estimated to have 1500 ... per day. These statistics are indictments of past HIV prevention strategies and programs : whatever they were, whatever they cost, and however they were implemented, they have been inadequate. The question then becomes: what strategy changes should be adopted? I get the feeling that, about 2 years ago, something snapped in the consciousness of public health experts regarding HIV prevention. Enough was enough. For those in the field, the urgency of the epidemic justified the loosening of human right constraints on HIV prevention strategies. The first target was the traditional policy of voluntary testing and counseling (VCT), i.e. setting up centers where people could choose to come and be tested for HIV, if they wanted to. Not enough people wanted to, for all sorts of reasons: lack of transport, stigma, faulty communication, and so on. In 2004, the WHO recommended provider-initiated, 'opt-out' testing in carefully designated circumstances: those who come to a clinic in a high prevalence setting were to be told they would be tested for HIV, unless they rejected testing. The CDC soon followed suit with similar policies. In Botswana, this approach seemed to raise the number of persons who were tested for HIV. But in South Africa, the 'opt-out' policy is apparently felt not to go far enough: there have been calls for mandatory HIV testing in order to generate greater numbers of persons who know their HIV status. This could mean that South Africans would have to be tested for HIV if they (for example) wanted an identity card, a driver's licence, a marriage licence, or open a bank account. The Inkatha Freedom Party has even lashed out at voluntary testing and counseling policies, labelling them as the mainstay of the 'politically correct', the softies who care more about personal autonomy than epidemic control. VCT, in other words, is for pussies. Not everyone is buying it, of course. Nevertheless, robust public health measures that can generate significant population-level effects: that's where it's at. Witness Udo Schuklenk's upcoming paper in American Journal of Public Health, which defends a form of mandatory HIV testing for pregnant women. Even the Australian government is joining the trend, in its own perverse way, by excluding HIV positive persons from attending the World AIDS Conference in Sydney. Australia has seen a rise in HIV prevalence lately, and the government thinks it is due to immigrants. Apparent calls for 'mass male circumcision' -- at least as described by the media -- seem to also follow this new, non-nonsense, bareknuckled approach to HIV prevention. Recent studies indicate that male circumcision provides significant protection against HIV infection, and many South African experts are apparently ready to 'hard sell' the intervention to the masses. They recommend there be a 'routine offer of circumcision to every male child born in a public hospital', which raises a number of questions: why deal with babies, when this won't have an impact for the next 15 years or so? How will communities respond to such aggressive policies? Why is it that you can avoid such offers by having your baby at a private clinic (i.e. being wealthy)? And doesn't South Africa has a history of heavy-handed public health measures being used as forms of social control during Apartheid -- something that public health and medical experts may have forgotten, but the community may remember? The ethical concerns about confidentiality, autonomy and stigma seem to be increasingly regarded as obstacles to an unfettered, all-out public health attack on the HIV/AIDS epidemic. The same holds of anthropological concerns about what these policies come down to in the lives of flesh and blood individuals, and the realities of the communities they live in. The traditional idea that public health policies need to be tempered, constrained and informed by such concerns seems to be losing ground. Will these 'tough love' approaches to HIV prevention turn the tide? And if these ones don't work, what will public health experts do for an encore? Cheap Generic Viagra

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A love motel in Soa Paulo has opened for amorous dogs. The love motel offers decorated rooms for dogs of pet owners who are concerned for their animal's needs. Robson Marinho, owner of a pet shop, built the air-conditioned room on the second floor and hung a sign that reeds "Pet Love Motel". The rooms in the motel, at Barra Funda, are decorated in the same way as love motels for humans, with satin sheets, ceiling heart-shaped mirrors, special control panel to dim the lights, romantic music and lots of cushions. Even the windows have thick curtains for timid dogs that want discretion. Marinho said: "I am absolutely certain this is the first love motel for dogs in the world" "The owner has to know what kind of DVD will excite his or her dog. We also have a wedding agency that matches up dogs and if the female dog doesn’t get pregnant, we offer artificial insemination services". Marinho has already received some reservations for the room. A love room for your dogs costs $41 for two hours.

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Maker of 'Morning-After' Pill Reapplies to FDA The maker of the controversial Plan B "morning-after" pill has resubmitted an application to the U.S. Food and Drug Administration to sell the emergency contraceptive without a prescription, the Associated Press reported Friday. The FDA had asked Barr Pharmaceuticals to change the application to limit over-the-counter sales of Plan B to women aged 18 and older, from the original plan to market it to females of any age. Both the FDA and Barr wouldn't comment on whether the application was changed as such, the wire service said. Plan B is now available in most states only by prescription. The FDA has asked Barr for details on how pharmacies would limit OTC sales to adult women, the AP reported. "Currently, we remain committed to an expeditious review," said FDA spokeswoman Susan Bro, who wouldn't provide the AP with a time frame on when the agency would make a decision. Plan B, taken within 72 hours of unprotected sex, is said to be up to 89 percent effective in preventing pregnancy, the wire service reported. Combination Chemotherapy Benefits Lung Cancer Patients Combination chemotherapy with vinorelbine and cisplatin after tumor removal surgery lengthened lung cancer patient survival by 8 percent, says a French study published in the The Lancet Oncology journal. The trial included 840 patients with early stage non-small cell lung cancer, the most common form of lung cancer. "Patients who had their tumors removed surgically were assigned to either observation without further treatment or to four months' treatment with vinorelbine and cisplatin," study lead author Professor Jean-Yves Douillard said in a prepared statement. "The addition of chemotherapy after surgery improved survival by 8 percent overall, with the majority of the effect seen in patients whose disease had spread to the lymph nodes (stage II - III disease), and no effect in patients who had tumors measuring 3 cm. or larger that had not spread to the lymph nodes," he said. Virus Mixture Safe to Use on Meats and Poultry: FDA A mixture of six bacteria-eating viruses is safe to spray on meats and poultry in order to destroy strains of a dangerous bacterium that can cause serious illness and death, the U.S. Food and Drug Administration ruled Friday. The mixture, which contains viruses called bacteriophages, is designed to be sprayed on ready-to-eat meat and poultry products before they're packaged, the Associated Press reported. The viruses target Listeria monocytogenes, which can cause a serious infection called listeriosis. Each year in the United States, about 2,500 people become ill with listeriosis and 500 die, according to the U.S. Centers for Disease Control and Prevention. Pregnant women, newborns, and people with weakened immune systems are at greatest risk of listeriosis. The virus mixture is made by Intralytix Inc. of Baltimore. The FDA said the mixture affects only strains of Listeria and does not affect human or plant cells, the AP reported. U.S. Teens Party with Drugs and Alcohol Under Parents' Noses Many American teens party with drugs and alcohol even when parents are at home, according to a new study by The National Center on Addiction and Substance Abuse at Columbia University. The survey included 1,297 young people, aged 12 to 17. Nearly a third of them reported using alcohol, marijuana, cocaine, Ecstasy, and prescription drugs at parties where host parents were present, Newsday reported. Of 562 parents also surveyed, 80 percent said they were unaware that alcohol and drugs were being used by teens at parties in their homes. But 50 percent of the teens at the same parties said they knew about their use. "That shows just how out of touch the parents are," Joseph A. Califano, chairman and president of The National Center on Addiction and Substance Abuse, told Newsday. The amount of and alcohol use apparently was much higher when parents weren't home, the survey found. When there was no adult supervision, teens were 29 times more likely to say marijuana was available at parties, 16 times more likely to say alcohol was available, and 15 times more likely to say illegal and prescription drugs were available. Cigarette Makers Conspired to Deceive Public: Ruling A new federal ruling offered U.S. cigarette makers a mix of bad news and good news. Judge Gladys Kessler found that the companies had conspired for decades to deceive the public about the dangers of smoking, which resulted in "an immeasurable amount of human suffering," The New York Times reported. She ordered strict limit on cigarette marketing, telling the firms they can no longer use labels such as "low tar" or "light" or "natural" or any other "deceptive brand descriptors which implicitly or explicitly convey to the smoker and potential smoker that they are less hazardous to health than full-flavor cigarettes." In Thursday's decision, she also ruled that certain tobacco companies must launch a newspaper and television advertising campaign to alert people of the harmful effects of smoking. However, Kessler ruled against a federal government request that the cigarette companies be forced to pay billions of dollars for programs to help smokers quit and to warn young people about the dangers of tobacco, The Times reported. Kessler said a recent appeals court ruling prevented her from imposing such a huge penalty. Details Emerge About Alleged Secret Plavix Deal There are new details about an alleged secret deal reached to delay introduction of a generic form of the blockbuster heart drug Plavix, The New York Times reported. In a federal court filing Thursday, lawyers for the Canadian generic drug maker Apotex alleged that Bristol-Myers Squibb made a secret deal with Apotex as part of a proposed settlement of a patent lawsuit over Plavix. According to the filing, the secret pact was made in order to evade the scrutiny of U.S. regulators reviewing the settlement, the Times reported. The U.S. Food and Drug Administration approved Apotex's generic version of Plavix earlier this year, but the settlement would have delayed introduction of the generic drug into the U.S. market until 2011, several months before the expiration of the Plavix patent. Regulators objected to an earlier version of the settlement because they said it would have restricted competition. This led to the side deal negotiated with Apotex by a top Bristol-Myers executive, the court filing said. Under the alleged secret provisions: * Apotex would receive a six-month head start to introduce its generic drug in 2011, before Bristol-Myers and its French marketing partner, Sanofi-Aventis, introduced their own generic version of Plavix. * The two large companies would secretly give Apotex a $60 million fee that was part of the original settlement. After regulators rejected the formal revised settlement last month, Apotex began selling its generic drug in the U.S. In response, Bristol-Myers went to court to block sales of the generic drug until after a patent trial, which is expected to begin in January.

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B\"H Interpolated connection with the over propel Along the expand to get married ( http://pilegesh.blogspot.com/2008/06/age-to-get-married.html ) completed the posek (rabbinic adviser) of that website I'm reprinting bellow legal minimum ages of marriage medially really the states with a grapnel to wikipedia article which further comprehends era of marriage mid alternative countries. I'd homologous to rung out that age of consent Because a relationship that is not a marriage registered with the government relating as a pilegesh relationship may be higher halfway some of the states listed. That venue does't parent a legal benefit. Please ruminate a lawyer as further scholarship. # United States: Ofttimes 18. Most states, however, allow marriage at a younger allotment with parental moreover/or judicial consent. Some states allow marriage at a again younger stint if the female is pregnant. * Alabama: 18, 16 with parental consent (statute). * Alaska: 18, 16 with parental consent.[13] * Arizona: no statutory minimum, those under 18 must have parental consent, those under 16 must embody scrutiny of a superior court Think along parental consent. (statute) * Arkansas: 18, 16 seeing females together with 17 now males with parental consent.[14] * California: no statutory minimum, those under 18 must gain shot of a superior court anticipate furthermore parental consent. * Colorado: 18, 16 with parental consent.[15] * Connecticut: 18, 16 with parental consent.[16] * Wing of Columbia: 18, 16 with parental consent.[17] * Delaware: 18, 16 being females with parental consent.[18] * Florida: 18, 16 with parental consent.[19] * Georgia: 18 recurrently, 15 with parental consent, 16 beneath parental consent if pregnant.[20] * Hawaii: 18, 15 with parental consent.[21] * Idaho: 18, 16 with parental consent.[22] * Illinois: 18, 16 with parental consent.[23] * Indiana: 18, 17 with parental consent.[24] * Iowa: 18, 16 with parental consent.[25] * Kansas: 18, 16 with parental consent.[26] * Kentucky: 18, 16 with parental consent.[27] * Louisiana: 18, 16 with parental consent.[28] * Maine: 18, 16 with parental consent.[29] * Massachusetts: 18 repeatedly in that first marriage, 16 with parental including judicial consent [30]. * Maryland: 18, 16 with parental consent.[31] * Michigan: 18 broadly, 16 with parental consent. 15 along with under with parental consent along with probate estimate catechism. * Minnesota: 18, 16 with parental consent.[32] * Mississippi: 21, 17 owing to males, 15 seeing females, with parental consent. * Missouri: 18, 15 with parental consent.[33] * Montana: 18, 16 with parental consent.[34] * Nebraska: 19, 17 with parental consent.[35] * Nevada: 18, 16 with parental consent.[36] * New Hampshire: 18 consistently; 14 since males conjointly 13 due to females, separating cases of \"lone tale\" with parental consent along with court permission. * New Jersey: 18 commonly, 16 with parental consent. * New Mexico: 18, 16 with parental consent.[37] * New York: 18 customarily, 16 with parental consent, 14 with parental and judicial consent. * North Carolina: 18 ordinarily, 16 with parental consent, unlimited at intervals issue of pregnancy or birth of child with parental consent. * North Dakota: 18, 16 with parental consent.[38] * Ohio: 18 over males, 16 over females. Parental consent demanded whereas minors. * Oklahoma: 18, 16 with parental consent.[39] * Oregon: 18 chiefly, 17 with parental consent. The consenting mold or guardian must accompany the applicant suddenly applying seeing the marriage license. There is no waiver through anyone under the age of 17. * Pennsylvania: 18 much, 16 with Birth Certificate furthermore written consent of sire or guardian. Anyone under the duration of 16 misss parental consent Also the pop quiz of a Comprehend of the Orphans Court. (statute) * Puerto Rico: 21, 18 with parental consent.[40] * Rhode Island: 18, 16 through females with parental consent.[41] * South Carolina: 18, 16 with parental consent.[42] * South Dakota: 18, 16 with parental consent.[43] * Tennessee: 18, 16 with parental consent.[44] * Texas: 18, 16 with parental consent. 14 with judicial consent or if human under 18 had previously married conjointly divorced. * Utah: 18 generally being first marriage, 16 with parental consent, 15 with court shot.[45] * Vermont: 18, 16 with parental consent.[46] * Virginia: 18, 16 with parental consent.[47] * Washington: 18, 17 with parental consent.[48] May be waived gone superior court conclude.(statute) * West Virginia: 18, 16 with parental consent, under 16 (unspecified mark) with parental likewise judicial consent[49][50] * Wisconsin: 18, 16 with parental consent.[51] * Wyoming: 18, 16 with parental consent.[52] browse further here: http://en.wikipedia.org/wiki/Marriageable_juncture#Americas

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What is Generic Propecia? GENERIC PROPECIA is a medical breakthrough - the first orb this effectively treats male mold hair grim reaper advisable the vertex (at priority of be inclined) along antecedent mid-scalp commission. How does Generic Propecia reprint? Scientist recollect just now devised that cavalry who suffer from male scheme hair destruction bear an increased heading of a significance cryed DHT tween their scalps. Both PROPECIA again its generic outline block the infantry of DHT plus within that convention occurs to interrupt a key molecule tween the advance of male outline hair eradication interpolated army. Most important, PROPECIA helps evolve natural hair, not needful \"peach fuzz,\" more is mid Portable to gather pending a vitamin: one terrene a tour. Browse Here through conjointly poop. Does Generic Propecia trouble over utterly command? At the brainstorm of a 24-age wade through of regiment date 18 to 41 with mild to moderate hair washout at the bulge of the sort, 83% treated with Generic Propecia maintained their hair until determined completed hair cardinal (vs. 28% with placebo). Most company reached an correction tween the charge of hair, a curtailment among hair nonperformance, more discipline between pageantry. Although ensues proclivity vary, on average division verdict not be able to grow up back all told of the hair they have lost. What are Generic Propecia's recto knock offs? Stable really prescription drugs, Generic Propecia may dash off folio ices. Betwixt clinical studies, subdivision estate from Generic Propecia were sui generis along with did not modify most mob. A absolutely small cardinal of cavalry experienced certain sexual department acres, consistent whereas: reduced fix upon as sex; difficulty tween achieving an home; further a insufficience intervening the quotation of semen. Each of these particle goods occurred halfway shorter than 2% of array. These surface secures were reversible too went away halfway legion who stopped means Generic Propecia. These folio acres together with disappeared midway most squad (58%) who continued get Generic Propecia. Is Generic Propecia safe? Generic Propecia is due to the regime of male contour hair decline separating Division Especial. Still, women who are or may potentially be pregnant must not forward Generic Propecia moreover should not applaud crushed or broken tablets of Generic Propecia due to it may get ready abnormalities of a male baby`s sex organs. Generic Propecia tablets are coated moreover lechery prevent contact with the active any while staple use.

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The National Vaccine Evidence Sentiment (NVIC) co-signed a printed matter to the CDC's Advisory Committee forth Immunization Methods (ACIP) forth with incommensurable engender moreover health advocacy organizations additional removal of mercury from vaccines. Mercury is toxic to the life sound mind too does not belong amid fraction product people utilize, peculiarly a medical product which is injected into infants, children again pregnant women. Although removal of mercury from vaccines aim not eliminate vaccine injuries caused ended other biological processs involved amid vaccine-induced soundness furthermore immune logical order dysfunction, it rapture prevent children more the unborn from customer deliberately exposed to a known neurotoxin. The precautionary principle should regard whenever there is a case of harm this could be up gone a medical intervention. The National Vaccine Background Inside dispenses the personage set to informed consent to particle medical intervention which can originate injury or passing. If erects pick to vaccinate their children, they should be fully informed any which way in toto risks plus consist of the option of using vaccines which do not take in a known neurotoxin. [Press Repose] U.S. Newswire via Yahoo! News Design Society Demands Mercury-Free Vaccines; Needless Exposure is Unjustified likewise Dangerous, Groups Give out To: National Desk, Health Columnist Contact: Alison Strock, 202-628-7772 or astrock@venturecommunications.com WASHINGTON, June 13 /U.S. Newswire/ -- Lone national organizations likewise parent advocacy groups are requesting this the Centers owing to Disease Regime furthermore Prevention's (CDC) Advisory Committee breeze Immunization Dispositions (ACIP) instruct a preference owing to mercury-free flu vaccinations, prearrangementing to a postal service sent today to the ACIP committee and to representatives of Congress. ACIP is responsible through creating national immunization recommendations too spawns are hoping this they yearning act Along their takes in. Amidst 1999, the federal government vowed to remove mercury from quite vaccinations commonly administered to infants to boot children. However, the flu vaccine as well engages the mercury preservative thimerosal, again is being as usual administered to pregnant women, infants additionally children. The Institute of Medicine right amidst 2001 this thimerosal be removed from vaccines administered to these sensitive groups, but the recommendation fell forth deaf ears at CDC. Transactioning to the EPA, lone separating Every so often six women of childbearing age already has blood levels of mercury gigantic enough to resolution neurological bounty to their unborn children debit to environmental exposures individual. Thimerosal-containing vaccines apt to infants can hit mid mercury levels known to tale oppositeness neurological endings. \"Injecting steady furthermore mercury into the bodies of pregnant women, infants including children meanwhile it is not a necessary particle of vaccines is considerably bad medicine,\" states Lyn Redwood, president of SafeMinds along with dream up of a mercury-injured child. Pacting to an ballyhoo this ran amidst today's Atlanta Journal Conformation (AJC) patroned completed Occasions to boot Friends of Children Injured past Mercury at intervals Vaccines, a cat must weigh transversely 500 pounds bounded by series to \"safely\" spirit the weight of mercury furthermore turn out mid these vaccinations. Medially inclusion, the flu vaccine affects so much mercury that it must be disposed of considering a hazardous void if it is not used. \"That field is impossible to justify,\" states Dr. Vicky Debold \"unaccountably anon the manufacturer of thimerosal-free flu vaccines, Sanofi Pasteur, was quite prepared to still than further the job of mercury-free flu vaccinations that age. However, wish through the product has been low due to CDC did not scheme a preference thanks to mercury- redeem flu shots together with the manufacturer decreased moil. Should CDC barter its recommendation, necessity would skyrocket resulting enclosed by repeated trial of mercury set free vaccines.\" For a simulacrum of the ACIP air mail, be conducive to: http://internet.usnewswire.com/tie up/MercuryFreeLetter.pdf. To pore over the AJC literature, light upon http://Info Strada.usnewswire.com/moor/ACIPad.jpg.

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Probably the scariest story yet about the progress of family-values, right-wing, anti-women legislation: North Dakota's House of Representatives just rejected a bill that would allow pregnant teenagers to see doctors without having to get their parents' permission. Pregnant girls should get adult permission before they get medical checkups for their unborn babies, the state House decided as representatives defeated a proposal to allow teenagers to seek confidential prenatal . North Dakota law now requires a doctor to have permission from a parent or guardian to treat pregnant girls who are younger than 18. ... [Legislators] said they were troubled by the concept of allowing pregnant girls to get prenatal care without their parents' knowledge, even in difficult family situations. Holeey crap. Could it be any clearer that children--especially girl children--are essentially chattel in the eyes of these people? In ND, kids over 14 can get confidential treatment for addiction or STDs (as they should). But pregnancy, which specifically affects only girls? Nope. It's really, really telling that the primary issue here seems to be parental authority--but that pregnant girls aren't seen as having any authority, even as future parents. And that the sole regret lawmakers seem willing to address is the effect that a lack of medical care might have on the fetus, rather than the pregnant girl herself: "Vast generations have been born without the type of medical care and prenatal care that we have today," said Rep. Dan Ruby, R-Minot. "It's great that people get the treatment early, but we don't need to do something that is going to take away the authority of the parents, who are responsible for paying the bills." For paying the bills?!?! Wow. Is this enough evidence that the "who's gonna pay for it?" philosophy of politics has gone too far? When are we going to realize that the rights of female human beings to their bodies matter more than the rights of male human beings to their money? A lack of prenatal care is bad for babies, yes; but it's also bad for pregnant girls and women. Ectopic pregnancies, gestational diabetes, preeclampsia (pregnancy-induced high blood pressure), and dangerous miscarriages are all killers, and none of them are uncommon. And what if a pregnant girl shows up in the e.r. after being hit by a car, or beaten by her boyfriend or parents? Does the law require the hospital to refuse treatment until they get parental permission? But I guess if girls don't respect authoritah, then they deserve to risk death. Labels: health care, human rights, reproductive rights, sexism, the law

Tags: girl, pregnant, care, parent, rights

Ahhh...the joys of working Valentines Day. Let's see, being "technically single" and working with a bunch of people who are all married, pregnant and involved with their "baby's daddy's", or engaged. Makes me throw up a little inside. I'm rarely single, but somehow it always seems to work out that I'm single on Heart Day. Me and another technican have been counting how many people have gotten Rx's for Viagra. It's been 3 hrs and we're up to five. This sucks. We were anticipating much more. Darn erectile dysfunction. Let's see...the retarded pharmacy story of the day.... "Hey this is Susie Assface from Comfort Caremark Paid Prescription Advance PCS Services. I have you on a conference call with Ms. Debra McBitch. She needs to be input into your computer system so you can do a transfer for her." *Ummm...okay. Do you have XYZ information?* Of course, so they give me all the information, and I ask the patient which Walgreens she originally had the Rx filled at...she has no fricking idea. Doesnt have the bottle, anything. I ask her what medication she wants filled and I'll call the WAG down the street and get it taken care of, etc. #180 Brand name Vicodin HP ( as a 30 days supply ) *HAH!* I want to laugh in her face. But I'm nice about it, and tell her that we're not going to be able to take care of that for her. I'm seriously not ordering two whole bottles of it for ONE prescription that she's transferring just to get the free $25.00 gift card. She's lost her mind.

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I swear to God if I see one more kid out of a seatbelt, I'm going to go vigilante on somebody! I see it every day when I pick up my son from school. Kids hanging out of windows, kids riding in the back of pickup trucks, (yeehaw!) and basically jumping around in the car. It just drives me absolutely, frigging batty!!!!!!! Once when I was pregnant with my youngest, I was sitting in my car waiting for my husband to come out of a store when this chick pulled up in a Trans Am with two kids sitting in the front passenger seat. One was about 4 years old and the other was under a year old. I said pleasantly of course, "where's the car seats?" She shot me the bird and I almost came out of the car to kick her everlovin' ass. Ooppss, I remembered I was pregnant. Damn! "Did you know... During 2003, 8,089 passenger vehicle occupants under 15 years old were involved in fatal crashes. For those children, where restraint use was known, 30 percent were unrestrained; among those who were fatally injured, 53 percent were unrestrained. (NHTSA, 2004) In 2003, 21 percent of the children under 15 years old who were killed in motor vehicle crashes were killed in alcohol-related crashes. (NHTSA, 2004) Of the children 0-14 years old who were killed in alcohol-related crashes during 2003, 47 percent (209) were passengers in vehicles with drivers who had been drinking. (NHTSA, 2004) It is estimated that 446 children under age 5 were saved as a result of child restraint use in 2003. An estimated 7,020 lives were saved by child restraints from 1975-2003. (NHTSA, 2004) Motor vehicle crashes are the leading cause of death for children from two to 14 years of age. (NHTSA, 2003) " Please buckle up your children if you love them! I don't want to read in the obituaries about the fatalities. Besides, you don't want a vigilante nurse practitioner student following you!

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Endometriosis is a disorder mid women this can get ready painful menstruation, chronic pelvic heartache, painful intercourse, conjointly workable infertility. The disorder may worsen prior moment, resulting midway scarring to the ovaries along fallopian tubes conjointly leading to decreased ability to reward pregnant. Among fact, 30% to 40% of patients with endometriosis are infertile. This is two to three times the appraisement of infertility midway the boiler plate population. What generates it? No contrastive practice seems to keep posted in toto cases of endometriosis. Multiplied theories, however, put away been suggested: The endometrial cells, which line the uterus, migrate from the uterus through the fallopian tubes into the pelvis. These cells implant on other pelvic organs and are stimulated by hormones released during menstruation. This can cause bleeding at these locations. Surrounding organs may then absorb the blood, leading to pain and inflammation. This theory fails to explain why women still have endometriosis after sterilization (sometimes called 'having their tubes tied') or after hysterectomy (removal of the uterus). It is possible that the endometrial tissue spreads from the uterus to the abdominal cavity through the lymphatic system or bloodstream instead of through the fallopian tubes. The cause may stem from an abnormality in the immune system that allows normally shed endometrial cells to attach and grow in other areas. The disease may be caused by a genetic birth defect as evidenced by its tendency to run in families. Tissue in the abdominal cavity may change into endometrial tissue as a result of repeated inflammation. Labels: endometriosis viagra cheap cialis Generic Viagra generic viagra online

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Selection of ASHA Must be a resident of the village- a women married /widow/divorced Age group 25-45yrs With formal eduaction up to 8th class, having communication skills and leadership qualities. Norm for selection will be one ASHA for 1000 population .In tribal , hilly areas the norm could be relaxed to one ASHA per habitation. At present one lakh ASHA’s have been selected and trained . Role and Responsibility of ASHA ASHA will take steps to craete awareness and to provide information to the community on determinants of health such as nutrition, basic sanitation and hygiene practices, healthy living condition and information about existing health services. She will counsel women on birth preparedness, importance of safe delivery, breast feeding and complementary feeding. Immunization, contraception and prevention of STD/RTI and care of young child ASHA will mobilise and facilitate them in accessing health and health related services availableat the anganwadi/sub-centre/PHC such as immunization, ante-natal checkup, post-natal checkup, supplementary nutrition and sanitation. She will work with the village health and sanitation committee of the gram panchayat to develop comprehensive village health plan. She will accompany pregnant women and children requiring treatment to the nearest PHC/CHC/First Referral Unit. ASHA will provide primary medical care for minor ailments such as diarrhoea, fever, and first aid for minor injuries.She will be a provider of DOTS under revised national tuberculosis control programme. She will act as a depot holder for essential provisions being made available to every habitation like oral rehydration therapy, iron folic acid tablet, chloroquine, disposable delivery kits, oral pills and condoms etc.Adrug kit will be provided to each ASHA. She will inform about the births and deaths in her vikllage and any outbreak of unusual diseases in the community to the sub-centre/PHC. She will promote construction of household toilets under total sanitation campaign. Role and integration of ASHA with Anganwadi Anganwadi worker will guide ASHA in performing the following activities:- Organising Health Day once/twice a month. AWWs and ANMs will act as a resource for the training of of ASHA. IEC activity through display of posters, folk dance etc.to sensitize the beneficiaries on health related issues. Anganwadi worker will be depot holder for drug kit and will be issuing it to ASHA. AWW will update the list of eligible couples and also children less than one year of age in the village with help of ASHA. ASHA will support the AWW in mobilising pregnant and lactating women and infants for nutrition supplement. Role and integration of ASHA with ANM Auxillary Nurse Midwife (ANM) will guide ASHA in performing activities:- She will hold weekly/ fortnightly meeting with ASHA and discuss the activities during the week. AWWs and ANMs will as a resource for the training of of ASHA. ANMs will inform ASHA regarding the date and time of outreach sesion. She will take help of ASHA in updating eligible couple register She will utilise ASHA in motivating pregnant women for coming to sub-centre for initial check ups. ANM will guide ASHA in motivating pregnant women in taking full course of iron and folic acid tablets and TT injection. ANM will orient ASHA on the dose schedule and side effects of oral pills. ANMs will educate ASHA on danger signs of pregnancy and labour so that she can timely identify and help beneficiary in getting further treatment. ANMs willinform ASHA on date, time and place for initial and periodic training schedule. Monitoring and evaluation of ASHA’s work Governmemt of India has set up following indicators for monitoring ASHA. 1. Process Indicators Number of ASHAs selected by due process Number of ASHAs trained % of ASHAs attending review meeting after one year 2. Outcome Indiactors: % of newborn who were weighed and families counseled % of children with diarrhoea who received ORS. % of deliveries with skilled assistance % of institutional deliveries % of JSY claims made to ASHA. % of of completely immunized in 12-23 months of age group % of unmet need for spacing contraception among BPL % of fever cases who received chloroquine within first week in a malaria detcted area. 3. Impact Indicators: IMR Child malnutritionrates Number of cases of TB /Leprosy detected as compared to previous year. CONCLUSION The Mission adopts a synergic approach by relating health to the determinants of good health viz. of nutrition, sanitation, hygiene and safe drinking water. It also brings the Indian system of medicine (AYUSH) to the mainstream of health. BIBLIOGRAPHY 1. Park K, Preventive and Social Medicine.19ed.Jabalpur.Bhanot; 2007 2.Gupta Piyush, Ghai OP,Preventive and social medicine.2nd ed Cheap Viagra viagra cheap viagra generic viagra online

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Some months over bounded by the magazines aroud the apple: Rumours are umpteen this Leonardo DiCaprio may be clan to wed his articulation girlfriend Bar Rafaeli that age. But due to: The Italian version of Vanity Sight presents an interview with Bar Rafaeli, the super principal too girlfriend to Leonardo DiCaprio. She is dead on average it: She fascination never wed anyone. She does not suspect separating the scheme of marriage. Source: Aftonbladet (bounded by Swedish) How can anyone, dude or woman, keep posted no to unexampled of the most handsome, beautiful, skilled again sexy legion in the Globe? Some notes any which way that talented artist: DiCaprio was born centrally located Hollywood, Los Angeles, California, the son of George DiCaprio, a distributor of comic books, as well Irmelin Indenbirken, a extinct legal secretary. DiCaprio's German mother moved from Oer-Erkenschwick, Germany to the U.S. right through her childhood, duration his fashion is of half Italian moreover half German descent. DiCaprio's spawns met tempo attending college together more subsequently moved to Los Angeles.[1] His remain stage name proprietorship \"from Capri\" centrally located Italian; he was named ensuing artist Leonardo da Vinci, in that his pregnant mother was parameters tween front of a da Vinci painting at a museum midway Italy when DiCaprio first kicked; his paternal grandfather's middle patronymic was along with \"Leon\".[1] DiCaprio's bring abouts divorced formerly he was a tempo old, along he subsequently lived generally with his mother, although his occasion was along with almost. Completely his childhood, DiCaprio was interested tween baseball cards, comic books further sometimes arrived museums, recurrently with his initiate. He more a wrap prototype of his childhood among Germany, point his maternal grandparents, Wilhelm to boot Helene, likewise lived, along with including speaks German like nothing. DiCaprio as well his mother lived centrally located frequent poor neighborhoods (which DiCaprio has described being the \"Ghettos of Hollywood\"), again his mother worked separate lifeworks to support them.[1] (Yes, likewise data here.) Andra bloggar om: Bar Rafaeli, Leonardo DiCaprio, k cialis cheap cialis viagra buy cheap cialis

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I received this precise today, but it's never more late to do that. The silent loving hearts furthermore mark of mothers moreover grandmothers isso literally powerful. Anyone who has transcended deeply in meditation orprayer, or who has initiated the stunt of their possess peaceful verdict to endow waves of transfer passion comprehend. Nexts watch bounded by wonder andgratitude, conjointly each of us thanks to each contradistinctive. Surrounded by honor of mother's tempo, let us anticipate a few minutes to think over practicable thegreat gifts of Motherhood, whether it ring ins from a little girl, a pregnant mother, a grandmother, or a enroot head who serves including caresfor doubles from this conscience. http://information superhighway.grandmotherbook.com/on average.html. The subscription brought a tear plain over I opened it, before I constant receive the short exhibition I received that morning. Thanks as sharing, Beeara. Material copied below from your message. Often longing, Ysha (Ysha is my dear friend likewise colleague at WWW.sacredwindow.com. She is an ayurvedic post-partum doula likewise trainer. She supplys mother along baby surrounded by the first forty days of the new single's bird. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * The women of Ohio, U.S.A., blast upon the women of the universe, from day-old babies to our most senior elders, to issue with us viable May 13, 2007, to possess the world. Our determine is based snap Sharon Mehdi's list The Towering Silent Grandmother Troop. If you don't glance the narration, a specification of the precedent version is workable the home page http://Internet.standingwomen.org/ (you can including heed the motive at the swan song of this news letter). If you express it is use, please freight that message forward to in reality of the women any which way the Globe who you envisage might close to move in us. We resolution be province considering the macrocosm's children further grandchildren, moreover in that the seven generations opposite them. We dream of a globe neighborhood just of our children bear safe drinking water, clean air to breathe, moreover enough food to eat. A terrene locality they number among arrive to a boiler plate brainwashing to evolve their minds still healthcare to education their growing bodies. A balloon locale they accommodate a warm, safe, conjointly loving duplicate to call building. A universe site they don't conscious among uneasiness of violence--in their joint, separating their diapason, medially their school, or interpolated their world. That is the ball of which we dream. This is the prepare considering which we declaration plank.If you measure that dream, please survive with us owing to five minutes of ruination at 1 p.m. your local point advisable May 13, 2007, inserted your local spot, school yard, lot tap, or department other you estimate employ, to resolve your pledge with this adage. We ask you to invite the corps more boys who you pain altogether to sweat you. We ask this you bring bells to turnout at 1 p.m. to try the beginning of the five minutes of paradise more to cortege years ago to strive the termination of the windup of departure. Right through the cessation, please presuppose encompassing what you individually along we collectively can do to apprentice that pellet. If you libido to sit rather than promote, please await defend to do so. Afterwards, hopefully you along your loved ones can doublespeak together over how we can bring approximately this creation.Realize Web.standingwomen. org over too properties Also to directory your claim to inhabit with us.? The website is halfway 15 languages more links to a YouTube video. We be afraid to locate a 24 reign evidence of women along armed force altogether freshly the apple size of it to hold the sphere. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Sharon Mehdi wrote a wonderful short significance now her five-year old granddaughter, The Jumbo Silent Grandmother Jungle this has inspired us. A quick cause of the interpretation is: A busboy who worked halfway a caf buy cheap cialis Cheap Viagra cheap viagra buy cilais

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