Jeffrey A Brinker, M.D.
- Professor of Medicine
- Joint Appointment in Radiology and Radiological Science
Women who reported using physical force also reported calling a higher number of boys more frequently during their teenage years compared with the other two groups (Anderson et al cheap dicaris children 50 mg overnight delivery. One of the most consistent behavioral findings in the literature is the high rate at which adjudicated female sexual assault perpetrators co-offend purchase dicaris children online pills, usually with one or more male partners (Rand and Catalano order dicaris children overnight delivery, 2006). One study of 277 women arrested for a sexual offense found that almost 50 percent committed the offense with another person (Vandiver, 2006). Other studies have identified high rates of co-offending female sexual assault perpetrators (Nathan and Ward, 2002). The majority of cases discussed, however, involve assaults conducted by adjudicated offenders against adolescents or children. It is unclear how many co-offending assaults are committed against other adults or in non-adjudicated samples. Conclusion the study of female sexual assault perpetrators is still emerging, with many fewer studies than the research on male-female sexual assault. In addition, most existing research has focused on the characteristics and behaviors of female offenders who commit assaults against children or adolescents. This focus on women who assault minors may be because many of the existing studies rely on clinical or incarcerated samples. Because of the stigma men may experience by being assaulted by a woman, these samples may not accurately capture the full range of situations in which women perpetrate sexual assault. Due to these limitations, there is currently 40 little consensus on the characteristics or behaviors of female sexual assault perpetrators, especially those that offend against other adults. Male Perpetrators Who Sexually Assault Male Victims Historically, there has been little recognition of sexual assault perpetrated by men against other men. Societal beliefs?for example, myths that men could not be raped and men who were raped must be gay?perpetuated the lack of recognition of this issue. As a result, our empirical knowledge of sexual assault perpetrated by men against other adult men is sparse. In recent years, some studies have begun to explore the issue of sexual assault perpetrations by men against other men. The research on this type of sexual assault, however, is still mostly exploratory in nature, and we still do not have a complete picture of its prevalence, the characteristics of these types of perpetrators, or the circumstances surrounding these assaults. In addition, much of the early research on male perpetrators who sexually assault other men simply described the incidents, rather than comparing the perpetration to a control group. Without a control group, we cannot know whether the characteristics observed in the study sample are more or less likely to occur compared with individuals who do not commit male-male sexual assault. Other studies included small sample sizes and/or relied on convenience samples that most likely do not represent the full range of this type of sexual assault. Below, we describe the handful of recent studies that have begun to shed light on male perpetrators who sexually assault male victims. Due to the limitations of existing research, however, results should be interpreted with caution. Frequency of Sexual Assault by Male Perpetrators Against Male Victims It is difficult to know the exact prevalence rates of sexual assault by male perpetrators against male victims. While some studies of male sexual assault specify the gender of the perpetrator, many do not (Peterson et al. Typologies of Male Perpetrators Who Sexually Assault Male Victims the existing research on the characteristics and behaviors of male perpetrators seems to indicate that they are a heterogeneous group, meaning there does not appear to be one single profile of a male perpetrator who sexually assaults male victims. Research examining known cases of male on-male sexual assault has generally identified two different types of perpetrators based on their motivations for committing the assault. The first group consists of homosexual men who commit assault against other homosexual men primarily for intimacy or sexual gratification. The second group consists of heterosexual men who commit sexual assault against other men as an expression of social dominance or control. In one classification analysis of a sample of male-on-male sexual assault cases, those incidents classified as heterosexual men committing assault for dominance/control were more likely to be stranger attacks and include multiple perpetrators (Hodge and Canter, 1998). Perpetrators who committed assaults for sexual gratification or intimacy were more likely to have had prior social interactions or interpersonal relationships with their victim (Hodge and Canter, 1998). While more research is needed to gain a better understanding of the full range of male perpetrators who sexually assault male victims, these studies indicate that, similar to other types of sexual assault perpetrators, the motivations, characteristics, and behaviors of these perpetrators are complex and likely vary between perpetrators. Characteristics of Male Perpetrators Who Sexually Assault Male Victims Because the study of male-on-male sexual assault is still an emerging area of research, we know very little about the characteristics of male perpetrators who sexually assault other men. These studies have often drawn on relatively small samples of individuals from specific populations, such as emergency rooms or psychiatric facilities. In addition, most studies have not examined the association between perpetrators and the types of characteristics often found to be related to other types of sexual assault. Ongoing research has examined sexual assault victimization among active-duty members of the armed forces (Morral et al. Approximately 70 percent of victimized men responding to questions regarding the most serious offense they had experienced in the past year indicated that their offenders were men or a mixture of men and women. In addition, 34 percent of victimized men indicated that the incident was a form of hazing. Additional research is needed to more thoroughly consider the extent to which hazing may provide a context for male-on-male 7 sexual violence. More research is also needed on the characteristics of various types of male perpetrators who sexually assault other men. It found that homosexual men who reported engaging in sexually aggressive acts were more likely to report experiencing abuse as a child (physical, sexual, or emotional), to have previously accepted money for sex or paying money for sex, to have their first homosexual experience at a younger age, and to report that they would rape a man if they would not be caught or 44 Behaviors of Male Perpetrators Who Sexually Assault Male Victims Studies on the behavior of male perpetrators who assault other men have drawn samples from different populations?for example, sexual assaults reported to police, emergency-room visits, or other clinical samples. In addition, some studies have focused exclusively on sexual assaults in which the victims and/or perpetrators are homosexual, and others have not differentiated their sample by sexual orientation. For example, some research found that most perpetrators know their victims and rarely use weapons during the attack, while other studies, using samples of victims who visited emergency rooms, reported high numbers of male-on-male sexual assaults perpetrated by a stranger who employed a weapon during the attack (Frazier, 1993, and Isely and Gehrenbeck-Shim, 1997).
These rights are enshrined in the Equality Act purchase dicaris children discount, mental capacity legislation buy dicaris children online pills, Think about the imagery that you see around dementia order dicaris children overnight. People from any race or sexuality can develop dementia, as Dementia can be challenging enough for people who can people with no family or home. For individuals with in prisons, with learning disabilities, in remote areas more specifc needs, the challenges are even greater. We communities need to be researched further, to have wanted to shine a light on these groups and look at the awareness raised about them, and to be supported inequalities they face. Work is taking place, but as always, more with dementia, carers and people working within these can be done to ensure that the needs of people affected groups and communities to discuss key issues. We have over Prisoners over the age of 60 are the fastest growing age 110 health and social care members, all committed to group in prisons and many prison staff lack the training supporting people affected by dementia, with an action required to spot the signs of dementia and to make the plan setting out what they hope to achieve. We run webinars, with dementia and carers who come from seldom heard roundtables, conferences, and thematic events; and groups face a number of additional barriers when trying meet up with all of our members to fnd out what they to access care and support. Focussing on campaigns is a large are not even aware that there are services out there for element of our work and campaigns have included them. Other times, people attend services only to fnd decreasing the use of antipsychotic drugs, considering out that they are unsuitable for their needs. There are a the language around dementia that is used, supporting number of reasons for this, ranging from a lack of training carers, and creating dementia friendly hospitals by and awareness, insuffcient funds to adapt services or in implementing a charter that we created. Minority Ethnic Communities’1 Many of the effective interventions we see do not require Prisons money, rather careful consideration, planning, and most importantly taking the time to engage with people from. We found there were common inequalities across the Learning Disabilities groups, such as the lack of services with joined-up. These fndings aren’t Statements for people with learning disabilities surprising, and they can relate to any number of seldom heard groups. The next immediate steps are to pull Disease International, it has led us to the following: together all of this information, along with case studies, pledges and our recommendations, and this should be available within the next six months. Dementia and Black, Asian and Minority Ethnic Communities Report of a Health and Wellbeing (ii) Read the report here: nationaldementiaaction. Marie waits at the crossing for the green light to come up and then tries to Marie begins the daily routine of picking up the various hurry over the road as the green light fashes with a tick, items she will need for going out. Marie glances up from her shopping list check, coatcheck, phonecheck, shopping list and feels a little overwhelmed at the supermarket. With her mental checklist ticked off, Marie steps senses are overloaded with so many impressions. Marie sees endless aisles of products, displayed in a messy waits for her regular bus but there is a waiting line and and unfamiliar way. She hears many different sounds, the driver overshoots the stop, so Marie rushes to catch background music, announcements, the cashier ringing, up with it. It takes a moment for Marie to steady herself and to search for her travel card in the bundle Marie starts to shop for the items on her shopping list. Marie can sense the the fruit and vegetable department, she wants to buy a people behind her are getting impatient so she asks the couple of apples. She reaches out to collect them before bus driver for help and hurriedly searches for the travel realising she is touching the refection of the apples in card. After quite some time, Marie has located most of the Once seated, Marie sees that the electronic bus items on the shopping list but she cannot fnd the coffee announcer is not showing the correct next stop. She realises they are directions to the coffee then shuffes off before Marie all looking at their phones. Marie goes up and down every aisle she stares at the screen trying to recall where to fnd the looking for the coffee, walking much further than she needed because the placement of the coffee is different today. Marie feels her anxiety building as she discovers it is the line for the Dementia-friendly and usable places self-service check-outs which she often experiences and services: problems using. She glances behind at the long line and tries to follow the instructions on the self-service check More service providers. Marie manages to scan some items but one should consider some simple measures that could item was on sale and would not scan. Marie feels very improve the experience of people with dementia when anxious indeed. A shop assistant comes over and helps accessing their products or services, including design her before leaving Marie to cope alone. In addition, consider engaging people with dementia and their caregivers about what By this time Marie is feeling stressed and she cannot works well and not so well. She tries two of moving products and facilities from familiar and different numbers but she still cannot recall the correct accessible locations and sign-posting any changes. So Marie decides to pay with cash but she Explain more about the vision, hearing and perception cannot fnd which slot to put the cash in. The shop challenges and consider providing ongoing and regular assistant comes over again and helps Marie put all her dementia-friendly training to staff to enable them to shopping back in the trolley and takes her to another recognise if a person has dementia and to provide till with a cashier where she can pay with cash. Dementia-friendly and usable Everyday Technology: the pace of everyday technological Technology developers should engage people living change with dementia and their carers in the design and testing In an age where technology is being adopted more and stages, to help identify and alleviate potential issues and more frequently to everyday situations, often replacing challenges often simple things that are not perceived a human interaction, there should be a consideration as challenges at the outset, primarily as the question is of the potential impact on people living with dementia, often not being asked. In retail environments, where the in the same way there could or should be for someone use of self-check-out technology is rapidly increasing, with a more visible disability (for example, the height of consider testing and adapting the technology from the a cash machine). Usability testing itself a challenge, with operators updating and adapting and technology development in collaboration with at a pace not previously seen. For example, self-check-in people living with dementia and caregivers also conveys desks at airports are improving through user feedback a thoughtful and caring approach from the business but airports are notoriously stressful environments to operator. Evidently, the benefts of such a automation of tasks like transfers, cheque deposit and choice by the retailer also helps other people who need bill paying.
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Symptoms most likely to purchase 50 mg dicaris children free shipping respond to dicaris children 50mg mastercard treatment were anger cheap 50 mg dicaris children mastercard, aggression, and psychosis (Sultzer et al. There is also at least one published, randomized controlled trial that did not demonstrate significant benefit of risperidone over placebo (Mintzer et al. The rate of discontinuation was lowest in the placebo group,and olanzapine had significantly higher rates of discontinuation when compared to both placebo and risperidone. Curiously the 5 mg dose showed greater efficacy than the 10 mg dose (Street et al. The group receiving 200 mg daily had improvement over the placebo group on the primary outcome (Zhong et al. A second randomized controlled trial of quetiapine (mean dose 96 mg), haloperidol (mean dose 1. A third trial of quetiapine (50–100 mg) compared to rivastigmine and placebo did not find that either active treatment was superior to placebo. Greater cognitive decline was observed with quetiapine when compared to placebo (Ballard et al. The second trial found that 10 mg of aripiprazole was superior to placebo on measures of psychosis, agitation, and global improvement, while lower doses (2 mg or 5 mg) were not effective (Mintzer et al. Adverse event rates were not statistically significant between the treatment groups. Open label trials of ziprasidone have also demonstrated efficacy for ziprasidone, although adverse events were also commonly observed (Rocha et al. There are a number of studies to show that dementia patients’ symptoms actually remain stable or improve when they are withdrawn from a conventional neuroleptic (Thapa et al. There are several randomized, placebo-controlled studies examining the effects of discontinuing long-term treatment with antipsychotics (van Reekum et al. Most studies have found that many individuals can have antipsychotics safely discontinued without worsening of behavioral symptoms. Predictors of successful discontinuation antipsychotics include lower daily doses of antipsychotics (van Reekum et al. Most studies have examined relatively short term behavioral outcomes, although one study found no significant difference in behavioral symptoms following discontinuation at 6 months (Ballard et al. Long-term mortality follow-up data from one study also indicated that discontinuation of antipsychotics was associated with reduced mortality at 12, 24, and 36 months (Ballard et al. Like all medications, side-effects need to be monitored during drug treatment with atypical antipsychotics. Most atypicals may be associated with dyslipidemia, impaired glucose tolerance, and weight gain. The risk of weight gain may be greatest in females treated with olanzapine or quetiapine, and olanzapine may be associated with the greatest adverse effects on cholesterol (Schneider et al. In addition, clozapine has significant anticholinergic and postural hypotensive effects, and it is associated with a risk of agranulocytosis that requires weekly white blood cell count monitoring. More recent studies have even suggested that the risk of death with typical antipsychotics may even be greater than with the atypical ones (Liperoti et al. It should be noted that, although antipsychotics are associated with increased risk of death, the absolute increase in mortality is between 1–2%. A prudent recommendation is that antipsychotics should be used more judiciously than they have been in the past. However, some authors believe that current prescription practices are still not cautious enough (Rochon and Anderson, 2010), and certainly more research needs to be urgently conducted regarding these concerns. In the meantime, before initiating the use of these medications, patients and substitute decision-makers should be informed about the warnings regarding them and the data supporting these warnings. In general, increases in dosage should occur at a maximum once weekly unless more rapid dose titration is required. If a 4 to 6-week trial of one agent at an adequate dose fails to decrease the frequency, severity, or impact of a target symptom, a trial of a second agent would be indicated. The first review included 17 placebo-controlled studies, 7 of which were of sufficient quality to be included in meta-analysis (Schneider et al. The doses of medications in these studies were modest (chlorpromazine equivalent 66–267/mg day). There was a small, but statistically significant difference between all antipsychotics and placebo in the meta-analysis. Meta-analysis comparing thioridazine or haloperidol to comparator antipsychotics did not find any significant difference between these two agents and all other antipsychotics. A more recent meta-analysis included 16 studies of typical antipsychotics (Lanctôt et al. Overall, 61% of individuals treated with typical antipsychotics had a clinical response, compared to 34% of individuals who received placebo. Dosages of medication were relatively low in most studies, defined by daily dose equivalents. There were no differences noted in response rates for different classes of antipsychotic potency. However, higher rates of side-effects were observed for all antipsychotics when compared to placebo, although there were no differences in trial withdrawals. There was no significant difference in side-effects or drop-outs for butyrylphenones when compared to other antipsychotics. A review of five studies examining haloperidol for agitation in dementia found that haloperidol was effective in reducing symptoms of aggression but not overall levels of agitation (Lonergan et al. There was no statistically significant difference in dropout rates for haloperidol when compared to placebo. There are relatively few studies comparing typical antipsychotics to atypical antipsychotics. Most trials have found similar efficacy for typical antipsychotics when compared to atypical antipsychotics, although some studies have found greater efficacy of atypicals when compared to typicals.
What is the management of iron By measuring the haemoglobin concentration defciency anaemia? Small pale red cells strongly suggest iron Ferrous gluconate (or sulphate) syrup 0 discount dicaris children 50mg amex. When you have completed this unit you should be able to: 5-3 Can diarrhoea be dangerous? List the causes and complications of electrolytes in the stool purchase dicaris children master card, which can result in diarrhoea buy dicaris children 50 mg on line. Diagnose and grade the severity of correct management of diarrhoea is important dehydration. The 2 commonest causes of diarrhoea are: Diarrhoea (or diarrhoeal disease) is defned as the passage of frequent, loose, watery stools 1. Food allergy or intolerance condition but simply a clinical sign, which note Less common causes of diarrhoea include has many diferent causes. With diarrhoea food poisoning (bacterial toxins), a side efect of excessive amounts of water and electrolytes antibiotics (bacterial overgrowth), some drugs (salts such as sodium and potassium) are lost which increase gut motility, coeliac disease and into the stool. Viruses, such as Rota virus and common with gastroenteritis but pyrexia is measles. The such as Giardia, Amoeba and infection is usually spread from the stool of Cryptosporidium. Poor hygiene or sanitation may result as otitis media, septicaemia and urinary in outbreaks of gastroenteritis. In some children who present with if the bowel mucosa is damaged by the diarrhoea, the infection is not in infection, gastroenteritis may also result in the bowel but elsewhere (parenteral persistent diarrhoea. Gastroenteritis is an acute infection of the bowel, Rota virus infection of the bowel is the causing diarrhoea. Acute protein intolerance usually cause persistent diarrhoea is usually due to gastroenteritis (an diarrhoea following earlier damage to the acute infection of the bowel). However, intolerance may be caused by the excessive acute diarrhoea is not always caused by an intake of fruit juice especially apple juice (fructose infection of the bowel but can also result from intolerance). Gastroenteritis (or acute diarrhoeal disease) is an acute infection of the bowel resulting Diarrhoea usually recovers within 7 days. It is caused by a wide 2 weeks (14 days), it is called persistent range of organisms which interfere with the (prolonged or chronic) diarrhoea. Cholera is a severe, highly infectious form of watery diarrhoea which is common in undeveloped countries. Cholera occurs in 5-10 What is the relationship between epidemics as has happened in some areas of diarrhoea and malnutrition? It is caused by Diarrhoea is commoner and more severe in a bowel infection with Vibrio cholerae. In addition, Cholera can rapidly lead to dehydration and malnourished children are more likely to death, even in adults. Diarrhoea is both common and more severe in Dysentery is a form of diarrhoea where the children with malnutrition. Dysentery is usually Persistent or repeated diarrhoea may result caused by organisms which invade and in weight loss and malnutrition in children damage the bowel wall. Diarrhoea, especially persistent diarrhoea, Dysentery is usually caused by Shigella, ofen precipitates marasmus or kwashiorkor in Salmonella, Campylobacter, Amoeba and children who already are mildly malnourished. The commonest cause Terefore, both malnutrition and diarrhoea of dysentery is Shigella. Dysentery is diarrhoea containing blood and Diarrhoea may precipitate or aggravate mucus. This dehydrates the tissues resulting in loss of skin turgor, sunken eyes and a sunken fontanelle. Malnutrition longer it takes for the skin to go back to the Severe dehydration is the commonest cause of normal position. Using the thumb and frst fnger, a fold of skin on one side of the umbilicus is lifed Dehydration is the most important complication and gently squeezed for 2 seconds and then and the commonest cause of death in infants released. Diarrhoea can rapidly lead to dehydration, especially if vomiting is also present. Both the history 5-19 How can the degree of dehydration be and the clinical examination are important in assessed? All children with diarrhoea must be In all children with diarrhoea the following examined for signs of dehydration. The signs must be looked for: degree of dehydration can be roughly assessed clinically into ?no visible dehydration, ?some. Is there increased thirst or a important as it is essential to identify children refusal to drink? Moderate degree of decreased skin body weight (and body fuid) before the signs turgor. When Shock (hypovolaemic shock in dehydration) pinched, the skin takes 2 seconds or is the failure of the heart to maintain adequate more to return to normal. Shock with delayed capillary flling time excessive fuid loss in the stools, the volume of fuid in the circulation falls and there is not Severe dehydration leads to shock, acidosis, enough fuid to allow normal blood fow to the electrolyte loss, an ileus and hypoglycaemia. As a result, blood Always start by frst looking for signs of severe fow slows down or stops in the capillaries and dehydration. If the child has 2 or more signs of the body cells do not receive enough oxygen severe dehydration, then the child is classifed and food. A weak radial pulse which is difcult to feel there are 2 or more signs of some dehydration. Shock is a very serious note Children with ?some dehydration often also sign and indicates that the child will probably have a dry mouth, poor urine output and do die unless immediate treatment is started.
Leadership of interprofessional health and social care teams: a socio-historical analysis order 50 mg dicaris children with visa. Impacts of geriatric evaluation and management programs on defined outcomes: Overview of the evidence order dicaris children visa. The impact of regular multidisciplinary team interventions on psychotropic prescribing in Swedish nursing homes buy dicaris children 50 mg overnight delivery. Interprofessional collaboration: effects of practice based interventions on professional practice and healthcare outcomes. Education and Staff Training Dementia Training Study Centres and Dementia Collaborative Research Centres. Challenges and strategies for implementing and evaluating dementia care staff training in long-term care settings. National guidelines for seniors’ mental health: the assessment and treatment of mental health issues in long-term care homes. An investigation of aged care mental health knowledge of Queensland aged care nurses. Nursing home staff training in dementia care: a systematic review of evaluated programs. Effectiveness of staff training programs for behavioural problems among older people with dementia. Evaluation of the sustained implementation of a mental health learning initiative in long-term care. The effect of continuing professional education on health care outcomes: lessons for dementia care. Recommendations for staff education and training for older people with mental illness in long-term aged care. Managing behavioural symptoms of dementia: Effectiveness of staff education and peer support. Guidelines Consensus statement on improving the quality of mental health care in U. National guidelines for the assessment and treatment of mental health issues in long-term care homes. Implementation of a mental health guideline in a long-term care home: A participatory action approach. It is intended to help individuals navigate and advocate for their own health care. It is also intended to help family and caregivers understand changes in condition, document and monitor those changes, communicate to providers and advocate for the individual’s health care. Also included in the guide book are videos of individuals and/or their families who have been on and/or have experienced the journey of dementia. Grantees carrying out projects under government sponsorship are encouraged to express freely their fndings and conclusions. Studies show that 6 out of 10 people with Down syndrome, over the age of 60, are affected by dementia. Alzheimer’s th disease is the 6 leading cause of death – more than prostate and breast cancer combined. There are similarities to how people age, Fbut aging will affect everyone differently as an individual. Therefore, aging throughout life should be planned for and tracked on an individual basis. This section will defne aging and look at different ways that people will age throughout their life and some ways to stay healthy. There is also information on some of the challenges people with disabilities face when it comes to healthcare and healthy aging. Challenges to Healthy Aging for People with Disabilities Aging Across the Lifespan 1 What is aging? Genetics, lifestyle, environment and attitude all infuence health and well-being in old age. The lifespan approach to advocacy and healthy aging connects all phases of life to the health and well-being of people with intellectual/developmental disabilities. The approach is based on the premise that what happens in childhood and young adulthood affects the quality of life in old age. To maintain health and well-being in later years, healthy practices across the lifespan can make a very positive difference. Decreased Motor Skills Impaired Senses Slower Reaction Time Decreased strength and Decreased processing of Vision problems coordination information Pain and stiffness in Decreased fexibility Hearing problems muscle and joints 1 Janicki, M. Hearing Loss: is common for individuals with Down Hearing tests are recommended at least every year. There is a If there is a known issue with an individual’s ears, higher chance of having ear wax impaction which can consult your doctor on how often to have tests cause some hearing loss. Hypothyroidism: is a condition that causes your the Thyroid gland is usually normal in babies with thyroid gland to be underactive which can cause Down syndrome, but it can stop working normally for symptoms of fatigue and mental sluggishness. Obstructive Sleep Apnea: is a sleep disorder that Since this is a very common problem for people leads to poor quality of sleep and makes people feel with Down syndrome, it is recommended that every sleep-deprived even after a full night of sleep. If you notice the following symptoms consult your doctor about a sleep study to test for Obstructive Sleep Apnea. X-rays are not needed unless you notice the this can cause pain and effect movement, strength following: stiff or sore neck, change in stooling or and function.