This document summarizes information about postpartum depression screening and education in New Jersey. It discusses celebrities and tragic cases that have brought awareness to postpartum depression. Statistics on incidence rates in New Jersey are provided. The document reviews the history of recognizing and diagnosing postpartum mood disorders. It outlines New Jersey's 2006 legislation requiring education and screening for new mothers and includes details on screening tools, potential effects of postpartum mood disorders, risk factors, and types of postpartum mood disorders.
Overcoming Shame By Mr. Nilesh Mandlecha
Overcoming Shame
When Socially unacceptable thing has happened with you and people look down at you- How you can deal with this situation is explained in this video.
For info log on to www.healthlibrary.com.
What is Postpartum Depression (PPD)?
1. Also called as “postnatal depression”
2. Complex mix of physical, emotional & behavioral changes occurs in women after giving birth.
3. A form of major depression occurs within 1 month—1 year.
SIGNS AND SYMPTOMS
Mood fluctuation
Crying more than usual
Severe fatigue
Increased anxiety
Thoughts of suicide or death
Extreme anger
Lack of interest in the baby
Thoughts of hurting the baby
Hearing voices or paranoia
ETIOLOGY AND RISK FACTORS
Sudden changes in hormone levels
Lack of sleep
Poor diet
Stress
Previous history of depression
Family history of mood disorder
Inadequate social support
Poor marital relationship
Disappointment in the child
DETECTION OF POSTPARTUM DEPRESSION
Edinburgh Postnatal Depression Scale
10 item questionnaire
Easy to score
Clinical Interviews with Patient or Family
TREATMENT
Anti-anxiety or antidepressants medications
Fluoxetine
Sertraline (Zoloft)
Psychotherapy
Cognitive-Behavioral Therapy- a type of psychotherapy that can help people with depression and anxiety.
Interpersonal Therapy-it is an evidence-based therapy that has been used to treat depression, including perinatal depression.
For severe cases of PPD:
Brexanolone (Zulresso)- is a medication used in the treatment of postpartum depression in adult women.
COMPLICATIONS
Mother:
Adverse physical health conditions due to disturbed lifestyle.
Negative effect on mental health in the future.
Increased risk of suicide.
Father:
When a new mother has depression, the father may be more likely to have depression too.
Child:
Child can develop ADHD
Excessive crying
Eating problem
Delays in language development
PATERNAL DEPRESSION
Paternal depression is a condition in which a first-time or seasoned father shows symptoms and signs of depression after a child is born.
SIGNS AND SYMPTOMS
Frustration
Irritability
increased use of drugs or alcohol instead of seeking treatment for depression
Loss of libido
RISK FACTORS
Difficulty developing an attachment with the baby
First-time father
Lack of social support or help from family and friends
Maternal depression
Overcoming Shame By Mr. Nilesh Mandlecha
Overcoming Shame
When Socially unacceptable thing has happened with you and people look down at you- How you can deal with this situation is explained in this video.
For info log on to www.healthlibrary.com.
What is Postpartum Depression (PPD)?
1. Also called as “postnatal depression”
2. Complex mix of physical, emotional & behavioral changes occurs in women after giving birth.
3. A form of major depression occurs within 1 month—1 year.
SIGNS AND SYMPTOMS
Mood fluctuation
Crying more than usual
Severe fatigue
Increased anxiety
Thoughts of suicide or death
Extreme anger
Lack of interest in the baby
Thoughts of hurting the baby
Hearing voices or paranoia
ETIOLOGY AND RISK FACTORS
Sudden changes in hormone levels
Lack of sleep
Poor diet
Stress
Previous history of depression
Family history of mood disorder
Inadequate social support
Poor marital relationship
Disappointment in the child
DETECTION OF POSTPARTUM DEPRESSION
Edinburgh Postnatal Depression Scale
10 item questionnaire
Easy to score
Clinical Interviews with Patient or Family
TREATMENT
Anti-anxiety or antidepressants medications
Fluoxetine
Sertraline (Zoloft)
Psychotherapy
Cognitive-Behavioral Therapy- a type of psychotherapy that can help people with depression and anxiety.
Interpersonal Therapy-it is an evidence-based therapy that has been used to treat depression, including perinatal depression.
For severe cases of PPD:
Brexanolone (Zulresso)- is a medication used in the treatment of postpartum depression in adult women.
COMPLICATIONS
Mother:
Adverse physical health conditions due to disturbed lifestyle.
Negative effect on mental health in the future.
Increased risk of suicide.
Father:
When a new mother has depression, the father may be more likely to have depression too.
Child:
Child can develop ADHD
Excessive crying
Eating problem
Delays in language development
PATERNAL DEPRESSION
Paternal depression is a condition in which a first-time or seasoned father shows symptoms and signs of depression after a child is born.
SIGNS AND SYMPTOMS
Frustration
Irritability
increased use of drugs or alcohol instead of seeking treatment for depression
Loss of libido
RISK FACTORS
Difficulty developing an attachment with the baby
First-time father
Lack of social support or help from family and friends
Maternal depression
Grief and Loss in Addiction and Recovery - September 2012Dawn Farm
“Grief and Loss in Addiction and Recovery” was presented on September 25, 2012; by Janice Firn, LMSW, Clinical Social Worker, University of Michigan Hospital; Matthew Statman, LLMSW, CADC, Dawn Farm therapist and Education Series Coordinator; and Barb Smith, author of “Brent’s World” (http://compassionhearts.com.) The culture of addiction is rife with experiences of grief and loss for the person with addiction and for family and friends. The nature of these experiences combined with the stigma, shame and general lack of understanding of addiction can make grief and loss associated with addiction exceptionally lonely and difficult to heal from. This program will describe Worden's and Kubler-Ross' theories of grief and grief recovery, losses that the chemically dependent individual and his/her family experience throughout the addiction and recovery processes, and how recovery program tools can help individuals cope with grief and loss. It will include a personal account of addiction-related grief, loss and recovery from a mother who lost her son to addiction-related causes. This program is part of the Dawn Farm Education Series, a FREE, annual workshop series developed to provide accurate, helpful, hopeful, practical, current information about chemical dependency, recovery, family and related issues. The Education Series is organized by Dawn Farm, a non-profit community of programs providing a continuum of chemical dependency services. For information, please see http://www.dawnfarm.org/programs/education-series.
December 2012 Women's Connection luncheon presentation on Women and Depression by Connie Marsh, MD, associate medical director of Via Christi Senior Behavioral Health.
This is a work made in the 8th grade about adolescent pregnancy, methods of contraception and abortion. At the end there's a quiz that is good to do when you're presenting. I hope it's useful, you
Although pregnancy has typically been considered a time of emotional well-being, recent studies suggest that up to 20% of women suffer from mood or anxiety disorders during pregnancy. Particularly vulnerable are those women with histories of psychiatric illness who discontinue psychotropic medications during pregnancy.
Presentation by Kaja LeWinn, ScD; Olga Tymofiyeva, PhD; and Eva Henje Blom, MD, PhD, at the UCSF Depression Center's "Adolescent Depression: What We All Should Know" event on November 16, 2015.
Professional Risk Assessment: Suicide and Self Harm RiskDr Gemma Russell
Presentation delivered to Lifeworks Australia as part of their professional development in 2013.
Specifically discusses how to conduct a comprehensive risk assessment and the implications for different levels of risk. Also highlights, ethical and legal responsibilities of the practitioner.
Depression is defined as a sad mood lasting continuously for 2weeks. It affect all ages, sexes and races. Depression affect over 300million people globally. 1 in 5 Nigerians suffers depression. 80% of the affected people are not on treatment and women are two times more affected than men.
Maternal Mental Health: CA Department of Public Health Nov 6, 2014Joy Burkhard
Maternal Mental Health is an underground health crisis impacting women, infants and families. This presentation was provided Nov. 6 2014 to the California Department of Public Health and discusses symptoms, risk factors and prevalence; impact on child development, why providers don't routinely screen/diagnose and treat, and what we can do to collectively change this course.
Grief and Loss in Addiction and Recovery - September 2012Dawn Farm
“Grief and Loss in Addiction and Recovery” was presented on September 25, 2012; by Janice Firn, LMSW, Clinical Social Worker, University of Michigan Hospital; Matthew Statman, LLMSW, CADC, Dawn Farm therapist and Education Series Coordinator; and Barb Smith, author of “Brent’s World” (http://compassionhearts.com.) The culture of addiction is rife with experiences of grief and loss for the person with addiction and for family and friends. The nature of these experiences combined with the stigma, shame and general lack of understanding of addiction can make grief and loss associated with addiction exceptionally lonely and difficult to heal from. This program will describe Worden's and Kubler-Ross' theories of grief and grief recovery, losses that the chemically dependent individual and his/her family experience throughout the addiction and recovery processes, and how recovery program tools can help individuals cope with grief and loss. It will include a personal account of addiction-related grief, loss and recovery from a mother who lost her son to addiction-related causes. This program is part of the Dawn Farm Education Series, a FREE, annual workshop series developed to provide accurate, helpful, hopeful, practical, current information about chemical dependency, recovery, family and related issues. The Education Series is organized by Dawn Farm, a non-profit community of programs providing a continuum of chemical dependency services. For information, please see http://www.dawnfarm.org/programs/education-series.
December 2012 Women's Connection luncheon presentation on Women and Depression by Connie Marsh, MD, associate medical director of Via Christi Senior Behavioral Health.
This is a work made in the 8th grade about adolescent pregnancy, methods of contraception and abortion. At the end there's a quiz that is good to do when you're presenting. I hope it's useful, you
Although pregnancy has typically been considered a time of emotional well-being, recent studies suggest that up to 20% of women suffer from mood or anxiety disorders during pregnancy. Particularly vulnerable are those women with histories of psychiatric illness who discontinue psychotropic medications during pregnancy.
Presentation by Kaja LeWinn, ScD; Olga Tymofiyeva, PhD; and Eva Henje Blom, MD, PhD, at the UCSF Depression Center's "Adolescent Depression: What We All Should Know" event on November 16, 2015.
Professional Risk Assessment: Suicide and Self Harm RiskDr Gemma Russell
Presentation delivered to Lifeworks Australia as part of their professional development in 2013.
Specifically discusses how to conduct a comprehensive risk assessment and the implications for different levels of risk. Also highlights, ethical and legal responsibilities of the practitioner.
Depression is defined as a sad mood lasting continuously for 2weeks. It affect all ages, sexes and races. Depression affect over 300million people globally. 1 in 5 Nigerians suffers depression. 80% of the affected people are not on treatment and women are two times more affected than men.
Maternal Mental Health: CA Department of Public Health Nov 6, 2014Joy Burkhard
Maternal Mental Health is an underground health crisis impacting women, infants and families. This presentation was provided Nov. 6 2014 to the California Department of Public Health and discusses symptoms, risk factors and prevalence; impact on child development, why providers don't routinely screen/diagnose and treat, and what we can do to collectively change this course.
PPD is similar to clinical depression.it is not only prevalent among women but also in men. sufferers are not alone and they can prevent this by talk, talk and talk.
1
6
Assignment template
Subjective Section
Chief complainant
The patient starts by saying, "I can't stop crying, all the time." The patient complains that since she gave birth to her child two months ago, she has been experiencing mood disorders and difficulties falling asleep even after the baby is already asleep. She complains that especially when the baby cries, she loses her appetite and is not comfortable with her new body shape and size. She says nothing interests her, even writing, which was one of the things she loved before she gave birth. She does not want to contact her friends, and everything seems to be upsetting her.
History of present illness (HPI)
L.T is a 32-year-old black female who resents for psychiatric evaluation due to mood depression. The patient has not been prescribed any psychotropic drugs recently.
Past psychiatric history
The patient has never been examined or treated for any mental disorders in the past. Recently she was hospitalized for a standard childbirth procedure.
Medication trials and current medication
She has not tried any medications in the past, neither is she under any medication currently.
Psychotherapy or previous psychiatric diagnosis
The patient has no history of psychiatric illness and has not been diagnosed or treated with any mental health disorder.
Pertinent substance use, social, and medical history
The patient denies any use of alcohol or cases of drug abuse in the family. Although she says that her uncle was not an opioid abuser, he committed suicide using GSW. She is married and currently lives with her husband with their two kids. She has been working in the retail business for the past five years, but currently, she is a housewife. The patient grew up with her sister together with her both parents. She has been diagnosed with hypertension recently, and she is taking drugs labelled as labetalol 100mg for HTN, which she says that she sometimes forgets to take them. The patient has no legal history or any issues related to violence.
Allergies
L.T is allergic to codeine. She gave birth two months ago, which automatically means that she is lactating. Currently, she is not using any form of contraceptive, and she has had no desire for sex since she gave birth.
ROS
General: No weight loss, fatigue or chills experienced by the patient.
HEET: Her vision is the same no issues of double vision or jaundice. Her ears, nose and throat are okay.
Skin: Her skin has not changed either is she having rashes.
Cardiovascular: No chest discomfort or pains.
Respiratory: She is not coughing or producing sputum, implying her respiratory is fine.
Gastrointestinal: She has eventually lost her appetite and wants to lose weight, although she is not vomiting or feeling abdominal pain.
Genitourinary: The urine colour or odour has not changed, and she is not experiencing any burns during urination. No headaches, no back or joint pains.
Hematologic: No bleeding realized or enlarged nodes.
Endocri ...
1
6
Assignment template
Subjective Section
Chief complainant
The patient starts by saying, "I can't stop crying, all the time." The patient complains that since she gave birth to her child two months ago, she has been experiencing mood disorders and difficulties falling asleep even after the baby is already asleep. She complains that especially when the baby cries, she loses her appetite and is not comfortable with her new body shape and size. She says nothing interests her, even writing, which was one of the things she loved before she gave birth. She does not want to contact her friends, and everything seems to be upsetting her.
History of present illness (HPI)
L.T is a 32-year-old black female who resents for psychiatric evaluation due to mood depression. The patient has not been prescribed any psychotropic drugs recently.
Past psychiatric history
The patient has never been examined or treated for any mental disorders in the past. Recently she was hospitalized for a standard childbirth procedure.
Medication trials and current medication
She has not tried any medications in the past, neither is she under any medication currently.
Psychotherapy or previous psychiatric diagnosis
The patient has no history of psychiatric illness and has not been diagnosed or treated with any mental health disorder.
Pertinent substance use, social, and medical history
The patient denies any use of alcohol or cases of drug abuse in the family. Although she says that her uncle was not an opioid abuser, he committed suicide using GSW. She is married and currently lives with her husband with their two kids. She has been working in the retail business for the past five years, but currently, she is a housewife. The patient grew up with her sister together with her both parents. She has been diagnosed with hypertension recently, and she is taking drugs labelled as labetalol 100mg for HTN, which she says that she sometimes forgets to take them. The patient has no legal history or any issues related to violence.
Allergies
L.T is allergic to codeine. She gave birth two months ago, which automatically means that she is lactating. Currently, she is not using any form of contraceptive, and she has had no desire for sex since she gave birth.
ROS
General: No weight loss, fatigue or chills experienced by the patient.
HEET: Her vision is the same no issues of double vision or jaundice. Her ears, nose and throat are okay.
Skin: Her skin has not changed either is she having rashes.
Cardiovascular: No chest discomfort or pains.
Respiratory: She is not coughing or producing sputum, implying her respiratory is fine.
Gastrointestinal: She has eventually lost her appetite and wants to lose weight, although she is not vomiting or feeling abdominal pain.
Genitourinary: The urine colour or odour has not changed, and she is not experiencing any burns during urination. No headaches, no back or joint pains.
Hematologic: No bleeding realized or enlarged nodes.
Endocri ...
Postpartum period is a critical period in the life of a female from the biopsychosocial perspective. There are a number of psychological conditions which have their origin post pregnancy viz postpartum blues, postpartum depression, postpartum psychosis. Given their lack of awareness and relatively common presentation, it is imperative to know more about these conditions.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
14. Postpartum Mood Disorders Maternity blues Adjustment Disorder Postpartum Depression Postpartum Psychosis/ Mania Disorder 26 to 85% About 20% 10 to 20% 0.2% Incidence Support and reassurance Support/reassurance psychotherapy Antidepressants, mood stabilizers & psychotherapy Hospitalization; antipsychotics; mood stabilizers; benzodiazepines; antidepressants; ECT Treatment 80% resolve by week 2; 20% evolve to PPD Excessive difficulties adjusting to motherhood Onset within 1 year Agitated Major depression often with obsessions. Onset after PP day 3. Mixed/rapid cycling. Risk of infanticide. Presentation
15. Severity of Symptoms Transient, nonpathologic Medical emergency Serious, disabling Postpartum Blues Postpartum Depression Postpartum Psychosis 50% to 70% 10% 0.01%
31. Screening Tools Postpartum Depression Predictors Inventory – Cheryl Beck Postpartum Depression Screening Scale – also Cheryl Beck – Self-administered followed by a clinician interview, copyright issues, reliability studied have been done but are not yet published Ante Partum Questionnaire – self-report, not widely used Zung Self-Rating Depression Scale – 20 item, self report (Aaron) Beck Depression Inventory – not specifically for PPD, used in psychiatry, cost associated Edinburgh Postnatal Depression Scale (EPDS)
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43. Hotline Process Call Family Health Line Request information Woman needing further assessment Brochures mailed Call transferred to UBHC Clinician triages call Immediate Danger Notify crisis center Needs Assessment and uninsured or underinsured Appointment arranged with community mental health center Needs Assessment and has private insurance Referred to her insurance company
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Editor's Notes
Health professionals have told us that they become considerably involved with women they suspect of being depressed, but they are often unsure of what to do. With adequate training, support and liaison with other services, it should be possible to develop a structured and effective approach to promoting the psychological well-being of women during the postnatal period.
114,443 births in 2004 Approximately ten to fifteen percent of all pregnant women experience postpartum depression within one year of giving birth. This incidence is known to be higher for certain populations, including inner city women.
Much of the historical data on postpartum mood disorders is available from Europe. Although there existed a hospital for postpartum psychiatric diseases in France by 1858, women’s issues were often minimized. “ Folie des nourrices” or psychosis of nursing was recognized but often only as a legitimate reason to get rid of a wife and have her sent to an asylum. In 1926, a paper by Strecker and Ebaugh erroneously concluded that there was no psychosis designated as postpartum. It was not until the 4 th edition of the DSM in 1994 that the postpartum onset of a psychiatric illness was used as a specifier. Although there is still no specific diagnosis of postpartum illness, the specifier allows for: A diagnosable illness that can be related to childbirth; A diagnostic code that allows the provider to be paid and pharmacy payments and follow up visits to be garnered. A categorization that will allow further research into these disorders.
Written and sponsored by Former Acting Governor Codey
So that they too can overcome the spillover effects of the illness and improve their ability to be supportive of the new mother, we anticipate that Nurses will probably be providing the bulk of screening and education.
Maternity Blues is not a psychiatric illness but a frequently experienced physiological event for most new mothers. It requires no clinical intervention and usually resolves within 2 weeks of birth. If present it does increase the risk of Postpartum Depression. Adjustment Disorder defines a mother who is experiencing a greater than normal adjustment that would be expected for a new mother. These women can benefit from short term therapy focused on education, support, skills training and family interventions. The exact incidence is unclear as many women who experience this condition will not seek clinical attention of any type. The onset of Postpartum Depression according to DSM IV is within four weeks. However clinical experience seems to indicate that the onset frequently occurs within 3 months but may present up to a year after the birth of the child. Many factors can contribute to the delay in the clinical identification of this disorder. Key factors may include denial of illness, shame and stigma, intermittent and fluctuating course of the disorder. Postpartum psychosis is rare and occurs with an incidence of one to three per thousand life births. It is a medical emergency usually requiring hospitalization and should be under the care of a psychiatrist. Although infanticide is a rare phenomenon in postpartum disorders, women with postpartum psychosis are at the highest risk. Finally postpartum mania can also present with or without psychotic features and may also require intensive treatment and hospitalization.
Postpartum or Maternity blues is the most frequently observed postpartum mood disturbance. Symptoms are generally transient and non pathologic. Depression during the postpartum period affects 10% of patients and rises to about 20% in women who have experienced postpartum blues. Untreated depression in the postpartum period is associated with health risks to the mother as well as the child in terms of cognitive, emotional, and social development. Postpartum psychosis rare condition that is considered a medical emergency when it develops. It typically has a dramatic onset and is categorized by psychotic symptoms, disorientation and disorganized behavior. The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4 th Ed.) postpartum onset specifier for major depressive disorder is restricted to episodes with an onset within 4 weeks of delivery. However, some women develop symptoms more insidiously weeks or even months after childbirth.
As compared to Baby Blues, Adjustment disorder is pervasive
Most commonly women with postpartum depression will present with these symptoms. Associated symptoms can also include feelings of detachment from the baby, and severe preoccupation with the baby, often with intrusive thoughts about hurting the child directly or through her carelessness. Typical symptoms in postpartum depression (versus depression occurring at other time of life) include agitation (vs retardation), marked liability of mood (referred to in the literature as “mercurial moods”), and insomnia (even when the baby is sleeping). Often anxiety is also present. It is not uncommon for women with postpartum depression to present with panic attacks and obsessive preoccupation with the well-being of the infant.
Among high and moderate risk factors for postpartum mood disorders most notable is any history of psychiatric illness, before or during the pregnancy. Anxiety, including panic attacks, obsessive compulsive symptoms and general fearfulness very frequently accompany or are markers of depressive episodes. Substance abuse is a red flag for other co-morbid conditions, which the patient may be “self medicating.” The other most significant risk conditions concern lack of social support systems, which include the family of origin and marital relationship, and finally severe life stresses occurring during pregnancy. Although, less predictive as a risk factor is lower socioeconomic status.
The perception of being not supported can be a central issue in a depressed post partum mother, even if the facts do not support her perception. In the case where multiple generations of relatively recent immigrants are living in a community, the extent of acculturation across generations may pose conflicts to the new mother who wishes either to reject or restrict cultural practices related to pregnancy and new motherhood. Ex: types of foods, level of activity etc. In our increasingly mobile society, new mothers may find themselves far away from family and friends and the isolating aspects of pregnancy have not given sufficient opportunity to create new friendships. When geographic or social circumstances already isolate a mother her relationship with her partner becomes even more important. If difficulties are present, the isolation can be profound. Very young or older mothers may find themselves in the position of lacking social support or identification with others in their age group. For example, an adolescent mother may feel more isolated and resentful as her friends continue to enjoy their youth and freedom without such responsibilities. An older mother may find she has little in common with mothers in their twenties and early thirties because her birth story and life circumstances are different, while women her age may have already passed through the motherhood experience. Within an isolated environment, the ability to put ones mood and feelings into proper context or perspective is difficult. Feelings of being totally cut off from the world and fear that depressive feelings will be harshly judged can prevent a new mother from seeking appropriate support. Most important, perhaps, is the esteem in which a woman holds herself. Self-esteem and sexuality may be severely damaged by abuse, especially sexual abuse, which must be inquired about, as shame and pain may hinder spontaneous revelation.
These include complications during pregnancy, more than normal antenatal visits or lack of prenatal care, multiple prior terminations and multiple births in assisted pregnancies. In addition, hyperemesis and antenatal depression have also been identified as risk factors.
When examining the potential effects of postpartum mood disorders, we can identify three areas of concern: Effects on The Mother/Infant Relationship Effects on Child Development Effects on the Partner Relationship Postpartum depression can have an adverse effect on maternal-infant interactions. Research also shows that postpartum depression has a small but significant effect on children’s cognitive and emotional development. (Beck, CT, 1998). The effect of PPD on cognitive development, such as language and IQ have been documented particularly among boys. (Grace SL, et al 2003). Lastly, several aspects of child outcome have been found to be associated with postpartum depression. This include the child’s behavior with the mother, behavioral disturbance at home, and the content and social patterns of play at school. (Murray L, et al 1999)
Unrecognized, untreated and poorly treated postpartum depression can result in chronic symptoms and a detrimental effect on child development. One longitudinal study of 5,000 mother/child pairs found that the severity and chronicity of maternal depression was related to child behavior problems and lower vocabulary scores at age 5.
Most mothers are told that “breast is best” from many respected professional sources. Mothers are encouraged to breastfeed their baby for up to one year. While the public health message about breastfeeding is good news for the baby and reasonable for a healthy mother, it can feel like another pressure for a mother who is trying to cope with a mood disorder. Depression can make it difficult to read the baby’s cues and to successfully navigate the ongoing efforts that surround breastfeeding. Mothers with Postpartum Mood Disorders may require additional education, support and information regarding breastfeeding. One might consider recommending a lactation consultant or a postpartum doula to facilitate the breastfeeding experience if the mother chooses to nurse.
Let’s watch how a baby may react to mother’s changing facial expressions. Pay special attention to the child’s facial expressions and movements in this example. Please be aware that the mother was instructed on how to change her interaction with the baby during this clip, from being playful to having a flat affect, back to playful. After the clip, we will explain the theories behind the study in which this pair was participating. Ask group for their observations and encourage brief discussion) The Face-to-Face/Still-Face Paradigm (Cohn & Tronick, 1983; Tronick and Field, 1986) investigates the parent-child relationship with a focus on the infant’s behavioral, affective and physiologic reactions during structured face-to-face infant-caregiver interactions. Studies have used the still-face paradigm to analyze split-screen videotaped episodes with both depressed and non-depressed mothers and their infants and toddlers. During the still-face episodes the mothers are asked 1) to engage with infant spontaneously, 2) to turn away from infant and the return with a simulated depressive affect or still-face, and 3) to turn away again and, after a brief pause, to reunite and re-engage the infant in spontaneous affective interaction. The affect and behavior of depressed mothers has been shown to disrupt the infant’s sense of control, emotional displays of joy and pleasure, and felt-security in the relationship. The studies dramatize the complexity of infants affective responses with their mothers during the still-face and subsequent reparatory interactions during the reunion. During the still-face, infants of non-depressed mothers protest, gaze avert and may make efforts to regain the positive interaction with their mother. During the reunion infants may show a mixed emotional reaction before fully re-engaging with parent. The behavior and affect of infants of depressed mothers seems to more closely mirror the affect of their mothers during each episode, with less of a range in affective responses. The theory behind the research was not so much that a parent with a flat affect was distressing to a child -- I think this could probably be proven fairly easily. The hypothesis was that a child who was routinely exposed to an effectually-flat parent would display markedly different interactions than a child that wasn't. The "control" dyad would show distress during the still-face, try to find ways to get a response from the mother, etc, which we saw in the video clip. The "experimental" dyad, however, would in theory show us a child who would have less distress during the still-face. Just as important, however, would be to see what types of differences were seen during the "normal play" portion of the interaction. A structured clinical research paradigm such as the still-face is useful for identifying patterns that assist in understanding parent-child interactions. Used thoughtfully, these data and findings can contribute to our understanding of infant-parent relationships and lend guidance to sensitive and accurate naturalistic observations of infants and caregivers. As you can see from the clip, infants of depressed mothers show: Less effort to engage mother, more fussing and emotional dysregulation (which is the inability to calm oneself), difficulty regulating emotions and repairing/restoring interactions after disruption. Depressed mothers are less sensitively attuned and more behave in a more negative fashion towards infants than non-depressed mothers Patterns of maternal behavior with infants include 2 types: Intrusive: handling baby roughly, actively interfering and interrupting infant’s activities, overt anger Withdrawn: Disengaged, unresponsive, affectively flat, not noting or supportive of infants activities Depression in mother distressing to infant Infant’s subsequent distress contributes to severity of mother’s depression as she feels she cannot comfort infant Infant’s unresponsiveness also validates mothers’ depressive sense of her parenting capacities and her experience of herself in relationships Mother’s depressed mood & unpredictability leads to distress for infant that in turn impairs infant responsivity and contingent responding Negative perceptions and fantasies “Ghosts in the Nursery” Impaired ability to consider the world from baby’s point of view
The policies and recommendations from the postpartum mood disorders working group were incorporated into the legislation. The institution of screening for postpartum mood disorders was one of the four recommendations suggested as a standard of care both pre- and postnatally.
The Edinburgh Postnatal Depression Scale has been developed to assist primary care health professionals to detect mothers suffering from postnatal depression; a distressing disorder more prolonged than the "blues" (which occur in the first week after delivery) but less severe than puerperal psychosis. Previous studies have shown that postnatal depression affects at least 10% of women and that many depressed mothers remain untreated. These mothers may cope with their baby and with household tasks, but their enjoyment of life is seriously affected and it is possible that there are long-term effects on the family. The EPDS was developed at health centers in Livingston and Edinburgh. It consists of ten short statements. The mother underlines which of the four possible responses is closest to how she has been feeling during the past week. Most mothers complete the scale without difficulty in less than 5 minutes. The validation study showed that mothers who scored above threshold 92.3% were likely to be suffering from a depressive illness of varying severity. Nevertheless, the EPDS score should not override clinical judgment. A careful clinical assessment should be carried out to confirm the diagnosis. The scale indicates how the mother has felt during the previous week and in doubtful cases, it may be usefully repeated after 2 weeks. The scale will not detect mothers with anxiety neuroses, phobias or personality disorder.
This is not a diagnostic tool, but rather a screening tool. Refer the patient should a score of more than 1 be identified. A positive answer to question 10 on the Edinburgh means that the woman is at risk for PPD. Implications of score on question 10, self harm. Health professionals without mental health qualifications who administer the scale often worry about positive scores on item 10 of the EPDS. The majority of women with a small infant are unlikely to act on suicidal feelings. There is little published evidence linking suicidal ideation and risk with response to item 10 on the EPDS. However, there is a strong correlation regarding thoughts of self harm and might be more difficult for a health professional to recognize. A positive score on item 10 should be taken seriously and action should be taken immediately. If the mother answers positively to question 10, you need to assess the severity of the situation and ask the following questions: Severity How often and how severe is the feeling? Has she made any previous attempts to harm herself or her baby? What is she looking forward to? Does she have a good support system who can help her see the positive factors in her life? Plan Has she thought about how she will go about it? (Does she have a plan?) Has she got the means? (And are these likely to be effective?) Support System What support does she have at home? If she has a partner, has she told him how she is feeling? Can she count on him to understand and give her emotional support? If she hasn’t told him, would she like someone at the office or her doctor to help her to explain how she is feeling? If she doesn’t have a partner or feels that she really can’t tell him, is there anyone else who would be understanding (and not judgmental) and whose support she could realistically call on? Has she told this person or anyone else about her feelings? Could she phone this person and would they come if she feels bad? Do her parents know? (Is she close to them?) The questions should be asked in a supportive way encouraging the mother to tell her own story in her way. If mother has a plan to hurt self or baby or is unable to answer questions satisfactorily she must not be left alone and should be accompanied to the nearest ER or Mental Health practitioner’s office.
We often see young women who have had life long mood disorders who come into treatment because those mood disorders have become unmanageable usually because of increased stressors. These women have been functional, even highly competent throughout their life. Self report instruments can yield inaccurate results when masking symptoms has become a part of their overall functioning. Such patients can slip through the cracks. When administering a self-report, it may be prudent to have a staff member conduct the interview or review the findings with the person, as some encouragement may be needed to express a level of discomfort that a person has either learned to live with or is hesitant to admit. In addition, if a pregnant woman has had previous experience post partum illness necessitating the involvement of community agencies, she may be loathe to repeat that experience for fear she may have her case reopened, lose the baby or have other children taken away, Such a woman may not be forthcoming in self-report or at interview. Lastly, we are all familiar with the motherhood myth that joyous expectation should be the prevailing mood. This discrepant assumption can isolate a woman who is not feeling this maternal joy and make her unwilling or unavailable to disclose her symptoms of depression.
Melting pot vs. chunks in the soup Background & experiences define who you are, and culture is a large part of it. How woman copes, seeks care, treatment falls in the framework of her culture.
Large group/population any person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. According to Pew Hispanic Center 83% of Latinos attain health information from media, primarily TV. 79% act on that advice. Important goal to have baby at young age and to have a male baby for namesake Trust of formal health care system & accessing local “tiendas”
Not supported, family physically unavailable, marital discord, history of sexual abuse culturally in conflict, first generation enculturated second generation acculturated
Language -- Hindi 41%, hundreds of dialects, 15 official state languages Religion – Hinduism, Muslim, Sikh, & Christian Illness is family problem not individual, family obligation/duty , Family responsible for any serious health decisions Family hierachy – speak with elders first, not disclose to patient Social/religious mobilized during crisis Medical care – less invasive procedures, path of least resistance first, minimal therapy Physician is only sought for serious medical issue