Presented at Diabetes Workshop 2017 in conjunction with World Diabetes Day. Organized by Malaysian Endocrine & Metabolic Society and Hospital Putrajaya. 15th November 2017.
Developing A Culturally-Sensitive Guideline for Women’s Reproductive Health: ...Dr. Umi Adzlin Silim
Presented at The World Psychiatric Association Regional Meeting and 42nd Annual Convention of the Phillipine Psychiatric Association. 4-6 February 2016, Manila, Phillipines.
Presented at Bengkel Latihan Pengumpulan Data Kajian Postnatal Depression- Malaysia Aspire 2016, Hotel Concorde, Shah Alam, 21-24 Ogos 2016, and Bengkel Latihan Pengumpulan Data Kajian Postnatal Depression- Malaysia Aspire 2016, Hotel Klagan, Kota Kinabalu, Sabah, 26-29 Ogos 2016.
Recently obesity is becoming one of the psychiatric disorder , we are discussing depression and ADHD associated with obesity , cognitive reconstruction and cognitive behavior therapy steps is discussed , medical therapy used in obesity
Developing A Culturally-Sensitive Guideline for Women’s Reproductive Health: ...Dr. Umi Adzlin Silim
Presented at The World Psychiatric Association Regional Meeting and 42nd Annual Convention of the Phillipine Psychiatric Association. 4-6 February 2016, Manila, Phillipines.
Presented at Bengkel Latihan Pengumpulan Data Kajian Postnatal Depression- Malaysia Aspire 2016, Hotel Concorde, Shah Alam, 21-24 Ogos 2016, and Bengkel Latihan Pengumpulan Data Kajian Postnatal Depression- Malaysia Aspire 2016, Hotel Klagan, Kota Kinabalu, Sabah, 26-29 Ogos 2016.
Recently obesity is becoming one of the psychiatric disorder , we are discussing depression and ADHD associated with obesity , cognitive reconstruction and cognitive behavior therapy steps is discussed , medical therapy used in obesity
Women's right to mental health scwsd 14 9-06VIBHUTI PATEL
Mental health issues of women are gaining ground in the social work discourse. Universalist ETIC approach is found limiting in dealing with mental health problems. EMIC approach that emphasises cross-cultural psychiatry and evaluates mental health condition of women from within a culture is found more useful. Worsening socio-economic and political situation has enhanced the rates of common mental disorders and minor psychiatric morbidity. Trauma caused by violence against women should be tackled with the help of psychotherapy and psychoanalysis. The paper also discusses mental issues of adolescent girls, substance abusers, HIV-AIDS patients and women in reproductive age group. Media can play progressive role by providing empowering role models for women. Mental health of women in shelter homes, mental hospitals and police custody\ prison needs enlightened intervention by the state, non-government organisations and civil society. Self help groups provide democratic space for rebuilding broken lives. To make women’s material reality more secure, liberating and healthy, breakthrough counselling is need of an hour. Sensitization and training of general practitioners and other health personnel with this objective is a must. Ethics of valuing and respecting others must be observed by the counsellor. The counsellor should know that healing is a part of empowerment.
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.
Demystifying Postpartum Depression And Anxiety For Moms And DadsSummit Health
This presentation identifies the symptoms of postpartum depression and anxiety that can occur in both mothers and fathers, how to seek support, as well as know when to seek treatment.
Women's right to mental health scwsd 14 9-06VIBHUTI PATEL
Mental health issues of women are gaining ground in the social work discourse. Universalist ETIC approach is found limiting in dealing with mental health problems. EMIC approach that emphasises cross-cultural psychiatry and evaluates mental health condition of women from within a culture is found more useful. Worsening socio-economic and political situation has enhanced the rates of common mental disorders and minor psychiatric morbidity. Trauma caused by violence against women should be tackled with the help of psychotherapy and psychoanalysis. The paper also discusses mental issues of adolescent girls, substance abusers, HIV-AIDS patients and women in reproductive age group. Media can play progressive role by providing empowering role models for women. Mental health of women in shelter homes, mental hospitals and police custody\ prison needs enlightened intervention by the state, non-government organisations and civil society. Self help groups provide democratic space for rebuilding broken lives. To make women’s material reality more secure, liberating and healthy, breakthrough counselling is need of an hour. Sensitization and training of general practitioners and other health personnel with this objective is a must. Ethics of valuing and respecting others must be observed by the counsellor. The counsellor should know that healing is a part of empowerment.
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.
Demystifying Postpartum Depression And Anxiety For Moms And DadsSummit Health
This presentation identifies the symptoms of postpartum depression and anxiety that can occur in both mothers and fathers, how to seek support, as well as know when to seek treatment.
The chronic health conditions are long lasting. Issues like diabetes, improper blood sugar levels, and heart issues are signs of chronic diseases. These happen due to age, heredity and unhealthy lifestyle. A regular doctor’s visit in such a condition is important. As the chronic health conditions last for lifetime, maintaining a lifestyle to not worsen the same is necessary.
The diabetes cure (the 5 step plan to eliminate hunger, lose weight, and rev...Aqileditz
This is a food plan for diabetes patients and we also provided you with a product specially for diabetes patients,that is smart blood sugar with a special offer.
"Empowered Living with Diabetes: Navigating the Path to Wellness" is an indispensable guide for individuals seeking comprehensive knowledge and practical strategies for effectively managing diabetes. Written by Dr. Olivia Mitchell, a renowned expert in the field of diabetes management, this book offers a holistic approach to understanding and navigating the complexities of diabetes.
From the introductory chapters that provide a thorough overview of diabetes and its various types, to the detailed discussions on prevention, management, and coexisting conditions, this book covers it all. With clarity and expertise, Dr. Mitchell delves into topics such as blood glucose monitoring, medication management, healthy eating, physical activity, stress management, and the emotional well-being of individuals with diabetes.
Through insightful chapters that address common comorbidities associated with diabetes, readers will gain valuable knowledge on how to effectively manage cardiovascular health, hypertension, kidney disease, eye complications, nerve damage, and mental health concerns. Practical tips, evidence-based recommendations, and real-life examples provide readers with the tools needed to take control of their health and embrace a life of empowerment.
Furthermore, this book offers guidance for navigating special occasions, traveling with diabetes, and staying motivated while overcoming challenges. Dr. Mitchell emphasizes the importance of a supportive environment, self-advocacy, and the power of a positive mindset in achieving long-term success in diabetes management.
"Empowered Living with Diabetes" is not just a guidebook, but a source of inspiration and empowerment for individuals living with diabetes. Dr. Olivia Mitchell's expertise and compassionate approach create a valuable resource that will help readers develop the skills, knowledge, and confidence to thrive while managing their condition.
Whether you are newly diagnosed, have been living with diabetes for years, or are a caregiver or healthcare professional seeking comprehensive insights, this book is an invaluable companion on your journey towards wellness and empowerment. With its practical advice, empowering strategies, and the belief that a fulfilling life with diabetes is possible, "Empowered Living with Diabetes" will guide you towards a healthier, happier, and more empowered future.
The PowerPoint document has side notes averaging 150-450 words depending with the content.
I can upload the ppt version upon request.
Kindly reach out for more content like this.
The prompt is about A topic area of Healthy people 2020 (Diabetes: Diabetes Mellitus).
Diabetes Mellitus Facts.
Racial/Ethnic distribution as indicated by the CDC.
Diabetes (Diabetes mellitus) prevalence
Diabetes Mellitus Pathogenesis.
Risk Factors associated with Diabetes Mellitus
Proposed Solutions to tackling/combating/prevention/preventing Diabetes Mellitus
Individual goals for patients with Diabetes Mellitus (Action Plan)
Role of Exercise in tackling/combating/prevention/preventing Diabetes Mellitus
Preventing the Diabetes Mellitus burden
Role of APN in the management of Diabetes (Diabetes Mellitus)
Presented at ‘Training of Trainers’ Latihan Penilaian Kesihatan Mental & Psikososial untuk Permintaan Pengguguran
Peringkat Nasional, Ministry of Health Malaysia . 22-23 August 2017.
Teknik Utama dalam Rundingcara Berasaskan Motivasi untuk Permintaan Penggugur...Dr. Umi Adzlin Silim
Presented at ‘Training of Trainers’ Latihan Penilaian Kesihatan Mental & Psikososial untuk Permintaan Pengguguran Peringkat Nasional, Ministry of Health Malaysia . 22-23 August 2017.
Presented at Bengkel Latihan Pengumpulan Data Kajian Postnatal Depression- Malaysia Aspire 2016, Hotel Concorde, Shah Alam, 21-24 Ogos 2016, and Bengkel Latihan Pengumpulan Data Kajian Postnatal Depression- Malaysia Aspire 2016, Hotel Klagan, Kota Kinabalu, Sabah, 26-29 Ogos 2016.
Presented at Bengkel Latihan Pengumpulan Data Kajian Postnatal Depression- Malaysia Aspire 2016, Hotel Concorde, Shah Alam, 21-24 Ogos 2016, and Bengkel Latihan Pengumpulan Data Kajian Postnatal Depression- Malaysia Aspire 2016, Hotel Klagan, Kota Kinabalu, Sabah, 26-29 Ogos 2016.
Presented at Bengkel Latihan Pengumpulan Data Kajian Postnatal Depression- Malaysia Aspire 2016, Hotel
Concorde, Shah Alam, 21-24 Ogos 2016, and Bengkel Latihan Pengumpulan Data Kajian Postnatal Depression- Malaysia Aspire 2016, Hotel Klagan, Kota Kinabalu, Sabah, 26-29 Ogos 2016.
Presented at Bengkel Motivational Interviewing “Motivating Changes in Your Patients”, Bahagian Perkhidmatan Farmasi, Kementerian Kesihatan Malaysia. 25-26 April 2016.
Motivational Interviewing 2015: Empowering Patients in Self-careDr. Umi Adzlin Silim
Motivational Interviewing for Behavioural Changes. Presented at Seminar Clinical Dietetic Updates in Cardiovascular Disease & Hypertension, Kementerian Kesihatan Malaysia. 17-18 August 2015.
Experiences in Melbourne under the Postgraduate Oversea Student Training Fellowship (POST) Program End of Fellowship Presentation. St. Vincent’s Hospital. 26 November 2014
Early Career Psychiatrist Organization in Malaysia: Steps, Challenges and Les...Dr. Umi Adzlin Silim
Overview on the Early Career Psychiatrist Organization in Malaysia. Presented at the 7th National Conference of Indonesian Psychiatric Association, Surabaya, Indonesia. 30 October – 2 November 2013.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
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.
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
2. Issues Unique to
Women with Diabetes
• Biologically
• Psychosocially
• Women’s multiple roles –
pregnant, mother, wife, work
• Women is vulnerable to
depression – twice more likely
than men
3. Overview
• Relationship Women, Diabetes & Depression &
Prevalences
• Diabetes Distress
• Practical Ways: How Healthcare Providers Can
Help Patients
• How to Listen So Patients Will Talk
• How to Talk So Patients Will Listen (and
change their health-related behaviour)
5. Risk of Depression in
Diabetes
• A significant increased risk of developing
depression in the diabetic patients compared
to non-diabetic patients during the 10 years of
follow-up, which supports the previous notion
that diabetes is a “depressogenic” condition
and “stress-sensitive” disorder.
• Depression in Diabetes may result from:
• the biochemical changes directly caused
by diabetes or its treatment,
• the stresses and strains associated with
suffering from diabetes and its often
debilitating consequences
6. Risk of Diabetes in
Depression
• Depressed mood was moderately associated
with increase of developing type 2 diabetes
after adjustment for various covariates.
• These results are consistent with accumulating
evidence that depression is a significant risk
factor for developing type 2 diabetes.
12. Fig 1. Hypothesized model of the relationship between depression, diabetes distress and self –efficacy with
self-care practices.
Devarajooh C, Chinna K (2017) Depression, distress and self-efficacy: The impact on diabetes self-care practices. PLOS ONE 12(3): e0175096.
https://doi.org/10.1371/journal.pone.0175096
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0175096
13. Prevalence of Depression in Diabetes
• The prevalence rate of depression is more than three-times higher in
people with type 1 diabetes (12%, range 5.8-43.3% vs. 3.2%, range
2.7-11.4%) and nearly twice as high in people with type 2 diabetes
(19.1%, range 6.5-33% vs. 10.7%, range 3.8-19.4%) compared to
those without.
• Women with diabetes and also women without diabetes experience a
higher prevalence of depression than men.
Epidemiology of depression and diabetes: A systematic review. Available from:
https://www.researchgate.net/publication/232715188_Epidemiology_of_depression_and_diabetes_A_system
atic_review [accessed Nov 15 2017].
14. Prevalence of Diabetes Distress
• Type 1 DM: The prevalence and 9-month incidence of elevated
diabetes distress was 42.1% and 54.4%, respectively (Fisher et al,
2016)
• Type 2 DM: Systematic Review & meta-analysis of 55 studies (n = 36
998) demonstrated an overall prevalence of 36% for diabetes distress
in people with Type 2 diabetes. Significantly higher in samples with a
higher prevalence of comorbid depressive symptoms and a female
sample majority. (Perin et al, 2017)
15. Diabetes is one of
the Most Difficult
Chronic Diseases
• Living with diabetes is a challenge.
o Multiple medications, finger sticks,
physician visits, dietary restrictions
and the need to be physically
active.
o Complex and sometimes confusing
set of directives that may lead to
anger, frustration, and feeling
overwhelmed.
o Conflict with loved ones and
strained relationship with health
care providers.
• As a result motivation for self care
may be impaired.
16. Diabetes Distress (DD)
Diabetes distress (DD) refers to the unique,
often hidden, emotional burdens and worries
that a patient experiences when they are
managing a severe chronic disease like
diabetes. High levels of DD are common and
distinct from clinical depression
Gonzalez et al Diabetes Care 2011; 34:236-239
17. Diabetes
Distress Scale
(DDS17)
Validated in
Malay
Emotional Burden- personal reactions like
feeling scared, angry, or diabetes controls
my life
Physician Related Distress- doctor does
not give clear directions or take me
seriously
Regimen Related Distress- too many
meds and finger sticks-not confident in
my ability to care for my diabetes
Interpersonal Distress— Friends and
Family do not appreciate how difficult it is
and may not provide support
18. Understanding
Diabetes Distress
DD - THE PATIENT
Unsuccessful diabetes self
management over time
Downward spiral of poor
management and poor coping.
Reduced ability to gain new
knowledge/skills, development
of unrealistic goals and
expectations, inaccurate
personal beliefs and perceptions
that are self defeating.
Common reactions for a
distressed patient facing a
demanding chronic disease like
diabetes.
Fisher et al, Diabetes Care 2013;36:2551–2558
19. Life changes
dramatically when
THE PATIENT
receives a diagnosis
of Diabetes.
• Food choices are now changed and some of their
favorite food choices may be limited
• Physical activity is no longer an option but a requirement
for their health
• Multiple medications are required to sustain life
• Finger sticks are now required to guide their treatment
• Visits to the doctor and other health care providers is
now changed from an occasional to a frequent
occurrence.
20. DD – THE PATIENT
• All of these changes are coupled
with the knowledge that if the
disease is not controlled you may
face loss of vision, heart attack,
stroke, amputation and kidney
failure.
• Self management is the key to
success but the patients reaction
to self management directions
may lead to an inability to self
manage.
21. DD – THE PATIENT
• It is not unusual for patients with
diabetes to feel overwhelmed with the
demands of self management.
• Feelings of frustration, fatigue, anger,
burnout, poor mood and depression are
common.
• It is difficult to keep up with a
complicated routine when you have all
the above feelings
• Diabetes distress makes it difficult to self
manage and results in poor diabetes
control.
22. Understanding
Diabetes Distress
DD – FAMILY &
FRIEND
Families of patients with diabetes
may or may not understand all of
these issues and their lack of
understanding may place an
additional burden on the patient.
Family meals are an example. If
appropriate options are not
available the patient does not
want to inconvenience other
family members.
23. DD – FAMILY & FRIENDS
Patients with diabetes benefit by discussing their fears and
concerns with individuals and groups they can trust. Family and
friends are usually the patients most trusted associates.
But communication with family, friends and spouse about
diabetes is not easy for the patient, they may be embarrassed or
do not want to burden family and friends with their problems.
24. Understanding
Diabetes Distress
DD – Health care
providers
Diabetes creates significant challenges for all health care
providers (HCP) not just physicians.
HCP are driven by the fear of diabetes complications and
the knowledge that achieving goals for HbA1c, LDL B/P
reduces complications.
This fear produces behaviors in HCP that may interfere
with diabetes self-management.
HCP feel guilty if a patient is not achieving diabetes goals.
The guilt may lead to a culture of blame—where someone
has to be blamed and the patient is usually the target of
the blame.
25. DD – HEALTHCARE
PROVIDERS
• The common reaction to blame is labeling the patient non-
compliant.
• A more productive way to face this issue is to replace the
concept of compliance with the concept of barriers to
adherence:
– past emotional health,
– lack of support from family and friends
– misconceptions about their disease and its treatment
– inability to understand, purchase and use medications
– understanding and availability of appropriate food choices
– and an environment that is not conducive to physical activity
26. Tekanan Berkait Diabetes
Diabetes DistressD)
• Isu emosi yang unik kepada diabetes
• Berkait dengan bebanan dari diabetes
dan kerisauan kerana hidup dalam
keadaan mempunyai penyakit kronik
• Dilalui oleh sebahagian besar pesakit
diabetes
27. Tekanan akibat bebanan emosi
• Diabetes ambil terlalu banyak tenaga fizikal & mental setiap hari.
• Marah, takut, sedih memikirkan kehidupan dengan diabetes.
• Merasakan diabetes mengongkong kehidupan.
• Merasa akan dapat komplikasi jangkamasa panjang yang serius
(penyakit menjadi semakin teruk), walau apa pun yang dilakukan.
• Merasa tertekan dengan tuntutan hidup dengan diabetes
28. Tekanan berkaitan
doktor/anggota kesihatan
Tidak memahami secukupnya mengenai
diabetes dan penjagaan diabetes.
Tidak memberikan cukup panduan
tentang bagaimana mengendalikan
diabetes
Tidak cukup memandang serius
mengenai apa yang bimbangkan.
Tidak ada doktor/anggota kesihatan
yang dapat ditemui secara berkala
dengan secukupnya
29. Tekanan berkait dengan
penjagaan diabetes
• Rasa tidak cukup memantau gula dalam
darah.
• Rasa sering gagal memastikan rutin kawalan
diabetes.
• Rasa tidak yakin dengan keupayaan
mengendalikan diabetes
• Rasa tidak cukup mematuhi perancangan
pemakanan yang baik.
• Rasa tidak bermotivasi untuk meneruskan
pengurusan diri
30. Tekanan interpersonal/sokongan sekeliling
Kawan atau keluarga:
Tidak cukup memberi sokongan terhadap usaha
membuat penjagaan diri (seperti merancang aktiviti
yang tidak bersesuaian dengan jadual, menggalakkan
makan makanan yang salah
Tidak dapat memahami betapa sukarnya hidup dengan
diabetes boleh dilalui.
Tidak memberikan sokongan emosi yang diharapkan.
31. Impak Tekanan Berkait Diabetes
•Menjejaskan
•Kawalan gula dalam darah
•Penjagaan diri
•Keupayaan diri mengawal diabetes
•Kualiti hidup
32. Menilai Tekanan
• Tahap Tekanan
• Tekanan (distress)
• Gejala kemurungan/gejala keresahan (depressive/anxiety symptoms)
• Penyakit kemurungan/penyakit keresahan (depressive/anxiety disorder)
• Punca Tekanan – adakah ia berkait dengan diabetes?
• Tekanan berkait diabetes (diabetes distress)
33. HOW CAN WE HELP
OUR PATIENTS WITH
DIABETES DISTRESS?
AASAP
34. How To Listen So The Patients Will Talk
How To Talk So The Patients Will Listen
(and Change Their Health-related
Behaviour)
35. AASAP
AA
• Anticipate and Acknowledge the distress
Reflect & name distress
• “Sounds like you are feeling guilty..”
Identify the Ambivalence.
• “On one hand you feel like you really want
to lose weight/change your diet/exercise
more but feel you might fail again”
Identify both feelings
36. AASAP
S=Standardize and normalize the feelings
• “You are not alone, many patients with Diabetes
feel they same way this is expected and does not
surprise me..”
Also standardize the ambivalence by
normalizing the desire to improve and
the road blocks that are preventing
improvement
• “Most people with diabetes feel this way; they want
to improve but they often feel that it is so hard..”
37. AASAP
A=Accept and Understand
• Understand where the distress comes from- an emotional
struggle experienced when change not successful.
Examples
• “Change is hard work and distress occurs when goals that
were anticipated are not achieved or harder than expected”
• “Why do you think these feelings are happening now?”
• “Some people tell us they feel guilty when they are not able
to control their diet”
Emotion and Behaviour are different things
• Distressed does not mean they have to respond to it in ways
that are harmful to change. Reframe it
Accept it
• Do not fight it or react blindly or discount it as not important
38. AASAP
P= Plan to incorporate distress
as part of the plan for
behavioral change. i.e how to
respond to distress if it should
come about
If distress is experienced by
discouragement with meal
planning or exercise and this
blocks performance use
anticipatory problem solving
39.
40. AASAP
STRATEGIES PESAKIT:
Saya paling tak suka bila semua orang membebel suruh saya jaga makan,
lagi orang buat macam tu lagi saya makan semua benda..
REPEAT Saya dengar encik kata … (ulang semua)
REPHRASE Encik pantang kalau orang berleter menyuruh-nyuruh encik jaga makan,
menyebabkan encik lagi makan semua benda
PARAPHRASE Encik pantang kalau orang berleter menyuruh-nyuruh encik makan, dan
kerana itu encik bertindakbalas dengan buat sebaliknya walaupun perkara
itu berbahaya untuk encik sendiri…
41. AASAP:
Contoh
Menamakan
Emosi
“Mesti puan merasa sedih kerana kawalan gula masih
tidak baik walaupun telah berusaha sedaya upaya”
“Puan merasa kecewa kerana doktor seperti tidak
percaya puan”
“Puan rasa marah kerana selalu dipersalahkan”
“Boleh saya tahu apa perasaan anda bila kita perlu
tambahkan ubat anda? Adakah anda rasa sedih seolah-
olah apa yang anda buat untuk mengawal diabetes tidak
Berjaya?”
42. AASAP:
Contoh
Menormalkan
Emosi
Semua orang pun akan rasa
leceh bila terpaksa mengawal
makanan sebegini
Dalam keadaan begini, bila
gula dalam darah sentiasa
tinggi, siapalah yang tak risau..
Memang semua orang dalam
situasi begini akan rasa sukar
untuk laluinya…
43. AASAP:
Mengendalikan ‘Ambivalence’
(Rasa berbelah-bahagi)
• “Jadi sebahagian diri encik memang mahu
turunkan berat badan dan encik nampak
pentingnya untuk imej, kesihatan dan ingin
kembali aktif seperti dulu tapi sebahagian
dari diri encik rasa sukar mencari masa untuk
bersenam dan sukar menjaga makan kerana
makan di luar…..”
44. THANK YOU
umiadzlin@gmail.com
• “Reducing distress, may have less to do
with providing patients with programs
of action and behavioral change and
more to do with health care
professionals listening to,
understanding, acknowledging, and
normalizing DD so that patients
internal resources can become free of
internal distress–related constraints”
45. Acknowledgement & References
• A significant part of this presentation is from Edward Shahady MD FFAFP, ABCL,
Clinical Professor Family Medicine & Medical Director Diabetes Master Clinician
Program
• AASP protocol personal communication L. Fisher
• Fisher et al, AASAP protocol- Patient Education and Counseling 2012;86:372-377
• Fisher et al Diabetes Care 2007;30:542–548
• Fisher et al, Diabetes Care 2010;33:23–28
• Fisher L et al, Diabetes Care 2012;35(2):259-264
• Fisher et al, Diabetes Care 2013;36:2551–2558
• Fisher et al Diabe. Med 2009; 26: 622–627
• Fisher et al Diabe. Med 2014 ;31(7):764-72
Editor's Notes
Rephrase: stay close to what is being said, just substitute with a slight phrase & adding or buiding on it