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E. Connor. C. R. Drew University of Medicine and Science.

If such a route were taken buy 5mg compazine mastercard, this would effectively be a form of outsourcing best 5 mg compazine, with such agreement typically following the well-worn tracks of medical tourist mobility. Countries continue to evaluate their positions on trade liberalization in health, as part of wider bi- lateral, regional and multilateral trade agreements. The latter especially has been the focus of debate, centred on the World Trade Organization‘s General Agreement on Trade in Services (Blouin et al. However, there is widespread recognition that the trade agenda (in services generally, and health specifically) is increasingly pursued at the regional or bi-lateral levels (Smith et al. Could this development be broadened to include medical tourist exchanges with countries where travel distance are longer, culture and language less familiar, but where cost savings to the public purse are more apparent? This is an important shift in the dialogue, as greater bi-lateral and regional trade may reduce many of the concerns expressed over health services trade, and offer greater benefits. For instance, it may result in greater quality assurance, as well as better litigation procedures. However, much of the research evidence, anecdote and opinion on trade in health services remain focussed on this multi-lateral perspective. It is important, therefore, to explore bi-lateral trade in more detail, and to assess how it compares to multi-lateral trade. Such a focus would move discussion from the level of global medical tourism to more specific bilateral exchanges – for particular treatments, under specific quality-assured conditions (Smith et al. Beyond the national level, medical tourism raises questions for trans-national and global structures and processes. How, indeed if at all, should the medical tourism industry be best regulated, and where is intervention most likely to be effective? There is currently a lack of agreed international standards for assessing and ensuring quality and safety of medical tourism providers and health professionals, and no obligation for them to ensure quality and safety other than an ethical one. Currently, there is no universal ―official agency/group‖, such as the United Nations, the World Health Organization, the World Tourism Organization or the World Trade Organization, engaged in either the delivery of accreditation, the co- ordination of delivery of accreditation, or licensing or studying the existing schemes that deliver accreditation. There is a range of possible solutions (both national and transnational) ranging from interventions that provide more information (although by whom and at what points is not clear); those that restrict choice of potential consumers (either directly prohibited or through discouragement); or attempts to restrict supply (whether approving or licensing providers or intermediaries). There are also interventions that may aim to offer consumer protection around poor-quality treatments which could involve encouraging independent holistic accreditation by recognised schemes, advising that clinicians responsible for delivering services take out personal medical indemnity which would compensate their patients in the event of problems occurring as a consequence of their seeking healthcare, or requiring medical tourists to take out insurance coverage (Cohen, 2010). Source health systems may attempt to shift risk onto individual medical tourists, for example with disclaimers to prevent medical tourists from seeking to rectify poor outcomes at cost to the public purse. What are the programme priorities surrounding medical tourism for both source and destination countries? As outlined, medical tourist choice may lead to externalities at the system and programme level. Costs may result from overseas cosmetic surgery or dental work that requires subsequent treatment within home countries. There are few case reports or studies of these aspects and the scale of any problem is not clear. Large numbers of medical tourists will also impact on the source country‘s own health system, because outflows reduce both revenue and support for local services. Patients who circumvent waiting times make access and equity for the wider population more problematic. Opportunities for financial benefit from medical tourism include potentially exerting competitive pressure on systems importing health care and may help drive down the costs and prices offered in domestic systems, or relaxing legal restictions in order to stimulate domestic provision of treatments. Most countries that engage in delivering care to medical tourists do so to increase their level of direct foreign exchange earnings. Some countries may promote health services in order to develop facilities 42 to better serve local patients, although the possibility of resources being diverted from the domestic population and invested into private hospitals and away from rural areas remains a potential dysfunctional outcome. Similarly, whilst the prospect of reversing the international brain drain is very positive, there are concerns that medical tourism will cause an internal brain drain, with health professionals leaving the public health system to work for the hospitals that attract medical tourists. Research is needed on the economic impact for source and destination countries, particularly those low- and middle-income countries where there is speculation but little evidence about the impact of medical tourism treatments on local citizens, either in a health sense or indeed an economic sense. Country case studies of such state-driven support for medical tourism would be a useful starting point to better understand the positive and negative impacts on country finances and populations of involvement with medical tourism. In terms of management of services and treatments, there are continuing questions about the range of information and its quality. Given the role of the internet, how (if at all) the quality of medical tourism information is best addressed is unclear: ranging from codes of conduct, through quality labels, user guidance tool, third-party quality and accreditation labels, to educating users and assisting those wishing to search (Lunt et al. Frontier medicine and the marketing of biotechnologies present a particular issue (Murdoch and Scott, 2010) given that such treatments may not be based on proven clinical trials. These should be better documented and understood, including their strengths and drawbacks, as well as the implications for managing quality, safety and risk. The roles and responsibilities of clinicians and healthcare providers within both provider countries and countries of origin, and organisations responsible for credentialing and continuing professional development of clinicians in provider countries, require clarification regarding their duties in relation to patients who seek help and advice in advance of engaging in medical tourism. What is the role of informing, persuading and advocating for individuals that intend to travel abroad, and the role on return? What about the public health dimensions, such as pre-travel vaccination, anti-malarial prophylaxis etc.?

Your plan may cover additional medications generic compazine 5 mg line; please refer to your enrollment materials for details buy compazine 5mg visa. Cigna does not take responsibility for any medication decisions made by the doctor or pharmacist. Cigna may receive payments from manufacturers of certain preferred brand medications, and in limited instances, certain non-preferred brand medications, that may or may not be shared with your plan depending on its arrangement with Cigna. Depending upon plan design, market conditions, the extent to which manufacturer payments are shared with your plan and other factors as of the date of service, the preferred brand medication may or may not represent the lowest-cost brand medication within its class for you and/or your plan. In accordance with Texas and Louisiana state law, customers with afected beneft plans who receive coverage for medications that are removed from the prescription drug list during the plan year will continue to have those medications covered at the same beneft level until their plan renewal date. To fnd out if these state mandates apply to your plan, please call Customer Service. Plans vary, so some plans may not include Cigna Specialty Pharmacy Services or Cigna Home Delivery Pharmacy. Please check your plan materials for more information on what pharmacies are covered under your plan. Costs and complete details of the plan’s prescription drug coverage are set forth in the plan documents. If there are any diferences between the information provided here and the plan documents, the information in the plan documents takes complete precedence. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. This booklet has been developed and a volunteer network to support others affected by the disease. We have answers We are the Asthma Society of Canada and we care about your lung health. The goal of asthma management is to keep asthma symptoms under control by reducing inflammation in your airways. You can help control your symptoms by avoiding asthma triggers and by using your asthma medications as prescribed. It will assist you in understanding what your medication does, how to take it properly and why an action plan is important. This booklet is for adults with asthma or parents with a child with asthma, and will address the following questions: What is good asthma control? Good asthma management includes education, avoiding triggers, using asthma medications properly and following a written action plan © 2007 Asthma Society of Canada, 4950 Yonge Street, Suite 2306, Toronto, Ontario Canada M2N 6K1. Use these steps to guide your discussions with your doctor, pharmacist and asthma educator. Step 3 Medication Step 1 Your doctor may prescribe Diagnosis Asthma controller medication Talk to your doctor about Learn what your your breathing difficulty medication does and Your doctor confirms you have how to take it properly asthma and may do tests Learn how a written Find out about asthma, what action plan can help you it is and how it can be controlled manage your asthma This step is discussed in the This step is discussed in booklet called Diagnosis this booklet called Medications Step 2 Triggers Find out what makes your asthma worse by keeping a diary and getting allergy tests Once you know what your allergic and non-allergic triggers are, you learn how to avoid them This step is discussed in the booklet called Triggers 2 © Asthma Society of Canada Step 4 Education Learn as much as possible. Ask your pharmacist and doctor lots of questions Read informational materials and visit www. Good asthma control means being able to participate in strenuous activity 4 © Asthma Society of Canada Reasons for poor asthma control If your asthma is poorly controlled, it might be because: You are not using your inhalers properly. Show your doctor or pharmacist how you use your inhalers You are being exposed to a trigger. Read the Asthma Basics Booklet called Triggers for information about things that can make your asthma worse. Talk to your doctor about allergy tests You are not using your controller medication regularly. Use your controller medication every day You may have something other than asthma, such as an infection, and you may need another different medication, in addition to your asthma medication One indicator of poor asthma control = needing your reliever inhaler 4 or more times a week because of breathing problems 5 Medications: Asthma Basics Booklet Controller medications Having asthma means having long-term inflammation in your airways. Avoiding your asthma triggers by modifying your environment is the best way to help reduce this swelling (see the Asthma Basics Booklet called Triggers), but it is often not enough to achieve and maintain good asthma control. Regular use of a controller medication, will treat the persistent inflammation of the airways. Inflamed airway and mucus Regular use of controller medicine Normal airway = normal function 6 © Asthma Society of Canada Controllers: Inhaled Corticosteroids Inhaled corticosteroids have an anti-inflammatory effect on the airways. When used regularly, inhaled corticosteroids reduce inflammation and mucus in the airways, making the lungs less sensitive to triggers. Everyone with asthma, including mild asthma, benefits from regular use of inhaled corticosteroids. When your asthma is poorly controlled, your doctor may prescribe an inhaled corticosteroid. It can take days or weeks for the inhaled corticosteroid to reduce the inflammation in your airways, so be patient.

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It reflects failure to receive adequate nutrition over a long period of time and is also affected by recurrent and chronic illness buy compazine 5mg without a prescription. Therefore wasting is acute malnutrition – a result of inadequate food intake or a recent episode of illness causing loss of weight and onset of malnutrition compazine 5mg generic. This is a composite indicator which takes into account both chronic and acute malnutrition. Causes include inadequate maternal food intake during pregnancy, short maternal stature and infection such as malaria. Cigarette smoking on the part of the mother also is associated with low birth weight. Most common medical complications in severely malnourished children include generalized oedema, hypothermia, hypoglycaemia, dehydration, anaemia, septicemia/infections and cardiac failure. Treat complications eg dehydration, shock, anemia, infections, hypothermia, hypoglycemia and electrolyte imbalance. In some cases obesity occurs secondary to other disorders or conditions such as hypothyroidism, Cushing’s disease and others. In this regard men with over 24 percent body fat and women with over 35 percent body fat are considered obese. Desirable amounts are 8 to 24 percent body fat for men and 21 to 35 percent for women. Reduction of haemoglobin impairs oxygen transport to the tissues – the basis of the clinical features of anaemia. Four major groups are distinguished:  Haemorrhagic anaemia develops due to various forms of bleeding (trauma, excessive menses, bleeding associated with pregnancy and birth giving, and parasitic infestations such as hookworms and scistosomiasis). Bone marrow depression can be caused by diseases (autoimmune, viral infection), radiation and chemotherapy and intake of some drugs (anti-inflammatory, antibiotics). Nutritional anaemias are o Iron deficiency anaemia o Folic acid deficiency anaemia o Vitamin B12 deficiency anaemia Anaemia affects all population groups but children aged below five years and pregnant women are the most vulnerable. Detection of anaemia is by determining the concentration Hb and the cut-off points at sea level are as follows: Table 4: Population group Hb levels indicating anaemia (g/dl) Children 6 to 59 months Below 11. Iron in foods of animal origin (haem iron) is more easily absorbed compared with iron in foods of plant origin (which is mostly non- haem iron). Vitamin C enhances absorption of iron while tea and coffee inhibits iron absorption. Iron Deficiency The main function of iron is transport of oxygen at various sites in the body. Thus iron is a component of haemoglobin and myglobin (protein molecule in the muscle which carries oxygen for muscle metabolism). Iron is a component of cytochromes (involved in cell respiration); component of xanthine oxidase (involved in catabolism of purines which make nucleic acids). Iron is a component of aconitase (involved in the Krebb’s Cycle) and many other enzymes such as peroxidase and catalase. While Hb concentration is used to define anaemia, it does not define the body’s iron status. Depletion of iron stores: the body’s storage pool (deposits in the liver, spleen and bone marrow) diminishes due to insufficient dietary intake. Iron deficiency erythropoiesis: storage levels substantially reduced, inadequate iron is available in the bone marrow for the synthesis of Hb. Iron deficiency anaemia: last and most severe stage of iron deficiency – iron stores are insufficient to maintain Hb synthesis. Also when food is boiled in water iron is leached and is lost if the water is discarded. The hormones have profound influence on energy metabolism, protein synthesis, growth and development. They also play part in the conversion of carotene to Vitamin A and synthesis of cholesterol. This, in turn, affects brain development, physical growth and functioning of muscles, heart, liver and kidneys. Goitre is an enlarged thyroid gland – a result of thyroid over-activity as it strives to capture sufficient iodine from the blood. The iodine is retained in the body tissues for a long period of time (three to five years), maintaining the thyroid hormones at normal levels  Iodinated oil capsules: 400 mg iodine administered orally, repeated after one to two years  Lugol’s solution: 3 drop (21 mg) once a month, up to one year 4. It plays important roles in the body, including role in vision, maintenance of epithelial tissue, synthesis of mucous secretion, growth, reproduction and immunity. It, contributes to body’s supply of niacin (another B vitamin) by facilitating in the conversion of tryptophan (an amino acid) to niacin. Deficiency is commonly caused by consumption of highly polished cereals or foods containing thiaminase (anti-thiamine factor). Signs and symptoms of deficiency  Characterized by enlargement of nerves, weight loss (due to loss of appetite), oedema and disturbance in heart function  Lack of energy  Lesions in nervous tissues. Also it plays part in synthesis of corticosteroids and production of red blood cells. Signs and symptoms of deficiency  It characterized by sore throat, pharyngeal and oral mucous membrane hyperaemia, angular stomatitis, cheilosis, glossitis and anemia  Riboflavin deficiency almost invariably occurs in combination with other vitamin deficiencies.

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