By W. Josh. Ashland University.

When members of diVerent cultures and social collectives demand their rights generic levlen 0.15 mg on line, their demands themselves need to be based on choice rather than social coercion order levlen 0.15mg with visa. In addition to such clearly collectivist values as solidarity, caring, mutual cooperation and social responsibility, these values must also include the universal acceptance of the demand for tolerance and equal respect. If the members of these cultures cannot within their communities live in accordance with these values they want to promote, the true nature of saving cultural identity can be questioned. When the universal demand for tolerance and equal respect for cultural identity is taken seriously, cultural choices are seen as an essential part of the development of one’s moral identity. This moral identity, however, can be Multicultural issues in maternal–fetal medicine 57 fully realized only when an individual has a chance to make independent ethical choices against her own cultural beliefs, and when she can judge her cultural practices against those of other cultures. A person’s moral identity cannot be equated with cultural identity, rather, moral identity is a precondition in our choices of lifestyles, traditions and cultural allegiances. In other words, when cultural diversity and respect is emphasized, it needs to be recognized that a person’s moral identity is always inXuenced by her cultural background. In a global context this means that sometimes we need to interfere with practices that we see as unjust, and to help both the victims of this oppression and the oppressors to recognize the injustice practiced. After all, these individuals as members of particular communities (as is particularly the case with women and children) themselves guarantee the further existence and Xourishing of these communities and cultures (Ben- habib, 1995: p. Towards a global bioethics From the point of view of global bioethics, we have to Wnd the proper ways to make a distinction between positive and negative cultural features. Finally, we have to diVerentiate those ethical issues which appear to be culturally bound but in fact are a consequence of invalid logic and/or misinterpretations of the values that we may already share. After we have identiWed the foundational cause for ethical disagreements, we need to Wnd the right way to educate people with diVerent cultural and social backgrounds. When communities as a whole understand that common good can be achieved only through the well-being of their individual members, they can develop grass-root level progressive forces. This means that in addition to access to basic maternal health care and family planning services, medical professionals have to make connections with the traditional leader- ship (chiefs, religious leaders and elders) within a particular community. Partnership between health services, formal political systems and traditional social systems will be necessary in order to Wnd an inter-culturally acceptable strategy for delivering the proper health services. Consultations with com- munities and community-based service provision are needed to identify community concerns and to design mutually satisfactory ways to promote better health. Conclusion Many reproductive health problems are caused by women’s unequal access to medical and other resources, as well as by oppressive sexual, health and birth practices. Particularly in patriarchal cultures, the real reasons for women’s chronic reproductive disabilities or premature death in labour/childbirth are often heavy burdens of work, poor nutrition of women and girls, too early and continual pregnancies and generally excessive childbearing, often accom- panied by direct physical violence. Women’s special needs are often ignored, whether deliberately or inadvertently, either in the name of universal respect for overestimated autonomy or in the name of cultural rights. All in all, human rights standards themselves tend to ignore the complexity of women’s social position and are used to justify practices and behaviour which, if done to men, would be automatically considered as human rights violation. If we take seriously the feminist challenge to modern bioethics when we deal with patients from diVerent cultural backgrounds, we can Wnd a proper Multicultural issues in maternal–fetal medicine 59 way to promote the health and well-being of women and children without ignoring diVerence, social ties and local cultures. In order to promote health as well as justice, we need to take into account the local context and the particular physical, social and cultural circumstances of the particular patient. This means that the delivery of health services to individuals has to start by focusing on their characteristi- cs and powers of their communities, instead of promoting standardized benchmarks. Sensitivity to diVerences between individuals and social collectives, and a focus on the positive features of particular cultural systems, help us to turn communities into progressive rather than regressive forces in the improve- ment of maternal and fetal health. Strong communal and family values, diVerent cultural beliefs and social practices should not be condemned, rather they should be objectively considered as an integral part of develop- ment. No culture is inherently unreasonably resistant to development and change towards better living conditions as long as enough sensitivity and respect is shown towards its particular, local characteristics. To summarize, this chapter aims to show that it is not impossible to Wnd a shared set of values that can be universally promoted in diVerent types of cultures, without requiring cultural assimilation. While individuals may disregard their communities, there is no logically valid or morally legitimate reason why they should not work for the good of these communities – as long as we treat the individual members as equally valuable. A recent breakthrough in research has shown that mother-to-child transmission (vertical transmission) can be reduced with the use of anti-viral drugs (Connor et al. This exceedingly bleak outlook is relieved in part by the discovery that the following measures can reduce vertical transmission: ∑ Avoidance of breast-feeding decreases transmission after birth by about 14 per cent (Dunn et al. In fact, provided that the resources are available, vertical transmission rates can now be reduced to less than two per cent (Tudor-Williams and Lyall, 1999). Neverthe- less, pregnant women in these countries can at least be conWdent that their oVspring can escape infection, and, that if they accept treatment, they themselves may beneWt from earlier diagnosis (de Cock and Johnson, 1998). Studies in the early 1990s in Kenya and other African countries have shown that the epidemic has had little impact on attitudes and subsequent child- bearing (Ryder et al. In addition, some countries, such as Uganda and Senegal, have managed to reduce transmission by vigorous public health education programmes (Anonymous, 2000b). Pregnant women are considered an ‘epi- demiological useful’ group because they represent a stable sub-group of the heterosexually active population at ‘normal risk’.

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Mechanism of action and physiological effects Naturopathic indications and When the electrode is applied to the body it induces applications: validation of efficacy = 2 a local current in tissues and creates a local heating The late naturopathic physician Dr Poesnecker effect as the tissues resist the current flow 0.15 mg levlen overnight delivery. The described clinical application of pulsed short wave increased resistance promotes increased tissue per- therapy using an indirect approach to enhance organ fusion locally 0.15 mg levlen otc. His treatment was body by thin gauze, electrical sparks will shower directed to hepatic, splenic, renal and adrenal tissue, the skin with a resulting counterirritation effect. If with the goal of enhancing organ metabolism and the electrode current is concentrated into a point it detoxification. He applied this indirect approach in can be used for fulguration and is the current used chronic disorders such as chronic fatigue syndrome in hyfrecation. The effects on tissue have been the higher pulse rates, which have less thermal dis- described as a ‘cellular massage’ (Hewlett-Parsons persion due to the increased frequency, for acute 1968). It: et al 2005 Trock et al 1994) and chronic tinnitus, and inconsistent results are found with ankle sprains. Ben- • increases oxidation and local nutrition eficial observation in neural tissue repair has been (Matijaca 1919b) reported consistently in animal models (Raji 1984, Raji • produces hyperemia and stimulates circulation et al 1983, Sisken et al 1989). A study on Guillain–Barré in areas to which it is applied (this hyperemia syndrome demonstrated enhanced neurological tissue is believed to last from 10 to 24 hours) healing with pulsed short wave (Gorbunov et al 1995). Subsequently we will not rely on his- • increases the temperature where applied torical manufacturers’ recommendations and restrict • is topically germicidal, encourages leukocytosis ourselves to independent sources. The effect of the current is considered lubricants as the sparks may potentially cause igni- soothing and able to reduce inflammation (Boyle 1988, tion. Naturotherapy 1937c, Scott 1990), trachoma (Post- Graduate Study of Naturotherapy 1939b), arthritis Indications: validation of efficacy = 2 (Post-Graduate Study of Naturotherapy 1939c), mus- cular spasm, torticollis, low back pain, rheumatoid Contemporary conventional application of high- arthritis (Post-Graduate Study of Naturotherapy frequency current is primarily limited to dermatalogi- 1939b), peritonitis, pelvic adhesions, ovarian neural- cal diseases such as acne and atopic dermatitis, for gia, tic douloureux, neuritis, neuralgia, migraine, which it is considered safe and effective. Extensive therapeutic applica- apy 1938d), menstrual cramping, muscle tears, local- tions were recommended historically by manufactur- ized pain, fibroids, ovarian cysts (Blake 2006), ers of the units until prosecution in the 1950s in the bronchitis and nephritis (Scott 1990). The current is delivered using adhesive electrode pads or graphite- conducting fabric. An ampere is the rate of movement of electrons past a point in space and one millionth of an ampere is a microamp (μA). The body itself gener- ates microamperage current in every cell and mem- brane as part of its normal physiological activity. This current flow creates the polarity observed by Becker in the human system in which the body is polarized Figure 12. Photograph courtesy of more positively at the head, negatively at the feet, Silhouet-Tone more positive centrally and more negative distally Chapter 12 • Electrotherapy Modalities 551 of unmodulated direct current or non-specific fre- quency choices. The frequencies were resurrected from lists of frequencies used with wall current elec- trotherapy modalities used from 1914 to 1937. While published clinical outcomes and some preliminary animal research have been performed in order to sep- arate the effects of the microcurrent alone from any additional frequency-specific effect, further research is necessary. The research needed to separate the effects of the current alone from the additional effects of the frequency response is an area of interest but published clinical outcomes and some preliminary animal research are promising. Validation of efficacy = 4 Microcurrent has documented effects in increasing wound, tissue and fracture healing, decreasing pain Figure 12. Photograph courtesy of International and edema and treating myofascial trigger points and Medical Electronics neuropathic pain. Most microcurrent devices • Thirty hospital patients with non-healing ulcers are battery operated but some are plugged into a wall were divided into two groups, one treated with current source and current levels are stepped down to conventional wound dressings and one with microamperage. The Microcurrent creates its effects by delivering current latter group was given two 2-hour stimulation within a normal physiological range, making it par- periods per day. After 6 weeks of such ticularly consistent with naturopathic principles and treatments, the group treated with appropriate to a naturopathic practice. Most electrotherapy of wounds, using negative polarity over the devices deliver current in the milliamp range, or thou- lesions in the initial phase, and then alternating sandths of amps, to create their therapeutic effect. Both • cannot run current through a pregnant uterus microcurrent and laser were found to be significantly more effective than placebo, with • cannot run current through the brain laser slightly more effective than microcurrent. Microamperage current has been used clinically in • Frequency-specific microcurrent has been ‘off label’ uses in all of these situations except during shown to be effective in the treatment of pregnancy. In clinical usage, microcurrent is safe to myofascial trigger points and pain in the head, use with plates, pins, artificial joints and implants, neck and face, and low back (McMakin 1998, and in new injuries, chronic pain and swelling. The frequency-specific response has been Caution should be exercised in running current shown to reduce inflammatory cytokines, near or through the chest in patients with demand substance P and pain and increase endorphin pacemakers and practitioners may best be advised levels in fibromyalgia associated with cervical to contact the pacemaker manufacturer’s technical spine trauma using 40 Hz on channel A and support line to ask for guidance about use with the 10 Hz on channel B (McMakin 2005). When in doubt it is best to • In unpublished animal research carried out at ‘do no harm’ and err on the side of caution. None of the three other fracture repair, myofascial trigger points, neuropathic frequency combinations tested had any effects pain and spinal cord-mediated pain in fibromyalgia on reducing inflammation. None of these indica- inflammation, 40 Hz/116 Hz produced a 30% tions can be claimed by the manufacturers or distribu- reduction of swelling which was equivalent to tors of the devices.

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