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The pregnancy 379 Fanconi Anemia: Guidelines for Diagnosis and Management should be considered high risk and should be co-managed by a maternal/ fetal medicine specialist and a hematologist anxiety symptoms scale discount 30mg cymbalta with mastercard. Skin (detailed in Chapter 9) Patients with suspicious nevi (birthmarks) or other abnormal skin lesions should be examined by a dermatologist anxiety symptoms of purchase cymbalta no prescription. Patients receiving transfusions need to be screened for iron overload or the effects of iron-chelation therapy anxiety chest pain purchase cymbalta with paypal. Some may have neurocognitive defcits and need educational anxiety symptoms while pregnant purchase cheap cymbalta on-line, vocational anxiety symptoms in 12 year old boy cheapest cymbalta, workplace anxiety symptoms eye pressure buy discount cymbalta online, community, or interpersonal relationship assistance. Autosomal dominant condition: A genetic condition that can be passed on when an individual inherits only one copy of an abnormal gene. B cells: Type of white blood cell, lymphocyte, that is responsible for antibody production. Biallelic mutations: Genetic changes that are found in both copies (alleles) of the same gene. Carriers usually do not develop the disorder, but can pass a copy of the abnormal gene onto their children. Gives the number, and/or percentage, and/ or characteristics of certain blood cells, primary white cells, red cells, and platelets. Centralization: A surgical procedure that moves and centers the wrist over the end of the ulna (a large bone in the forearm). Chelation: the use of a chelator (an organic chemical that bonds with and removes free metal ions) to bind with a metal (such as iron) in the body. Clonal abnormalities: Changes in the structure or number of chromosomes in certain cells of the bone marrow. A relatively common virus in the herpes family that causes mild symptoms in healthy people but can pose a serious health risk to immune-compromised individuals. Colposcopy: A medical procedure in which a doctor uses an illuminated magnifying device called a colposcope to examine the vulva, vagina, and cervix. Cortisol: A steroid produced by the body that plays important roles in the stress response, immunity, metabolism of nutrients, and other processes. A drug that suppresses the immune system and is used to prevent transplant rejection. Duodenal Atresia: A condition in which the entrance to the small intestine, known as the duodenum, is incomplete or blocked and does not allow the contents of the stomach to enter the intestines. Endocrine: the endocrine system produces hormones that allow the body to develop and function. Esophagoscopy: Examination of the esophagus by means of a fexible endoscope, a thin, tube-like instrument with a light and a lens for viewing. The levels of ferritin in the blood increase as the amount of iron in the body increases. Flow cytometry: A laboratory technique used to diagnose blood cancers and other conditions that can separate, count, and evaluate cells with distinct characteristics. A drug capable of suppressing the immune system before transplant to prevent rejection of the new blood-forming stem cells, and is also used to treat some cancers. A hormone produced by the pituitary gland that stimulates the growth of ovarian follicles in women and sperm-producing cells in men. Gastrointestinal system: this system digests food and absorbs the nutrients the human body needs to function properly. A red blood cell protein that is responsible for transporting oxygen to various parts of the body through the bloodstream. A protein found on the surface of cells in the body; this protein helps the body determine what is self and what is foreign. Impaired glucose tolerance: People with impaired glucose tolerance have trouble breaking down the sugars found in their diets, but they do not yet have diabetes. Leukemia: Leukemia is a group of bone marrow diseases involving an uncontrolled increase in white blood cells (leukocytes). Lymphocyte: Type of white blood cell that fghts infection by producing antibodies and other protective substances. Macrophage: A white blood cell that helps to destroy invading micro organisms and is involved in the immune response. Opportunistic infection: this type of infection is common in immune compromised patients who are unable to fght off microbes that do not normally cause disease in humans. Pap test: A gynecological test used to detect cervical cancer and precancerous lesions. A condition that occurs when blood vessels in the liver called sinusoids become excessively dilated and form large blood-flled spaces, like cysts, that are scattered throughout the liver. Polypharmacy: the administration of many different medicines during the treatment for the same disease. Pouce fottant: A so-called foating thumb that lacks bones and is composed of skin and soft tissue. Radius: Of the two long bones in the forearm, the radius is the shorter and thicker one. Recessive: A mutation is said to be recessive if an individual must inherit two copies of the mutant gene, to have the disease. Short bowel syndrome: this condition occurs when nutrients from food are not properly absorbed because a large segment of the small intestine is non functional or has been surgically removed. Stem cells: Cells that can develop into one of many types of specialized cells in the body. Stem cell gene therapy: A novel treatment that combines gene therapy and stem cell therapy in an effort to correct a faulty gene in the stem cells of the recipient. Transferrin saturation: the amount of iron carried by the transferrin protein in the blood. If a disorder is X-linked recessive, it means that females must inherit two copies of an abnormal gene for the disease to develop, whereas males need only inherit one. This manual was written, designed, and produced by the Technical Writing Department of 3M Health Information Systems. Microsoft and Windows are registered trademarks of Microsoft Corporation in the United States and/or other countries. A single dash (-) symptoms; clinical or diagnostic indicates a Definition is not available. Signs and symptoms of anemia may include pallor of the skin and mucous membranes, shortness of breath, palpitations of the heart, soft systolic murmurs, lethargy, and fatigability. Navigational Note: Disseminated intravascular Laboratory findings with no Laboratory findings and Life-threatening Death coagulation bleeding bleeding consequences; urgent intervention indicated Definition:A disorder characterized by systemic pathological activation of blood clotting mechanisms which results in clot formation throughout the body. There is an increase in the risk of hemorrhage as the body is depleted of platelets and coagulation factors. Navigational Note: Leukocytosis >100,000/mm3 Clinical manifestations of Death leucostasis; urgent intervention indicated Definition:A disorder characterized by laboratory test results that indicate an increased number of white blood cells in the blood. Navigational Note: Thrombotic Laboratory findings with Life-threatening Death thrombocytopenic purpura clinical consequences. Navigational Note: Atrioventricular block Non-urgent intervention Symptomatic and Life-threatening Death complete indicated incompletely controlled consequences; urgent medically, or controlled with intervention indicated device. Navigational Note:If left sided use Cardiac disorders: Left ventricular systolic dysfunction; also consider Cardiac disorders: Restrictive cardiomyopathy, Investigations: Ejection fraction decreased. Navigational Note: Mobitz type I Asymptomatic, intervention Symptomatic; medical Symptomatic and Life-threatening Death not indicated intervention indicated incompletely controlled consequences; urgent medically, or controlled with intervention indicated device. Navigational Note: Myocarditis Symptoms with moderate Severe with symptoms at rest Life-threatening Death activity or exertion or with minimal activity or consequences; urgent exertion; intervention intervention indicated. Navigational Note: Pericardial effusion Asymptomatic effusion size Effusion with physiologic Life-threatening Death small to moderate consequences consequences; urgent intervention indicated Definition:A disorder characterized by fluid collection within the pericardial sac, usually due to inflammation. Navigational Note: Pulmonary valve disease Asymptomatic valvular Asymptomatic; moderate Symptomatic; severe Life-threatening Death thickening with or without regurgitation or stenosis by regurgitation or stenosis by consequences; urgent mild valvular regurgitation or imaging imaging; symptoms controlled intervention indicated. Navigational Note: Sick sinus syndrome Asymptomatic, intervention Symptomatic, intervention Symptomatic, intervention Life-threatening Death not indicated not indicated; change in indicated consequences; urgent medication initiated intervention indicated Definition:A disorder characterized by a dysrhythmia with alternating periods of bradycardia and atrial tachycardia accompanied by syncope, fatigue and dizziness. Navigational Note: Ventricular arrhythmia Asymptomatic, intervention Non-urgent medical Urgent intervention indicated Life-threatening Death not indicated intervention indicated consequences; hemodynamic compromise Definition:A disorder characterized by a dysrhythmia that originates in the ventricles. Navigational Note: Hyperparathyroidism Mild symptoms; intervention Moderate symptoms; medical not indicated intervention indicated Definition:A disorder characterized by an increase in production of parathyroid hormone by the parathyroid glands. Navigational Note: Precocious puberty Physical signs of puberty with Physical signs and biochemical no biochemical markers for markers of puberty for females <8 years and males <9 females <8 years and males <9 years years Definition:A disorder characterized by unusually early development of secondary sexual features; the onset of sexual maturation begins usually before age 8 for girls and before age 9 for boys. Navigational Note: Corneal ulcer Corneal ulcer without Perforation in the affected eye perforation in the affected eye Definition:A disorder characterized by an area of epithelial tissue loss on the surface of the cornea. Navigational Note:If corneal ulcer is present, grade under Eye disorders: Corneal ulcer. Navigational Note: Optic nerve disorder Asymptomatic; clinical or Moderate decrease in visual Marked decrease in visual Best corrected visual acuity of diagnostic observations only acuity (best corrected visual acuity (best corrected visual 20/200 or worse in the acuity 20/40 and better or 3 acuity worse than 20/40 or affected eye lines or less decreased vision more than 3 lines of from known baseline) decreased vision from known baseline, up to 20/200) Definition:A disorder characterized by involvement of the optic nerve (second cranial nerve). Navigational Note: Papilledema Asymptomatic; no visual field Symptomatic; moderate Symptomatic with marked Best corrected visual acuity of deficit decrease in visual acuity (best decrease in visual acuity (best 20/200 or worse in the corrected visual acuity 20/40 corrected visual acuity worse affected eye and better or 3 lines or less than 20/40 or more than 3 decreased vision from known lines of decreased vision from baseline) known baseline, up to 20/200) Definition:A disorder characterized by swelling around the optic disc. Navigational Note: Retinal tear No retinal detachment and No retinal detachment and treatment not indicated treatment indicated Definition:A disorder characterized by a small laceration of the retina, this occurs when the vitreous separates from the retina. Navigational Note: Uveitis Anterior uveitis with trace Anterior uveitis with 1+ or 2+ Anterior uveitis with 3+ or Best corrected visual acuity of cells cells greater cells; intermediate 20/200 or worse in the posterior or pan-uveitis affected eye Definition:A disorder characterized by inflammation to the uvea of the eye. Navigational Note: Anal fissure Asymptomatic Symptomatic Invasive intervention indicated Definition:A disorder characterized by a tear in the lining of the anus. Navigational Note: Anal fistula Asymptomatic Symptomatic, invasive Invasive intervention Life-threatening Death intervention not indicated indicated consequences; urgent intervention indicated Definition:A disorder characterized by an abnormal communication between the opening in the anal canal to the perianal skin. Navigational Note: Ascites Asymptomatic; clinical or Symptomatic; medical Severe symptoms; invasive Life-threatening Death diagnostic observations only; intervention indicated intervention indicated consequences; urgent intervention not indicated operative intervention indicated Definition:A disorder characterized by accumulation of serous or hemorrhagic fluid in the peritoneal cavity. Navigational Note: Belching Increase from baseline Intervention initiated (including over the counter medications) Definition:To expel gas noisily from the mouth. Navigational Note: Chylous ascites Asymptomatic; clinical or Symptomatic; medical Severe symptoms; elective Life-threatening Death diagnostic observations only; intervention indicated. Navigational Note: Colonic fistula Asymptomatic Symptomatic, invasive Invasive intervention Life-threatening Death intervention not indicated indicated consequences; urgent intervention indicated Definition:A disorder characterized by an abnormal communication between the large intestine and another organ or anatomic site. Navigational Note: Dental caries One or more dental caries, Dental caries involving the Dental caries resulting in not involving the root root pulpitis or periapical abscess or resulting in tooth loss Definition:A disorder characterized by the decay of a tooth, in which it becomes softened, discolored and/or porous. Navigational Note: Duodenal fistula Asymptomatic Symptomatic, invasive Invasive intervention Life-threatening Death intervention not indicated indicated consequences; urgent intervention indicated Definition:A disorder characterized by an abnormal communication between the duodenum and another organ or anatomic site. Navigational Note: Enterocolitis Asymptomatic; clinical or Abdominal pain; mucus or Severe or persistent Life-threatening Death diagnostic observations only; blood in stool abdominal pain; fever; ileus; consequences; urgent intervention not indicated peritoneal signs intervention indicated Definition:A disorder characterized by inflammation of the small and large intestines. If reporting a documented infection, use Infections and infestations: Enterocolitis infectious. Navigational Note: Esophageal fistula Asymptomatic Symptomatic, invasive Invasive intervention Life-threatening Death intervention not indicated indicated consequences; urgent intervention indicated Definition:A disorder characterized by an abnormal communication between the esophagus and another organ or anatomic site. Navigational Note: Esophageal hemorrhage Mild symptoms; intervention Moderate symptoms; Transfusion indicated; Life-threatening Death not indicated intervention indicated invasive intervention consequences; urgent indicated; hospitalization intervention indicated Definition:A disorder characterized by bleeding from the esophagus. Navigational Note: Esophageal perforation Invasive intervention not Invasive intervention Life-threatening Death indicated indicated consequences; urgent operative intervention indicated Definition:A disorder characterized by a rupture in the wall of the esophagus. Navigational Note: Gastroesophageal reflux Mild symptoms; intervention Moderate symptoms; medical Severe symptoms; operative disease not indicated intervention indicated intervention indicated Definition:A disorder characterized by reflux of the gastric and/or duodenal contents into the distal esophagus. It is chronic in nature and usually caused by incompetence of the lower esophageal sphincter, and may result in injury to the esophageal mucosal. Navigational Note: Gastrointestinal fistula Asymptomatic Symptomatic, invasive Invasive intervention Life-threatening Death intervention not indicated indicated consequences; urgent intervention indicated Definition:A disorder characterized by an abnormal communication between any part of the gastrointestinal system and another organ or anatomic site. Navigational Note: Gingival pain Mild pain Moderate pain interfering Severe pain; inability to with oral intake aliment orally Definition:A disorder characterized by a sensation of marked discomfort in the gingival region. Navigational Note: Hemorrhoidal hemorrhage Mild symptoms; intervention Moderate symptoms; Transfusion indicated; Life-threatening Death not indicated intervention indicated invasive intervention consequences; urgent indicated; hospitalization intervention indicated Definition:A disorder characterized by bleeding from the hemorrhoids. Navigational Note: Ileal fistula Asymptomatic Symptomatic, invasive Invasive intervention Life-threatening Death intervention not indicated indicated consequences; urgent intervention indicated Definition:A disorder characterized by an abnormal communication between the ileum and another organ or anatomic site. Navigational Note: Ileal perforation Invasive intervention not Invasive intervention Life-threatening Death indicated indicated consequences; urgent operative intervention indicated Definition:A disorder characterized by a rupture in the ileal wall. Navigational Note: Lower gastrointestinal Mild symptoms; intervention Moderate symptoms; Transfusion indicated; Life-threatening Death hemorrhage not indicated intervention indicated invasive intervention consequences; urgent indicated; hospitalization intervention indicated Definition:A disorder characterized by bleeding from the lower gastrointestinal tract (small intestine, large intestine, and anus). Navigational Note: Oral cavity fistula Asymptomatic Symptomatic, invasive Invasive intervention Life-threatening Death intervention not indicated indicated consequences; urgent intervention indicated Definition:A disorder characterized by an abnormal communication between the oral cavity and another organ or anatomic site. Navigational Note: Oral hemorrhage Mild symptoms; intervention Moderate symptoms; Transfusion indicated; Life-threatening Death not indicated intervention indicated invasive intervention consequences; urgent indicated; hospitalization intervention indicated Definition:A disorder characterized by bleeding from the mouth. Navigational Note: Periodontal disease Gingival recession or Moderate gingival recession Spontaneous bleeding; severe gingivitis; limited bleeding on or gingivitis; multiple sites of bone loss with or without probing; mild local bone loss bleeding on probing; tooth loss; osteonecrosis of moderate bone loss maxilla or mandible Definition:A disorder in the gingival tissue around the teeth. Navigational Note: Rectal fistula Asymptomatic Symptomatic, invasive Invasive intervention Life-threatening Death intervention not indicated indicated consequences; urgent intervention indicated Definition:A disorder characterized by an abnormal communication between the rectum and another organ or anatomic site. Navigational Note: Rectal hemorrhage Mild symptoms; intervention Moderate symptoms; Transfusion indicated; Life-threatening Death not indicated intervention indicated invasive intervention consequences; urgent indicated; hospitalization intervention indicated Definition:A disorder characterized by bleeding from the rectal wall and discharged from the anus. Navigational Note: Rectal perforation Invasive intervention not Invasive intervention Life-threatening Death indicated indicated consequences; urgent operative intervention indicated Definition:A disorder characterized by a rupture in the rectal wall. Navigational Note: Tooth discoloration Surface stains Definition:A disorder characterized by a change in tooth hue or tint. Navigational Note:Also report Investigations: Neutrophil count decreased Upper gastrointestinal Mild symptoms; intervention Moderate symptoms; Transfusion indicated; Life-threatening Death hemorrhage not indicated intervention indicated invasive intervention consequences; urgent indicated; hospitalization intervention indicated Definition:A disorder characterized by bleeding from the upper gastrointestinal tract (oral cavity, pharynx, esophagus, and stomach). Navigational Note: Visceral arterial ischemia Brief (<24 hrs) episode of Prolonged (>=24 hrs) or Life-threatening Death ischemia managed medically recurring symptoms and/or consequences; evidence of and without permanent invasive intervention end organ damage; urgent deficit indicated operative intervention indicated Definition:A disorder characterized by a decrease in blood supply due to narrowing or blockage of a visceral (mesenteric) artery. Navigational Note: Death neonatal Neonatal loss of life Definition:Newborn death occurring during the first 28 days after birth. Navigational Note: Biliary fistula Symptomatic, invasive Invasive intervention Life-threatening Death intervention not indicated indicated consequences; urgent intervention indicated Definition:A disorder characterized by an abnormal communication between the bile ducts and another organ or anatomic site. Navigational Note: Budd-Chiari syndrome Medical management Severe or medically significant Life-threatening Death indicated but not immediately life consequences; moderate to threatening; hospitalization or severe encephalopathy; coma prolongation of existing hospitalization indicated; asterixis; mild encephalopathy Definition:A disorder characterized by occlusion of the hepatic veins and typically presents with abdominal pain, ascites and hepatomegaly.

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South-South in Action; Sustainability in Thailand; Experience for Developing Countries anxiety order cymbalta on line. The evaluation of a multi-level oral health intervention to improve oral health practices among caregivers of preschool children anxiety symptoms all the time order cymbalta online. Health literacy of village health volunteers in municipality anxiety symptoms but dont feel anxious purchase 30 mg cymbalta amex, Nakhon Ratchasima anxiety symptoms vomiting discount cymbalta 60mg amex, Thailand anxiety symptoms in adults buy cymbalta 30 mg lowest price. Abilities of Village Health Volunteers in Determining Drug Related Problems for Diabetes and Hypertension Patients anxiety worse in morning generic cymbalta 40mg online. In addition, there is an escalating emergence of non-communicable diseases such as cardiovascular diseases, cancer and diabetes in Uganda. These diseases are now making an increasingly important contribution to the illnesses and deaths currently occurring within the population. Furthermore, access to improved drinking water sources increased significantly from 52% in 2001 to 72% in 2013, and the level of poverty declined by two-thirds. At the top of the health system structure are national referral hospitals (that offer highly specialized services), followed by regional referral hospitals (offering high-level surgical and medical services). Community members identify the people who are interested in the role and agree to work on a voluntary basis. The training is usually offered with the support of implementation partners operating within a district, and the content may differ according to the focus of the program. However, this role in practice is played by other cadres in some districts such as Health Inspectors. Such incentives include compensation for transport fares to attend meetings, and non-financial incentives in the form of T-shirts, gumboots, solar panels, raincoats, umbrellas, bicycles, bags and badges. The type of incentives provided is dependent on the program being implemented or the implementation partners involved in the particular activity. The exchange of this information is managed by the District Health Information System. These challenges span several areas including training, transportation, remuneration, motivation and retention. Village health team strategy and operational guidelines: Ministry of Health Kampala, 2010. The contribution of malaria control interventions on spatio temporal changes of parasitaemia risk in Uganda during 2009-2014. Working with community health workers to improve maternal and newborn health outcomes: implementation and scale-up lessons from eastern Uganda. Integrated community case management in a peri-urban setting: a qualitative evaluation in Wakiso District, Uganda. Beyond pilotitis: taking digital health interventions to the national level in China and Uganda. Strengthening accountability chains for maternal, newborn and child health in Uganda. Can volunteer community health workers decrease child morbidity and mortality in southwestern Uganda The performance of community health workers in the management of multiple childhood infectious diseases in Lira, northern Uganda a mixed methods cross sectional study. Supporting and retaining Village Health Teams: an assessment of a community health worker program in two Ugandan districts. Performance of community health workers and associated factors in a rural community in Wakiso district, Uganda. Supervision is supposed to be conducted at the health facility and the community level on a monthly basis using standardized supervisory checklists but is often not carried out because of the pressing clinical demands of the supervisors. It is estimated that only half of the rural population lives within five kilometers of a health facility. A central aim of the strategy was to formalize the role of the volunteer community health workforce to ensure the quality of training and services being provided. Of the 1,956 health facilities in Zambia, 81% are government owned, 13% are private, and 6% are faith based. In 2013, the Zambian health system underwent another reorganization and created the Ministry for Community Development and Mother and Child Health which was responsible for implementing health activities at the district level and below. The number of work hours and type of incentives offered were also considerably variable by partner. They document their work and referrals in community health registers, which are then submitted monthly via health facilities to the district level where they are entered in the health management information system known as District Health Information System Version 2. This includes a community diagnosis (baseline health status of the community through available primary or secondary data sources) and mapping of the catchment area and resources. The practical component involves rotating recruits to local clinics near the training schools. Supervisors are equipped with a supervision manual and monthly supervision tools to facilitate routine supervision. In practice, supervision out in the community, which is supposed to occur on a monthly basis, rarely happens due to competing work priorities on the part of the supervisor. The first strategy was a community-service poster outlining the opportunity to help communities through health education and services. The career-orientated recruitment strategy not only generated more highly qualified candidates, but these candidates also completed 30% more household visits when deployed after their training. Zambia Community Health Strategy 2019-2021: Community Health Driving Primary Health Care for Universal Health Coverage (draft). Lusaka, Zambia: Department for International Development, Government of the United Kingdom, 2012. Do-gooders and Go-getters: Career Incentives, Selection, and Performance in Public Service Delivery. An exploration of facilitators and challenges in the scale-up of a national, public sector community health worker cadre in Zambia: a qualitative study. They also work with community based volunteers and extension workers where they take the lead role. They also are trained to diagnose and treat common conditions such as diarrhea and malaria. Refresher trainings are conducted twice a year or as needed and when funds are available. They are also broadly supervised and supported by community leaders and the Ward Health Team. Zimbabwe moved from a curative, urban-based and minority-focused health care system to one which emphasized health promotion and prevention and provided some acceptable level of health care to the majority rural population. Zimbabwe has had one of the lowest life expectancies in the world, falling from 62 years in 1990 to 44 years in 2008,10 and more recently recovering to 61 years. In 2010, the infant mortality rate was 86 deaths per 100, 000 live births whereas in 2018 it had dropped to 46 deaths per 100,000 live births. Health system structure the government health system operates in all 10 provinces in the country. The health system is decentralized, and care is provided at four levels: primary, secondary, tertiary, and quaternary. The secondary level includes facilities that receive patients who need hospitalization. These facilities also provide primary care services for those living in the immediate area surrounding the facility. The tertiary level has facilities with specialist staff to attend to referrals from the lower levels. The most advanced level of care is the quaternary level, which includes six central hospitals that have the equipment, staff, and pharmaceuticals for patients requiring highly specialized care. They are trained to diagnose and treat common conditions such as diarrhea and malaria. They also coordinate other community-based health workers, including traditional healers, traditional birth assistants, and community-based distributors of family planning, as shown in Box 1. However, in practice these additional trainings are not routinely held due to lack of funding. Responsibilities are further delegated to the Provincial Nursing Officers, District Nursing Officer, and finally to clinic staff. The community leaders, particularly the Ward Health Team, are the first line of support and supervision in the community. This is presented to the nurse-in-charge at the nearest health center every month, where they go over the registers together, discuss visits conducted and propose tasks for the following month. They also receive transportation allowances, per diem payments and/or lunch vouchers during training and monthly meetings. There also non-financial incentives including bicycles (provided primarily by the Global Fund), uniforms and sometimes T-shirts. They are expected to report to their nearest health center every month to provide updates on key indicators including monitoring and reporting suspected epidemics. At the end of each month, the nurse-in-charge at the rural health center uses this information to create an aggregated report for the health facility. However, in many locations these registers are not checked by supervisors, not completed or not returned regularly. This interrupts longitudinal reporting and introduces bias in monitoring time trends in communities. The vent pipe sucks out air from the pit and fresh air is drawn down through the squat hole. We are grateful to the late David Sanders and to Rukundo Kambarami Benedict for their comments on an earlier draft. Health in Zimbabwe since independence: the potential and limits of health sector reforms in Zimbabwe. Ouagadougou Declaration on Primary Health Care and Health Systems in Africa: Achieving Better Health for Africa in a New Millennium 2008. Supporting the National Health Strategy to Improve Access to Quality Health Care in Zimbabwe. Addendum 2 for the Village Health Worker Trainer Epidemic Preparedness, Response and Other Communicable and Non-Communicable Diseases. Commonly shared challenges Among the commonly shared challenges are weak political support and funding, unreliable supply of medicines and other program commodities, lack of career advancement opportunities, threats to motivation, and unsafe work conditions. Notable trends and achievements Over time, many programs have gradually shifted to a more comprehensive package of services, including, increasingly, family planning and curative services such as treatment of serious childhood illnesses. They can also make important contributions toward eventually reaching Health for All. Observations, Trends, and the Way Forward 445 446 Health for the People: National Community Health Worker Programs from Afghanistan to Zimbabwe Introduction Including only the programs documented in this compendium, there are 8. Some longer-standing programs have taken notable twists and turns over the past four decades. Thus, there was a decade-long process of progressive expansion of tasks and responsibilities during which time the value of the program became increasingly evident. However, the government terminated the program in 2013 in response to a political crisis. Thailand has one million Village Health Volunteers (one for every 10-20 households). This can include dispensing program commodities either on an ongoing basis as depot holders. Such programs have been introduced in Afghanistan, Bangladesh, Ethiopia, Ghana, Liberia, Malawi, Mozambique, Nepal, Niger, Rwanda, Sierra Leone, Tanzania, Uganda, and Zambia. Their roles vary; in some programs they help to mobilize the community so that when a government vaccinator comes to the community, those who need a vaccination will be there to receive it (as happens in Bangladesh, Nepal and India). In India, Auxiliary Nurse Midwives have now been renamed Multipurpose Health Workers, reflecting new responsibilities for non-communicable diseases and care for the elderly. Most of the programs covered in this compendium provide six weeks to three months of initial training. However, this is often sporadic and frequently is funded by external donors on disease-specific topics. Supervision In the case studies in this compendium, supervision is a commonly mentioned challenge. Because these programs tend to be underfunded, supervisory responsibilities are often tacked on to staff of the nearest health facility who themselves may be overloaded with clinical and other responsibilities. Time pressures on supervisors and lack of transport are the most common constraints cited. However, there are countries that appear to have been able to overcome these constraints. At this point, however, there is a shortage of nurses and the program has yet to ramp up due to the lack of funding. Still, it represents an interesting emerging approach to supervision and close teamwork. Historically, supervision has often been carried out by other cadres of health worker. Following completion of this training, these Family Health Professionals will receive a university degree and return to work at their health post doing similar work as before, at a health center to work as a clinician, or in a district or regional office to assume a management position (Zufan Abera, personal communication, 2020). Many programs utilize volunteers and provide no salary (Afghanistan, Ethiopia, Indonesia, Kenya, Nepal), but these volunteers usually receive other incentives, from per diem payments to social recognition and in-kind benefits.

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Syndromes

FSH level
Hematoma (blood accumulating under the skin)
IVP - less utilized tests
Green, leafy vegetables (spinach and romaine lettuce)
Has it grown bigger?
Pericarditis
Have a history of radiation exposure to the head or neck

References

Daugherty HI, Franzini JE. Steady fl ow of incompressible fl uids in pipes. In Fluid mechanics with engineering applications, 4th edn. New York:McGraw - Hill, 1965:191.
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Warren GW, Singh AK. Nicotine and lung cancer. J Carcinog 2013;12:1-8.
Razvi, H.A., Chun, S.S., Denstedt, J.D., Sales, J.L. Softtissue applications of the holmium:YAG laser in urology. J Endourol 1995;9:387-390.