By: John Hunter Peel Alexander, MD
The street demonstrators who in 1966 had been instrumental in pushing Sukarno aside and crushing communism were reined in and told to cheap 25mg benadryl with visa allergy to sunscreen resume their normal activities under the guidance of the military-dominated government. Political competition was regarded as the enemy of economic growth, and all political parties were told to toe the government line. Most were eventually merged into two large parties substantially controlled by the government. At the same time, the hard-driving governor of Jakarta was quickly learning demo graphic lessons in his attempts to renovate a city with poor housing, schooling, trans port, and basic services. By mid-1966, Sadikin was regularly making speeches linking urban problems to rapid population growth. Toward the end of 1966, Sadikin challenged the Indonesian Planned Parenthood Association to devise a project that would help ease the rate of natural population increase in the capital. Between 1966 and 1968, most official family planning initiatives were taken under the aegis of the city government, and later, as programs began in other areas, the example of Jakarta was cited as proof that strong, responsive leadership could overcome the problems of religious opposition and com munity intransigence (Hull 1987). Concentrating on actions by individuals such as Suharto and Sadikin prevents an understanding of the environment in which the debate took place and changing atti tudes in the broader community. One example illustrates how fragile the situation was and how important the political factor was in the development of family plan ning in Indonesia. One of the key activities leading to the establishment of an official family planning program in 1968 was the compilation and publication of a pamphlet on Views of Religions on Family Planning? (Panitya Adhoc Keluarga Berentjana [Ad Hoc Committee for Family Planning] 1968). Based on a panel discussion that included government representatives and religious leaders in February 1967, the pur pose of the pamphlet was to document the general acceptance of principles of fam ily planning by four of the five officially recognized religions: Islam, Protestant Chris tianity, Catholic Christianity, and Balinese Hinduism. The consultations did not include Buddhists, as at that time many Indonesians did not recognize Buddhism as a religion. The discussion and the pamphlet captured an important moment in social change, a tipping point when national consensus around the morality of birth con trol was turning from strongly negative to strongly positive. Those who contributed to these discussions made many points that remain con troversial decades later. The pamphlet repeatedly condemned abortion, yet the implied definition of abortion was often vague and contradictory. The acceptable motivations for family planning were couched in terms of the welfare of the family, and the pamphlet assumed that having too many? children was a threat to both mothers and offspring. Yet at the same time, it stated that the use of birth control for selfish reasons, just to have a luxurious lifestyle and the like, obviously cannot be accepted by religion? (Panitya Adhoc Keluarga Berentjana 1968, p. In summary, while religions could be accepting of birth control, it was only acceptable in the context of a philosophy of family planning that was responsible, unselfish, and moral. Nonetheless, the social breakthrough of 1967?68 provided the foundation for a change of approach by the government that led directly to a major fertility decline. As a result, a completely new set of issues came to the fore as the program established its place in the bureaucracy. The most obvious were budgets and staffing issues, but other important issues related to the exercise of authority, including who was to control clinics and outreach services, how research priorities were to be set, who would set the terms of evaluation, and who would have the right to administer foreign assis tance. Agency for Interna tional Development and United Nations Population Fund assistance to train the staff of departments and nongovernmental organizations at both the central and the provincial levels (Haryono and Shutt 1989; Moebramsjah 1983; Moebramsjah, D?Agnes, and Tjiptorahardjo 1982; Sumbung 1989).
Advisethe couple about theirgeneral health cheap benadryl 25 mg on-line allergy medicine covered by insurance,importanceofregular exercise, andavoiding excessive alcohol drinking andsmoking. If thecouplefailtoconceive aftertryingfor an appropriate time,bothpartnersneed to be referredfor evaluation. According to studies from around theworld,bothwomen andmen areaffected by infertility. But many socio-culturalfactorsare associated with theoccurrenceofinfertility, either directly or indirectly,inadditiontothe alreadyestablishedphysical causes. Ifawoman gets marriedasateenager she will experiencealongerperiodofproductivity andtendtohave more childreninher lifetime. Ifawoman fails to usebirth controlmethods,either to limitortospace herchild bearing, shewill continue to give birth throughout herlifetime. C isfalse because in denselypopulated areas thepopulationisforced to liveinovercrowdedareas with smallpieces of land to cultivate. Eisfalse because rapidpopulationgrowth, lowagriculturalproduction anddestructionofthe environmentare commontomostofthe sub-SaharanAfrican countries, includingEthiopia. Threeofthemare as follows: Avoiding tooearly and toolatepregnancies:Familyplanning helps mothersavoidpregnancy whentheyare vulnerablebecause of their youthorold age. Therefore,once thedesirednumberofchildrenhas been achieved, awoman can avoid further pregnancybyusing family planning methods. Facility-based service delivery:thisapproach providesfamilyplanning services in Ethiopia through public health centresand hospitals. Possible major activitiesfor theaboveobjectives couldbe: 1 Secure contraceptive commodities. Additionally,your answer couldpoint out that most of theimpacts cannotsimplybecalculatedfromroutineservice data. Use model households andcommunity volunteerstoconveyfamily planning messages to thecommunity. Make useoftraditionalforms of entertainment,suchasroleplays,folk songs,theatre andpuppetshows, in ordertotransmitinformationwith regard to theprogramme. Cisalso false because counsellingisacontinuous process in whicha client learns about family planning step by step. A, Dand Eare truebecause counsellingisanongoing, two-way communicationprocessthattakes place in everyhealth andfamily planning service encounter. Thisenables aperson to be informed about differentmethods,ask questions,makeaninformedchoice about method, andleavethe clinic feelingcon? E ExplaintoW ozeroMisgane how to usethe method chosen;ask her to repeat theinstructions. Providerfactors, such as your ability to engage in effective communication, your technicalknowledge,skills,attitudesand behaviours. Externaland programmatic factorswhich you cannot control, such as lack of availabilityofcertain methods or equipment, or irregular suppliesoffamilyplanning materials. Couples with lowerlevelsofeducationcan usenatural family planning methods effectively, providing thecoupleare highlymotivated andhavebeen well trained in themethod.
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The neurological literature reveals a consistent finding of a predominance of right hemisphere lesions in association with disinhibition syndromes as well as secondary mania (Starkstein et al purchase benadryl 25 mg fast delivery allergy forecast today austin tx. Earlier work on the phenomenon of pathological laughing and crying sup ports this localization. Left-sided brain lesions tend to produce pathological crying while right-sided lesions produce pathological laughing (Sackeim et al. Lesions associated with these syndromes are heterogeneous in nature, including head injuries (Jorge et al. However, predominating in frequency are right sided cerebrovascular lesions (Cummings 1993, Fawcett 1991, Carroll et al. One case of mania occurring after cardiac surgery had even been preceded by a right-sided cerebrovascular accident (Isles and Orrell 1991). Further support for the significance of neurological comorbidity in mania in late life comes from a retrospective cohort study that compared elderly bipolars to a sex and age matched group of unipolar depressives (Shulman et al. More that one-third of the manic group had evidence of heterogeneous neurological disorders compared to only 8% of the depressives. Table 1 documents the nature of these disorders and their relationship to age at onset and family history. While genetic factors tend to be less prominent in late-onset disor ders (Mendlewicz et al. Bipolar disorder in old age 161 A fortiori, in very late-onset first episode mania, 10 of 14 patients had comorbid neurological disorders; largely cerebral infarctions (Tohen et al. Thus, lesions of the inferior and frontal aspects of the brain impact on these connections, thus accounting for the psychomotor, emotional and instinctive symptoms of secondary mania. Similarly, the diagnostic term "frontal lobe dementia" includes elements of disinhibition associated with decreased metabolic activity in the orbito-frontal circuit (Starkstein et al. Neuroimaging research has helped to elucidate the nature, more so than the location, of brain lesions (Shulman 1997). These findings include a preponderance of subcortical hyperintensities, decreased cerebral blood flow and evidence of silent cerebral infarctions. An increase in subcortical (basal ganglia) hyperintensities has been found in elderly manics, largely in the inferior half of the frontal lobe (McDonald et al. The relationship to cerebrovascular disease is strengthened by the associated risk factors such as hypertension, cardiovascular disease and diabetes mellitus. Late-onset mania is associated with a higher prevalence of silent cerebral infarctions (Kobayashi et al.
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