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In areas that are eczema free purchase rumalaya forte overnight, there is xeroderma or drying of the skin with some fine scaling order rumalaya forte 30 pills online. In places where the eczema is active buy rumalaya forte discount, the skin is red from the increased blood supply and swollen because of the oedema order rumalaya forte without a prescription. Symptoms of skin disorder Skin disease causes pruritus (itching), pain, soreness and discomfort, difficulty with movements of the hands and fingers, and cosmetic disability. Any skin abnormality can give rise to irritation, but some, such as scabies, seem particularly able to cause severe pruritus. Most scabies patients complain that their symptom of itch is much worse at night when they get warm, but this is probably not specific to this disorder. Itching in atopic der- matitis, senile pruritus and senile xerosis is made worse by repeated bathing and vigorous towelling afterwards, as well as by central heating and air conditioning with low relative humidity. If pruritus is made worse by aspirin or food additives such as tartrazine, sodium benzoate or the cinnamates, it is quite likely that 20 Symptoms of skin disorder urticaria is to blame. Persistent severe pruritus can be the most disabling and dis- tressing symptom, which is quite difficult to relieve. Scratching provides partial and transient relief from the symptom and it is fruitless to request that the patient stop scratching. Scratching itself causes damage to the skin surface, which is visi- ble as scratch marks (excoriations). In some patients, the repeated scratching and rubbing cause lichenification and in others prurigo papules occur. Uncommonly, the underlying disorder occurs at the site of the injury from the scratch. This phenomenon is found in patients with psoriasis and lichen planus and is known as the isomorphic response or the Koebner phenomenon. The notable exception to this is shin- gles (herpes zoster), which may cause pain and distorted sensations in the nerve root involved (see page 52). The pain may be present before the skin lesions appear, while they are there and, occasionally, afterwards. Pain and tenderness are characteristic of acutely inflamed lesions such as boils, acne cysts, cellulitis and erythema nodosum (see page 77). Most skin tumours are not painful, at least until they enlarge and infiltrate nerves. However, there are some uncommon benign tumours that cause pain, including the benign vascular tumour known as the glo- mus tumour and the benign tumour of plain muscle known as the leiomyoma. Chronic ulcers are often ‘sore’ and cause a variety of other discomforts, but they are not often the cause of severe pain. Painful fissures in the palms and soles develop in patches of eczema and psoriasis due to the inelastic, abnormal, horny layer in these conditions. For reasons that are not altogether clear, there is a primitive fear of diseased skin, which even amounts to feelings of disgust and revulsion. The idea of touching skin that is scal- ing or exudative seems inherently distasteful and it is something that one tries to avoid. These attitudes appear universal and inherent, and it is difficult to prevent them. It is little use pointing out that there is no rational basis for them, and all that can be hoped for is that a mixture of comprehension, compassion and common sense eventually supplants the primitive revulsion felt by all. It has been suggested that the origins of the inherent fear described above are the contagious nature of lep- rosy and the infestations of scabies and lice. Regardless of the origins, it is only too abundantly evident that individuals with obvious skin disease do not do well where the choice of others is concerned. They suffer more unemployment overall, but in addition 21 Signs and symptoms of skin disease Figure 2. Young patients with acne have particular problems because the disease is only too visible, as it usually affects the face. Psoriasis quite often affects the hands, nails and scalp margin, also causing difficulty for those whose occupations put them into contact with the public. Numerous other skin disorders put the affected individual at an economic and social disadvantage. Vascular birthmarks and large neurofibromata are disfiguring and tend to isolate the bearers. Chronic inflammatory facial disorders such as rosacea and discoid lupus erythematosus also cause problems (Figs 2. To summarize this point, individuals with visibly disordered skin are disabled because of society’s inherent avoidance reaction. One other aspect of this same problem is the sufferers’ own perception of the impact they are making on all with whom they come in contact. In most subjects who have persistent, ‘unsightly’ skin problems, the affected individuals become depressed and isolated. It is especially damaging for those in their late teens and twenties who are desperately trying to make relationships. Self-confidence is, in any case, not at a high point at this time in their emotional development and a disfiguring skin disorder lowers their self- esteem incalculably. Many youngsters with acne and psoriasis find it difficult to con- quer their embarrassment sufficiently to have ‘girlfriends’ or ‘boyfriends’ and that aspect of their development may become stunted. It was once thought that many skin disorders were caused by neurotic traits, ‘stress’ and personality disorders. Although the areas only occupy some 1–2 per cent of the body’s skin surface, dis- ease of these sites may prevent walking and use of the hands for anything but simple tasks, i. Psoriasis and eczema are the usual causes of this form of disablement because of the painful fissures that tend to develop (Fig. Patients with a severe atopic dermatitis may develop similar painful fissures around the popliteal and antecubital fossae, so that limb Figure 2. Those with severe congenital fissures in popliteal fossae disorders of keratinization are often severely troubled by this disordered mobility. From what has been said so far, it will be appreciated that, contrary to popular belief, patients with skin disorders are often appreciably disabled. They are disabled on account of society’s and their own reaction to the disease and because of the physical limitations that the skin disease puts on them. Skin disease infrequently kills, but often produces unhappiness, usually loss of work and social deprivation as well as considerable physical discomfort. Summary ● Skin disorders may be generalized or localized to ● The degree of skin pigment depends on the rate of ‘lesions’. Pigment shed into the dermis causes ● Skin colour is mainly determined by melanin persistent darkening. Prurigo papules and impetiginization Papules, nodules and tumours are progressively also result from scratching. Annular lesions ● Itching is particularly a problem in atopic occur, for example, in ringworm, erythema dermatitis, scabies, dermatitis herpetiformis and multiforme and granuloma annulare. This results ● Intraepidermal blisters (bullae if large, vesicles in emotional deprivation, occupational disadvantage if small) occur in pemphigus of various types, and economic loss. The stratum corneum is a remarkably efficient barrier, protecting against water loss to the environment and against the entry of toxic substances that the skin may encounter. Vasodilatation and vasoconstriction allow loss and conservation of body heat, respectively. The sweat glands, the hair and the subcutaneous fat are other parts of the skin that assist in thermal homeostasis. Evaporation of sweat assists loss of body heat, and the subcutaneous fat and hair help conserve heat because of their insulating functions. We are subjected to a constant barrage of mechanical stimuli, which vary in intensity, direction, area to which they are delivered and rate of delivery. The der- mis contains a network of oriented, tough, collagenous fibres, in the interstices of which there is a viscid proteoglycan ground substance as well as elastic fibres and fibroblasts. Most of the mechanical response to physical stimuli is due to dermal connective tissue. This means that skin extends in response to a linear force and will tend to regain its original length after release of the force (elastic). Skin is also said to be anisotropic, as its 25 Skin damage from environmental hazards mechanical properties vary according to the orientation of the body axis in which the mechanical stimulus is delivered.

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In the weight-bearing knee cheap rumalaya forte 30pills with visa, valgus force al- functionally related structures discount rumalaya forte 30 pills otc, thereby improving diag- so creates compressive load across the lateral compart- nostic confidence purchase rumalaya forte online now. The medial compartment is images are interpreted with an understanding that struc- compressed during varus stress purchase rumalaya forte with paypal, leading to impaction of tures with strong functional or anatomical relationships the medial femoral condyle against the tibia. By deducing the traumatic the most common traumatic mechanisms combine valgus mechanism, it is possible to improve diagnostic accuracy force with axial load. Therefore, compression with im- by taking a directed search for subtle, surgically relevant paction injury usually occurs in the lateral compartment, abnormalities that might otherwise go undetected. It may whereas tension with distraction injury occurs in the me- also be possible to communicate more knowledgeably dial compartment. Trauma-re- Acute ligamentous injuries are graded clinically into lated medial meniscal tears tend to be located at the pos- three degrees of severity. In mild sprain (stretch injury), teromedial corner (posterior to the medial collateral liga- the ligament is continuous but lax. The ligament can re- ment) because the capsule is more organized and thick- turn to normal function with appropriate conservative ened in this location, and its meniscal attachment is tight- treatment. In moderate sprain (partial tear), some but not all Although the posterior oblique ligament can be dissected fibers are discontinuous. Remaining intact fibers may not free in most cadaver knees, it is only rarely identified on be sufficient to stabilize the joint. Degenerative (attrition) tears of the medial bundles hang loosely, and intact fibers are overstretched meniscus also predominate posteromedially, but they in- with marked edematous swelling and ecchymosis. In severe sprain (rupture), the liga- a vertical orientation that can extend across the full thick- ment is incompetent. At operation, torn fiber bundles ness of the meniscus (from superior to inferior surface), hang loosely and can be moved easily. Once established, this vertical tear can propagate over time following the normal fiber architecture of the menis- cus. Propagation to the free margin creates a flap, or par- Meniscal Injury rot-beak, configuration. If the tear propagates longitudi- nally into the anterior and posterior meniscal thirds, the Why are most trauma-related medial meniscal tears pe- unstable inner fragment can become displaced into the in- ripheral in location and longitudinally orientated, where- tercondylar notch (bucket handle tear). When a distractive force sepa- dists recognize an association between longitudinal tears rates the femorotibial joint, tensile stress is transmitted and mechanical symptoms, and may decide to repair or across the joint capsule to the meniscocapsular junction, resect the inner meniscal fragment before it becomes dis- creating traction and causing peripheral tear. Compressive placed and causes locking or a decreased range of mo- force entraps, splays and splits the free margin of menis- tion. If an unstable fragment detaches anteriorly or pos- cus due to axial load across the joint compartment. Since teriorly, it can pivot around the remaining attachment site the most common traumatic mechanisms in the knee in- and rotate into an intraarticular recess or the weight-bear- volve valgus rather than varus load, the medial femorotib- ing compartment. The identification and localization of a ial compartment is distracted whereas the lateral compart- displaced meniscal fragment can be important in the pre- ment is compressed. Lateral compression means sile stress can avulse the capsule away from the menis- that the lateral meniscus is at risk for entrapment and tear cus (meniscocapsular separation), with or without a along the free margin. Meniscocapsular injury avulsed at sites where they are fixed, but can escape in- may be an important cause of disability that can be jury in regions where they are mobile. Compared to the treated surgically by primary reattachment of the cap- lateral meniscus, the medial meniscus is more firmly at- sule. Since the capsule stabilizes the medial meniscus, tached to the capsule along its peripheral border, and is meniscocapsular separation or peripheral meniscal avul- far less mobile. Normal knee motion involves greater sion can cause persistent pain and lead to posteromedi- translation of the femorotibial contact point in the lateral al instability with eventual degenerative change. In order to shift with the condyle and avoid images, meniscocapsular injury is more difficult to injury, the lateral meniscus requires a looser capsular at- identify than meniscal tear. Since with scarring and apparent reattachment of the capsule the medial meniscus is tightly secured by menis- to meniscus. Similarly, small avulsed corners of menis- cofemoral and meniscotibial ligaments along the joint cus may be difficult to identify unless a directed search line, it is subjected to greater tensile stress with lesser de- is made for them. Imaging of the Knee 33 The same valgus force that distracts the medial com- Therefore, depending on knee position and the direction partment also compresses the lateral compartment. Since of mechanical load, different structures are functioning the lateral meniscus is loosely applied to the joint cap- synergistically to stabilize the joint. During axial load across the lateral compartment, the meniscus is sometimes crushed, which Medial Collateral Ligament and Medial splays and splits the free margin, creating a radial (trans- Meniscus verse) tear. Radial tears of the lateral meniscus usually originate at the junction of anterior and middle meniscal The medial collateral ligament complex comprises super- thirds. They are most difficult to identify on coronal im- ficial and deep capsular fibers. The superficial compo- ages since they are vertically orientated in the coronal nent, also called tibial collateral ligament, resists both plane. Thin-slice, high-resolution sagittal images opti- valgus force and external rotation. Sometimes, ligament is the primary restraint to valgus force in the a fortuitous axial slice through the lateral meniscus is the knee, providing 60-80% of the resistance, depending on only image that demonstrates the tear and allows diag- the degree of knee flexion (greatest stabilizing role oc- nostic confidence. If the tear lateral ligament form the joint capsule, which includes extends all the way to the joint capsule, fluid may leak femorotibial fibers that pass directly from bone to bone, into the extraarticular space along the lateral joint line, as well as meniscofemoral and meniscotibial fibers. The medial collateral ligament and medial meniscus are anatomically related through the deep capsular fibers, Anatomical and Functional Synergism of which attach to the meniscus at the meniscocapsular Structures junction. These deep meniscocapsular and superficial lig- amentous fibers simultaneously develop tension during Supporting structures function synergistically to stabilize valgus force, and therefore are often injured together dur- the knee. They ergism, the medial collateral ligament and medial menis- are stressed by the same joint position or mechanical cus are functionally related through the posterior oblique load, and therefore are at risk for combined injuries when ligament at the posteromedial corner of the knee. These that joint position or mechanical load exceeds physiolog- structures are both stressed by external rotation, with or ical limits. In hibit synergism in one position often relinquish that sta- large part, it depends on the degree of external rotation bilizing function to a different group of structures when compared to medial joint distraction. During internal rotation more likely to injure the medial collateral ligament and of the knee, the anterior and posterior cruciate ligaments subjacent medial meniscus; pure external rotation is more develop functional synergism by coiling around each likely to injure the posterior oblique ligament (menisco- other, becoming taut, pulling the articular surfaces to- capsular junction) or medial meniscus posterior to medi- gether and checking excessive internal rotation. In combined valgus-external rota- external rotation, the cruciates become lax and lose their tion, both of these medial structures are injured. The anterior fibers of tib- ate and lateral collateral ligaments are also parallel struc- ial collateral ligament develop greatest tension during ex- tures that course anteroposteriorly from femur to tibia ternal rotation and, therefore, are the first to tear. The ax- and together maintain joint isometry during internal rota- ial plane is ideal for showing focal abnormalities limited tion of the knee combined with flexion and varus force. Palmer displacement from bone, and surrounding edema or he- moving freely with the tibia. Conversely, the posterior oblique eral ligament, a knee-jerk reflex (pun intended) should ligament or medial meniscus may tear before the anteri- next occur: focus attention on the meniscocapsular junc- or cruciate ligament. First on coronal images, follow the peripheral bor- ternal rotation or valgus force or both, the anterior cruci- der of meniscus posteriorly from the level of tibial col- ate ligament becomes the last remaining check against lateral ligament to the posteromedial corner, searching anterior tibial translocation, markedly increasing its risk for contour abnormalities and soft-tissue edema or hem- for rupture. Then, on sagittal images, fol- Rupture of the anterior cruciate ligament is often ob- low the medial meniscus and meniscocapsular junction vious or strongly suspected based on history and physical medially from the posterior thirds to the posteromedial examination. Depending on the knee position during imaging, ligamentous rupture, but rather to identify other intraar- either the coronal or sagittal images may better demon- ticular lesions that might further destabilize the knee. The strate peripheral meniscal tear or avulsion at the postero- absence or presence of such a lesion may determine medial corner. The anterolateral bundle is tighter in knee flexion and the High-grade tears of the anterior cruciate ligament are posterolateral bundle is tighter in extension. In the acute set- cruciate ligament is the primary restraint to anterior tib- ting, mass-like hematoma occupies the expected location ial displacement, providing 75-85% of resistance de- of the ligament, which may be completely invisible. Tension is least at several days or weeks, the torn ligamentous margins be- 40-50° of flexion, and greatest at either 30° or 90° of come organized and better defined as thickened stumps flexion [92,93]. Quadriceps contraction pulls the tibia separated from each other by a variable distance. Axial forward and creates greatest stress on the anterior cruci- images are superb for confirming a normal ligament that ate ligament at 30° of knee flexion. Partial tear is unusual, but may major secondary restraint to anterior tibial translocation. A classic mechanism for ligament in- tear, same as for medial collateral tear, should lead auto- jury is the pivot shift, when valgus stress and axial load matically to a directed search for traumatic injury at the are combined with forceful twisting of the knee as the meniscocapsular junction.

The handhold is held by the surrogate and pressed firmly against the body of the baby or pet cheap 30pills rumalaya forte mastercard. It can be laid flat against the arm trusted 30pills rumalaya forte, body or leg of a baby and held in place firmly by the whole hand of the adult discount rumalaya forte 30 pills visa. For a pet rumalaya forte 30 pills on-line, the end is held firmly pressed against the skin, such as between the front legs or on the belly. A wet piece of paper towel, about 4 inches by 4 inches is placed on your leg, to make better contact. Place a few milligrams (it need not be weighed) in a small glass bottle, add 2 tsp. All persons with cancer have ortho-phospho-tyrosine in their urine as well as in the cancerous tissue. Persons who have recently been treated clinically for cancer are much less likely to have ortho-phospho-tyrosine in the urine. Urine cannot be considered a chemical in the same way as a sugar or salt solution. If combined with another tissue on the test plates, it will not resonate as if a solution of pure ortho-phospho-tyrosine were used. Common snails from a fish tank or outdoor snails are the natural hosts for Fasciolopsis buskii (human intestinal fluke) stages. The stages will produce ortho-phospho-tyrosine when the snails are fed fish food polluted with propyl alcohol. Obtain some snails, put them in a tank, feed them propyl alcohol polluted fish food. Put these snails in the freezer to kill them humanely, then crush them and place in a specimen bottle with 50% grain alcohol to preserve. Test for cancer by placing the test sample you just made (any of the four) on one plate and a white blood cell sample on the other plate. Immediately, search for your cancer in your breast, prostate, skin, lungs, colon, and so forth. As you know by now, you can confirm the cancer by testing yourself to propyl alcohol and the human intestinal fluke in the liver. Also continue to test yourself for propyl alcohol and the intestinal fluke in the white blood cells; make sure they are gone. Also test yourself to several varieties of popcorn, brown rice, and corn chips as an indication of zearalenone, which must be eliminated in order to get well. Follow up on yourself every few days to be sure your new found health is continuing. Homemade preparations of strep throat, acute mononucleosis, thrush (Candida), chicken pox, Herpes 1 and 2, eczema, shin- gles, warts, measles, yeast, fungus, rashes, colds, sore throats, sinus problems, tobacco virus, and so forth can all be made by swabbing or scraping the affected part. Method: Test yourself for a variety of diseases, using your white blood cell specimen first. Materials: Benzene sample, slides of tissue samples like thymus, liver, pancreas, penis, and vagina. Also a collection of disease specimens such as the ones used in the previous lesson. Materials: Do not try to purchase a pure sample of aflatoxin; it is one of the most potent carcinogens known. Having it on hand would constitute unnecessary hazard, even though the bottle would never need to be opened. Simply make specimens of beer, moldy bread, apple cider vinegar, and any kind of peanuts using a very small amount and adding filtered water and grain alcohol as usual. Find a time when your liver is positive to aflatoxin (eat a few roasted peanuts from a health food store and wait ten minutes). You must search your muscles and liver for these, not saliva or white blood cells, because they are seldom seen in these. Tapeworms and tapeworm stages can not (and should not) be killed with a regular frequency generator. Each segment, and probably each scolex in a cysticercus has its own frequency and might disperse if your generator misses it. A small number of intestinal flukes resident in the intestine may not give you any noticeable symptoms. Similarly, sheep liver flukes resident in the liver and pancreatic flukes in the pancreas may not cause noticeable symptoms. Their eggs are shed through the organ ducts to the intestine and out with the bowel movement. But if you become the total host so that various stages are developing in your or- gans, you have what I term fluke disease. You can test for fluke disease in two ways: electronically and by microscope observation. Materials: Cultures or slides of flukes and fluke stages from a biological supply company (see Sources) including eggs, miracidia, redia, cercaria, metacercaria. If you have any fluke stages in your white blood cells you may wish to see them with your own eyes. Place your body fluid samples on one plate, your parasite stages on the other plate, and test for as many as you were able to procure, besides adults. After finding a stage electronically, you stand a better chance of finding it physically with a microscope. A milliliter is about as big as a pea, and a femtogram is -15 1/1,000,000,000,000,000th (10 ) of a gram! Rinse the glass cup measure with filtered water and put one half teaspoon of table salt in it. A teaspoon is about 5 grams, a cup is about 230 ml (milliliters), therefore the starting concentration is about 2½ (2. Label one clean plastic spoon “water” and use it to put nine spoonfuls of filtered water in a clean glass bottle. The glass bottle now has a 1 in 10 dilution, and its concentration is one tenth the original, or. Use a new spoon to transfer a spoonful of salt solution from bottle #1 to bottle #2 and stir briefly (never shake). If you want to calculate how many salt molecules you can detect, select the concentration at the limit of your detection, and put 2 drops on a square inch of paper towel and rub into your skin. If you can detect water -15 from bottle #13, you have detected 510,000 molecules (10 23 fg/ml divided by 58. Water in bottle #12 would therefore have 10 times as many molecules in one drop, and so forth. Even if your error is as much as a factor of 2 (100%), you can still get a good idea of what you can measure. Atomic absorption standards start at exact concentrations; it is easy to make a more exact dilution series with them. When testing for iridium chloride by this skin test method, I was able to detect 3025 molecules! Troubleshooting: Always extend your set until you get a negative result (this should happen by at least bottle #18). Sensitivity of Pollutant-In-Product Testing Get some slides of Salmonellas and Shigellas and find some milk that tests positive to at least one. Make a dilution series of the milk up to bottle #14, being careful not to shake the bottles. It was the same for toxic elements starting with standard solutions, about 1000 µg/ml, showing this method is less sensitive than skin testing. Microscopy Lesson Purpose: To observe fluke stages in saliva and urine with a microscope. A total of 100x magnification is satisfactory for the four common flukes, Fasciolopsis, sheep liver fluke, human liver fluke and pancreatic fluke. For sanitation purposes (wiping table tops, slides, micro- scope and your hands) a 50% to 70% alcohol solution (not rubbing alcohol! Dilute this with equal parts of filtered water to get 18½%, which is close enough to 20%, for the purpose of “fixing” (killing) the specimens.

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State consultations order 30pills rumalaya forte with amex, meetings/advocacy workshops :Development of New to create enabling environments in Policies as well as review of existing policies will require State consultations buy rumalaya forte 30 pills with visa, different settings (Schools order genuine rumalaya forte line, work meeting/advocacy workshops with different stakeholders (administrators buy generic rumalaya forte 30 pills line, places, industries, hospitals etc. Planning for development of Health promotion Infrastructure- alcohol and responsible sexual Improvement/up gradation of old/ existing buildings for Health Promotion ; behaviour etc. Area Specific/population-based/settings- based/problem specific Health Promotion units at different levels i. Networking, Partnerships and Inter-sectoral Coordination:To develop improving/upgrading existing necessary linkages, networks and Partnerships in the priority areas for action institutions to build strong health with both National and International organizations promotion infrastructure and its 10. Coordination with the sectors within and outside the health system to institutionalization in the country. To plan, design and conduct research studies on the Policy Research determinants of health as well as health related behaviour, Policy research will include studies which provide attitudes, beliefs & knowledge among members of the evidence for policy-makers to develop and implement community with regard to desirable health practices in public policy for improving the health of the order to feed and support the policy makers / planners and population. To coordinate, develop & strengthen the capacity at the attitudes, beliefs & knowledge of the community and central & state levels as well as South East Asia region to Assessment of Health Promotion Needs gather evidence through research on health promotion in Programme Development & Evaluation order to support policy, advocacy and programmes of Generate data for for evaluating ongoing health interventions pertaining to health promotion. To plan, design and conduct research studies on various interventions in collaboration with practitioners, health promotional initiatives focussed on different settings policymakers & local communities in the identified for health promotion (schools, workplaces, hospitals areas as listed under the ingredients. To conduct evaluation studies on various healths’ particular focus on equity of access. To collect, review and analyse the information on health stakeholders promotion research in order to document and disseminate to Documentation and dissemination of information all stakeholders including practitioners, funders, related to health promotional research to all policymakers, researchers and the general public and allied. To collaborate with universities, research and training related components of various National institutions to promote research studies on various issues Programmes for chronic diseases. Human Resource Development Division Objectives Activities • Prepare and standardize training curriculum 1. Identify Human Resource needed for Health for the training of various categories of promotion and develop training programmes personnel from health and allied fields and accordingly e. Experts in Policy areas, Social peoples representatives Scientist Strategies development, Research, Bio- • Sensitize the govt. Curriculum development for Training for at national and state level to the need of various stakeholders in the focus areas as coordinating the efforts of various mentioned under Ingredients. Conduct In service training programs for • provide training in health promotion medical and paramedical professionals, teachers through long and short term training and other stakeholders programmes for both technocrats and 4. Conduct Need based Orientation and bureaucrats to equip them with knowledge Sensitization courses for different stakeholders on various health promoting aspects including Schools, Panchayati Raj Institutions and requiring policy level decision Community members. Conducting seminars; symposiums conferences services to the selected field area etc throughout the year 8. To identify health promotion needs in respect of different health settings • To help formulate healthy public 2. School Schools/ Adolescent Health Interpersonal communication colleges, workplaces, health colleges/ Healthy behaviour Organizing Declamations, seminar, workshops, facilities village’s cities etc. Nehru Yuva • To help build appropriate Educating specially Kendra, Campaigns, Provision of special infrastructure and partnership challenged children schools and educators for specially challenged mechanisms for implementation of children health promotion Hospitals Health Patient Safety and Hand Hygiene Promotion, Safe Waste programmes/policies for different centres Infection Control Disposal, Safe Surgeries, Green buildings, settings. Healthy and Safe Landscaping , Solar Energy, Horticulture, Hospital environment Water Harvesting, Disabled friendly, Disaster • To provide orientation and training preparedness to various stakeholders to ensure Workplaces Healthy environment Executive Health programmes, fitness and yoga their broadest possible and healthy centres, De-Stress workshops. Settings child health, nutrition communication in local dialects etc Market place Healthy environment Clean toilets, General Sanitaion, Disabled • To formulate interventions aimed Friendly, Safe products, Fire prevention, at improving the access to essential Zoning, Safe food, Display information on health and nutrition care food products, Waste disposal, Safe water Fairs and Mela Crowd Management, Sanitation • To identify the social determinants Chlorination of water etc. Advocacy for creation of enabling environment for promoting Healthy Lifestyles in among political leaders and different settings. To provide mechanisms for communities to identify key areas to be addressed and organize administrations. The cell will be equipped with one consultant, one data entry operator and necessary infrastructure and equipments. This cell will also provide technical inputs to the stakeholders with the help of experts on various issues related to all the aspects of patient safety. Later on such cells can be created at regional or state levels once the necessary expertise is developed in this subject at these levels. Development, printing and dissemination of Policies and guidelines will also be undertaken by the central cell. Patient safety committee - Each hospital willing to participate in this program must show its commitment by forming a Patient safety committee which will among other things oversee the functioning of Hospital Infection control committee. The hospitals must designate a trained nurse as Infection control nurse exclusively for infection control work. The committee will also do the gap analysis in their respective institutes with the help of a checklist developed for the same or through some standardized proforma. The aspects covered must 276 relate to, among other things, infrastructure and policies and procedures being followed. Hospitals will be required to organize regular meetings of the patient safety committee to review various patient safety issues, adverse events reported, actions taken and maintain records of all the meetings of their patient safety committees Research: – Under the programme the globally accepted interventions for ensuring Patient Safety shall be implemented, however, it is appropriate to know the magnitude of the problem to know the baseline existing situation in the country so that the progress of the programme can be assessed periodically. Patient Safety surveys will also be undertaken at the level of each medical college and district hospital to identify the gaps and take appropriate corrective measures. Research shall also be undertaken to develop appropriate models for implementing various strategies. Awareness generation - it is necessary to create requisite awareness regarding the problem so as to draw the attention of all the stakeholders as well as community in general. Awareness generation shall be undertaken at all three levels; National, medical college and District Hospital. Media, both electronic as well as print, may be used to create impact among the general public. Advocacy workshops for all stakeholders shall be organized or academic forums like conferences etc. In this endeavor the services of professional medical associations and similar bodies will help in creating awareness and training programmes. Moreover, the participation of these bodies will result in "buy in" of the concept of patient safety among healthcare professionals. Patient safety day shall be celebrated to highlight its importance in the country every year. Training – Master trainers will be identified at National Level and if necessary capacity building of Nodal officers of the programme and Master trainers shall be organized. Mater trainers will impart Training of Trainers through workshops to train the identified trainers/ programme officers from States/Medical colleges regarding the concepts of patient safety to implement the steps in their institutions for providing safe patient care. These trained professionals shall act as Patient Safety Champions/Ambassadors for further training at the level of medical colleges/district Hospital level so as to percolate the practices at all levels of care including District Hospitals, Sub-district Hospitals and Community Health Centers. Regional Patient safety centers - Some of the medical colleges and hospitals can be encouraged to assume the role of Regional centers and they can adopt hospitals in their region for propagating the patient safety culture. Activities of the Programme To implement the above strategies, the activities of programme at the three levels will be as given under Central level 1. Monitoring and Evaluation Medical Colleges th All 149 medical colleges will be covered during the 12 Plan. Many of such diseases are very fatal and also have potential to spread very rapidly. The history is full of such instances where diseases prevalent in a country has spread to other countries causing severe damage to the mankind. Recent outbreak of swine flu pandemic is still poised to be threat to the world security. In order to prevent cross country spread of such infectious diseases, traffic restriction are being applied to the travelers and cargo since the time immemorial. In our country there are 2 set of rules known as “Indian Aircraft (Public Health) Rules, 1954, and “Indian Port Health Rules, 1955” to be applied at international Airports and ports respectively. Already there are 21 such health units functioning in our country since 1950s at various airports, ports and land border of the country for implementation of statutory regulations. Existing infrastructure There are 21 such health units already functioning at various airport, ports and land borders of the country established under the regulatory provision. Ministry of Civil Aviation has been requested to provide space for these organizations. Out of these 10 airports 5 (Bengaluru, Hyderabad, Lucknow, Ahmedabad, and Trivandrum) are under plan scheme. Functions: Following are the major functions of Port/Airport Health Organizations 1. Supervision of sanitation, drinking water supply, anti-mosquito and anti-rodent work. Administration of yellow fever vaccine and issue of yellow fever vaccination certificate at identified yellow-fever vaccination centres.

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