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Sutures sutures corrosion-resistant steel trusted 100mg pristiq symptoms 0f parkinsons disease, between 3/0 and 1 will be appropriate for reusable pristiq 100mg on-line medications enlarged prostate, size 2 discount pristiq 50 mg with visa symptoms after hysterectomy, 3 order pristiq with amex medications bipolar disorder, 4 and 7 most situations; suture 2/0 is generally the most useful size. It may be single pack, sterile more useful to buy separate sterilisable needles and suture materials. Use triangular curved cutting needles for suturing skin and round half circle needles for subcutaneous tissue and episiotomies. Littauer Section 3 Supplies and equipment for primary health care 121 Probe Needle holder Suture and needle pack – sterile Forceps artery – curved Suture without needle pack – sterile Suture reel Needles suture set – 1/2 circle Needles suture set – 3/8 circle Scissors stitch – Littauer 122 Section 3 Supplies and equipment for primary health care First aid Item Specification No. On the plaster write the date it was applied and time needed for fracture to heal. When applying make sure tubular without seam, it is not too tight, does not fold, is at least plastic wrapping 5mm longer than the plaster at both – 5cm x 20-25m roll ends. Cotton wool 1kg, see p115 At least 1 roll At least 5mm thick cotton padding should cover all bony parts and skin folds. Bohler Set of splints Multipurpose splint (for At least 1 of each For immobilising and supporting fractures arms and legs): before sending patients to hospital. Airway Semi-rigid, soft rubber At least 1 of each Used to keep airway clear by preventing (oropharyngeal) with hard plastic insert, size blockage by the tongue. Sizes: – Infant (53-55mm) – Child (62-69mm) – Adolescent (67-86mm) – Adult (82-96mm) Section 3 Supplies and equipment for primary health care 123 Item Specification No. Before buying, check bags are easy transparent plastic to assemble/take apart, and bags and dome, latex cuff- masks are easy to clean, disinfect and moulded shell and sterilise to prevent cross infection. Sizes: – Infant: (0 newborn; 1 older infant) – Child (2) – Adult (4) Carrying case Splint Cramer Airway – Geudal Resuscitation bag with face mask 124 Section 3 Supplies and equipment for primary health care Eye care This sub-section describes the supplies, equipment and essential drugs required for health workers to provide primary eye care. Primary eye care includes promotion of eye health, screening to identify children with visual problems, e. Thest is chart, vision E chart for the illiterate, facility and for performed at a distance of 6m from the testing chart, washable vinyl plastic card, outreach chart, vision in both eyes is checked opotypes) marked both in feet and separately by covering each eye in turn. Alternatively, use (standard or heavy duty) worker carrying ordinary flashlight or otoscope (see px). Folding magnifier (plastic) lens, glass protected, 1 for outreach or binocular (magnifying) loupe with magnifications either X8 headband, which free the hands, may be or X10, diameter 1. Pad helps to reduce cotton, either: discomfort and promote healing by – Sterile single units, At least 100 stopping the eyelid moving over the individually packed single units injured part. Section 3 Supplies and equipment for primary health care 125 Item Specification No. Put the tape across the corners (not across the centre) of the eye, from forehead to cheek. Cotton buds see p64 At least 1 pack For cleaning eyelids and everting the (Q tips) upper eyelid. Essential drugs At least: Eye ointments Thetracycline 1%, 5g tube 1 tube per patient Best local treatment for red eyes (conjunctivitis), trachoma, corneal ulcers, eye injuries. Use as prophylaxis to prevent eye infections in newborns (apply within 1 hour of birth). Ideally, each patient should have their own tube, and a separate tube for each infected eye. Care should be taken to avoid eye dropper and tube contact with eyelids and lashes. Eye drops have a shorter life than ointments and, if possible should be kept in a refrigerator at between 2-8°C. Using a mix of materials and methods, including those that do not need any teaching aids i. When selecting materials, remember that they should be: acceptable to the community’s culture and beliefs; appropriate for the local level of literacy; easy to understand; use local terms and words and show familiar situations; simple and convey one or two ideas at most; and relevant and support your message. Item/Specification Quantity Remarks Chalkboard, chalks At least Chalkboards, flipcharts and overhead projectors and board cleaner 1 chalkboard are visual aids used to display notes, pictures, 1 box each of assorted words and diagrams. People usually remember images At least 144 sticks per more easily than words, and visual aids can add box impact to your message. You can repaint old chalkboards with special blackboard paint or make 1 board cleaner your own permanent or portable chalkboards. Permanent chalkboards can be made by plastering a smooth surface onto a wall, approx. When the plaster is almost set, smooth carefully with a trowel and cover the wall with damp sacking or plastic to allow it to dry slowly, preventing cracking. Cut a piece of wood into 2 halves and hinge together (using either metal hinges or a strip of strong cloth glued to both halves). Flipcharts are a series of workers doing health posters bound in a set to teach about a particular education and range of subject. Slide projector, 1 projector and variety of Slide projectors can be used to project images portable, mains and slide sets against walls, sheets or screens. Posters are often available in a range of sizes and workers doing health free of charge from national and international types, e. Use posters in local language hanging, mounted or and replace regularly if possible. Alternatively, draw or cut pictures out of magazines, mount on thin cards, glue small pieces of sandpaper on the back of pictures so they will stick to the cloth. Picture cards show a series (flash cards) workers doing health of pictures or messages linked to a special script. Cards offer flexibility as they are not attached together in a given order so they can be re-arranged to tell different stories or to teach different ideas. Games and models are workers doing health very popular training aids, as they make learning education and range of fun and enjoyable. Practical guides and Books workers doing health sources of information can be adapted by education and range of healthworkers for use in their local situation. Flannelgraph Section 3 Supplies and equipment for primary health care 129 Flipchart Picture cards Games 130 Section 3 Supplies and equipment for primary health care 3. It is divided into the following categories: major equipment; supplies and minor equipment; miscellaneous consumables; and reagents and stains. Laboratory tests can help to improve the accuracy of diagnosis and the effectiveness of treatments. The tests performed, methods used, and the type of equipment and supplies will depend on the: level of your health facility and of the laboratory; availability of utilities, trained staff and funds; and the most common health problems in the community. They offer better –Thick and source, powered by quality of work and are thin films mains electricity (220- more restful for the eyes. Natural light and 100X (oil) tends to be insufficient – precentred Abbe when using a binocular condenser, with iris microscope with a 100X diaphragm and filter oil immersion objective. When the spring arm, and microscope is not being movement controls used, cover with cotton – condenser focus cover to protect from dust control and dirt. If not being used – course and fine for several days, store focusing and focus under an airtight plastic tension control bag containing silica gel – lamp brightness (see Section 2. Accessories: At least Rubber bulb blower 1 Section 3 Supplies and equipment for primary health care 131 Procedure Item Specification No.

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Encouraging and facilitating open dialogue to exploit the lessons that may have been learned but not documented may also contribute to capacity purchase 50mg pristiq free shipping medicine tour. More extensive and detailed publication of process and impact evaluations would usefully contribute to the ongoing development of policy and practice [6] order pristiq on line medicine urology. The consultations identified a desire among the stakeholders for the development of a more reciprocal relationship between those working in the area of health communication and transnational agencies purchase discount pristiq on line treatment zinc toxicity. Workforce The availability of qualified human resources with sufficient skills and knowledge and the availability of training options buy pristiq acute treatment. The challenges and opportunities offered by the diversity of the workforce involved in health communication for communicable diseases in Europe were highlighted earlier. Health communication competencies may be defined as the combination of the essential knowledge, abilities, skills and values necessary for the practice of health communication (adapted from [36]). Overall, stakeholders considered that education and training for health communication in the prevention and control of communicable diseases is currently underdeveloped across Member States [1-3]. It is important that, in consultation with Member States, research is conducted to establish the core competencies required for health communication so as to clarify the focus of the education and training provision. A number of key skills deficits were identified in the stakeholders consultations. One was around evaluation research, which was perceived to require specific skills and resources. The types of evaluation reported in the data collection suggest that participants are at least familiar with outcome, impact and cost- effectiveness evaluations. A second area of concern to the stakeholders was in the use of media in general, and specifically new media and new technologies. Because of the variability between countries in their capacity to develop and effectively use health communication activities, any strategic development at a European level must be cognisant of this discrepancy in capacity and experience. Effective guidelines and tools to support health communication in a consistent way will be of significant value. During the consultation, the stakeholders identified a number of specific training needs, including in the area of social media, evaluation, and public relations in order to be prepared to deal with the media, particularly in crisis situations. A particular challenge of social media was identified as its speed, requiring health communicators to respond immediately to issues in order to pre-empt the dissemination of misinformation and also to react immediately to counter any misinformation that has already been disseminated [3]. In the absence of relevant training or education courses, such courses might usefully be developed. The range of communicable diseases was, in itself, seen as a challenge to professionals working in the area of health communication; particularly emerging diseases that are new to Europe, such as West Nile virus and chikungunya fever. A database of resources developed during the Translating Health Communication Project may represent a first step towards the establishment of a research and knowledge infrastructure that can support professionals. The database records link to over 600 resources for communicable disease topic areas with information about the target audience of the resource, the organisation that developed the resource, the language of the resource, and the date it was developed. It also includes a further category which logs a diverse range of 49 health communication and information portals and websites. This database, while not designed to constitute an exhaustive list, nor act as a compendium of best practice examples, aims to facilitate improved sharing of online health communication resources and materials between European countries and regions. A wide range of expertise is evident among identified stakeholders working towards the prevention and control of communicable diseases [1]. Health communication is often one part of the overall remit of such experts, particularly in countries with smaller populations. Stakeholders identified that structured health communication training was required and suggested that European-level organisations should coordinate and facilitate such training. A scoping study of education and training courses that currently exist would prove a useful preliminary to this endeavour. Collaboration with the higher education sector could advance the development and uptake of education and training opportunities including continuing professional development. A wide variety of professionals are involved, to varying extents, in health communication, but there is a lack of clarity and little consistency about where the responsibility for health communication lies in individual countries. At present, the organisational structures do not support high levels of strategic planning or collaboration. Stakeholders suggested that the focus of health communication was on crisis rather than planned communication. However, it is also clear that the key stakeholders, as represented in the consultation phases of this project, are committed to the development of health communication for communicable diseases. They identified the need for a coherent and coordinated approach to build on the expertise, knowledge and evidence that currently exists to enhance health communication to improve health and reduce health inequalities. Stakeholders also identified the need for a shift from a top-down approach to a more participatory, citizen-centred way of working. The utilisation of new digital media, such as social media, to deliver timely and relevant health messages and to dialogue with citizens was also widely recognised as an emerging opportunity. Some of it pertains to health communication for communicable diseases but much relates to non-communicable diseases. This evidence represents a resource that can be mined to establish its relevance and transferability to health communication for communicable diseases in the European context. Likewise, there are a significant number of guidelines and toolkits that have been developed and used in other contexts that could be adapted for use alongside the relatively limited number of resources relating to communicable diseases in Europe. In the European context, research activity for health communication in communicable diseases is in a nascent stage of development. The lack of systematic evaluation of health communication for communicable diseases has resulted in a limited evidence base which could give rise to inefficient use of resources. Stakeholders should encourage, and be encouraged to, evaluate interventions and to coordinate their research so as to construct a useful European knowledge base. A coordinated approach to research at a European level would result in greater collaboration across countries and the development of a more robust evidence base. The potential for capacity building for health communication in communicable diseases in Europe is manifest. This will involve the development of knowledge, skills, commitment, structures, systems and leadership at all relevant levels, including the advancement of health communication knowledge and skills among practitioners; the expansion of support and infrastructure in organisations at a country and pan-European level; and the development of greater collaboration and partnerships for health communication research, practice and policy in the European region [17]. Stakeholders identified their own need for further education and training in health communication, and a first step in the provision of this would be the development of a database of existing courses. Particular attention should be paid to all the issues surrounding the use of technology and new media, not least to ensure that it does not have the effect of widening health inequalities. Likewise, the development and maintenance of an online platform for disseminating relevant resources and materials would support the advancement of a quality strategy for the promotion of health communication for communicable diseases. Digital communications – a dynamic, interactive, continually evolving medium – have become an established source of health information for both consumers and health professionals. It would appear to provide the ideal medium for the provision of information about the prevention and control of communicable diseases. Little research exists in the European context about online health information-seeking behaviour in relation to communicable diseases and more information is required about issues concerning trust and credibility in internet- based health-related information and the specific needs of European public health organisations [7]. Likewise, particular attention should be paid to population health literacy interventions by governments and other agencies that wish to harness the power of the internet; the quantity of available information and the speed at which it can be transmitted heightens the importance of enhancing communicative and critical health literacy as well as basic or functional literacy. Such organisations could provide the leadership and coordination required to advance the field of health communication for communicable diseases in a coordinated and strategic way. Perceived priorities of key public health stakeholders in Europe on the use of health communication for the prevention and control of communicable diseases.

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Human Immunodeficiency virus (Micro effective pristiq 50mg treatment eczema, Med generic 100mg pristiq free shipping symptoms vaginitis, Paeds buy pristiq 50 mg without prescription medications gabapentin, Comm Med) Congenital infections 22 cheap 50mg pristiq visa medicine 5e. Laboratory diagnosis of malaria — Preparation, staining and examination of peripheral blood smear for malarial parasite — Identification of various species and stages — Thick smear — Demonstration of vector and newer methods 2. Laboratory diagnosis of enteric fever — Sample collection methods and transport — Blood culture (in detail) — Stool and urine culture for Salmonella — Widal test — Identification tests and slide agglutination for Salmonella 4. Practical: Practical examination include spotting, different bacterial staining procedures, identification of bacterial strains using conventional methods. Understand the concepts of cell injury and changes produced thereby in different tissues and organs and the body’s capacity for healing. Understand the normal homeostatic mechanisms, the derangements of these mechanism and the effects on human systems. Understand the etiopathogenesis, the pathological effects and the clinico-pathological correlation of common infectious and non-infectious diseases. Understand the concept of neoplasia with reference to the etiology, gross and microscopic features, diagnosis and prognosis in different tissues and organs of the body. Correlate normal and altered morphology (gross and microscopic) of different organ systems in different diseases to the extent needed for understanding of disease processes and their clinical significance. Have a knowledge of common immunological disorders and their resultant effects on the human body. Have an understanding of the common haematological disorders and the investigations necessary to diagnose them and determine their prognosis. Perform and interpret in a proper manner the basic clinico-pathological procedures. Know the principles of collection, handling and dispatch of clinical samples from patients in a proper manner. Amyloidosis and Calcification a) Calcification : Dystrophic and Metastatic b) Amyloidosis : classification, Pathogenesis, Morphology 4. Inflammation and Repair a) Acute inflammation : Features, causes, vascular and cellular events. Circulatory Disturbances a) Edema : Pathogenesis and types b) Chronic venous congestion : Pathogenesis and changes in Lung, Liver, Spleen c) Thrombosis and Embolism : Formation, Fate and Effects d) Infarction : Types, common sites, Gangrene e) Shock : Pathogenesis, Types, Morphologic changes f) Derangements of Fluid and electrolyte imbalance 6. Growth Disturbances and Neoplasia a) Atrophy, Hypertrophy, Hyperplasia, Hypoplasia, Metaplasia, Malformation, Agenesis, Dysplasia b) Neoplasia : Classification, Histogenesis, Biologic Behaviour : Benign and Malignant; Carcinoma and Sarcoma c) Malignant Neoplasia : Grades and Stages, Local and distant spread d) Carcinogenesis : Environmental carcinogens, chemical, viral, occupational, Heredity and cellular oncogenes e) Tumour and Host Interactions : Systemic effects including paraneoplastic syndromes, Tumor immunology f) Laboratory diagnosis : Cytology, Biopsy, Tumor markers 7. Immunopathology a) Immune system : organisation, cells, antibodies and regulation of immune responses. Miscellaneous Disorders a) Autosomal and sex-linked disorders with examples b) Metabolic disorders c) Protein energy malnutrition and vitamin deficiency disorders d) Radiation Injury e) Disorders of Pigment and Mineral metabolism such as bilirubin, melanin, hemosiderin (B) Systemic Pathology 1. Pathology of the Gastro-Intestinal Tract a) Oral Pathology : Leukoplakia; Carcinoma oral Cavity and Esophagus b) Salivary gland tumors : Mixed, Adenoid cystic, warthin’s c) Peptic ulcer : etiopathogenesis and complications; gastritis: types d) Tumors of stomach : Benign; Polyp, Leiomyoma, Malignant; Adenocarcinoma, Lymphoma e) Inflammatory diseases of small intestine : Typhoid, Tuberculosis, Crohn’s, Appendictis f) Inflammatory diseases of appendix and large intestine : Amoebic colitis, Bacillary dysentery, Ulcerative Colitis g) Ischemic and Pseudomembranous enterocolitis, diverticulosis h) Malabsorption : Celiac disease, Trophical sprue and other causes i) Tumours and Tumor like condition of the large and small intestine : Polyps, Carcinoid, Carcinoma, Lymphoma j) Pancreatitis k) Pancreatic tumors : Endocrine, Exocrine and periampullary 5. Hematopathology a) Constituents of blood and bone marrow, Regulation of hematopoiesis b) Anaemia : classification and clinical features; clinical and lab. Liver and Biliary Tract Pathology a) Jaundice : Types, Pathogenesis and Differentiation b) Hepatitis : Acute and Chronic, Etiology, Pathogenesis and Pathology c) Cirrhosis: Etiology, Postnecrotic, Alcoholic, Metabolic, Pathology, Morphology (Macronodular, Micronodular, Mixed), complications d) Portal Hypertension : Types including non-cirrhotic portal fibrosis and Manifestations e) Tumors of Liver : hepatocellular and metastatic carcinoma, tumor markers f) Concept of hepatocellular failure g) Diseases of the gall bladder : Cholecystitis, Cholelithiasis, Carcinoma 7. Lymphoreticular System a) Lymphadenitis : nonspecific, Granulomatous b) Hodgkin’s and Non-Hodgkin’s Lymphomas : Classification, Morphology c) Diseases of the spleen : Splenomegaly causes and effects d) Thymus : Dysgenesis, Atrophy, Hyperplasia, Neoplasia 8. Osteopathology a) Bone – general considerations, reactions to injury and healing of fractures b) Osteomyelitis : Acute, Chronic, Tuberculous, Mycetoma c) Metabolic diseases : Rickets/Osteomalacia, Osteoporosis, Hyperparathyroidisism d) Tumors : Primary, Osteosarcoma, Osteoclastoma, Ewing’s Sarcoma, Chondrosarcoma; Metastatic e) Arthritis : Rheumatoid, Osteo and tuberculous 10. Endocrine Pathology a) Scope of endocrine control and investigations b) Diabetes Mellitus : Types, Pathogenesis, pathology c) Nonneoplastic lesions of thyroid : Iodine deficiency goiter, autoimmune thyroiditis, thyrotoxicosis, myxedema d) Tumors of thyroid – adenoma, carcinoma : Papillary, Follicular, Medullary, Anaplastic e) Adrenal diseases : Cortical hyperplasia, atrophy, tuberculosis, tumors of cortex and medulla f) Parathyroid hyperplasia and tumors and Hyperparathyroidism g) Pituitary tumors h) Multiple endocrine neoplasia 11. General Pathology Taught with the help of Didactic lectures on specific topics, followed by Practicals pertaining to that topic. Besides microscopic examination, fresh specimens obtained at autopsy or surgical operations are shown. Systemic Pathology The following tools are employed: i) Didactic lectures: discussing a particular topic at length in an one hour lecture ii) Paraclinical seminars: are conducted by a combined team of pathologist and a clinician who discuss the pathophysiology and clinical aspects of the particular disease entity. This is followed by demonstration of the gross and microscopic features of the disease in that case by the pathologist. By a combination of above modalities/tools, student learns applied aspects of the disease process. Understand pharmacokinetic and pharmacodynamic principles involved in the use of drugs 2. Understand and identify the various factors that can affect the action of drugs 3. Know the various routes of drug administration with advantages and disadvantages of the various routes 4. Undertake dosage calculations as appropriate for the patient and be able to select the proper drug and dose for the at risk population i. Understand the importance of rational prescribing of drugs and the concept of essential drugs 6. Understand the methods in experimental pharmacology, principles of bioassay and be able to correlate drug effects with the action of drugs at the receptors. Each lecture session will be planned to deliver maximum relevant information to the student. The clinical aspects as well as rationality of use of a given drug shall be discussed with the students. In addition, seminars on some important topics will be planned in which the use of a given drug shall be discussed by a clinical expert in the field. Practicals The given practical exercise shall be discussed and demonstrated beforehand to the students. In addition, the students will learn prescription writing and discuss exercise on drug interactions and shall also be shown various spots. The spots shall include various chemicals, drugs and instruments used in pharmacology. The physician should have a good knowledge of what the anesthetic will do to the patient, even though the physician does not administer it him or herself. The student, therefore, should observe and study the physiological changes which take place in the anesthetized patient. When these changes are of sufficient magnitude, they become complications or toxic effects. The student should learn what these are, how they are caused, and how they may present and be treated. Students should learn basic techniques of maintaining a clear airway and giving assisted or artificial ventilation. They should also learn how to position the patents head, how to hold the chin and how to insert an airway. In addition to these technical accomplishments, the student may have the opportunity to administer either general or spinal anesthesia under the direct and constant supervision of a member of the staff. Introduce principles of acute medicine as it is practiced in managing the anesthetized patient in the operating room and in managing the patient in the recovery unit.

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However buy cheap pristiq 50 mg on-line symptoms 6 days post embryo transfer, Wilson believes that with a chart of suf- ficient duration trusted pristiq 100 mg treatment depression, one can discern a pattern of substantially low temperatures buy pristiq with american express treatment zoster ophthalmicus, which can be used to guide therapy buy pristiq 50 mg without prescription treatment refractory. One can use both approaches, asking patients to record early morning temperature and having them obtain two subsequent readings at 3-hour intervals. A persistently low temperature tends to indicate hypometabolism, the cause of which needs to be investigated within the context of the other aspects of the clinical picture. Thus a modestly overweight, unstressed, ade- quately nourished, 40-year-old woman who has low temperatures in sum- mer is likely to have hypothyroidism. On the other hand, low temperatures in a chronically stressed, young, ectomorphic woman on a low-protein diet are likely to be of a nutritional or adrenal origin. Successful treatment strategies are often reflected in an increase in average body temperature, a testimony to overall improvement in metabolic efficiency. The accurate lab- oratory determination of basal metabolic rate would be ideal for assessment and follow-up, but this is not usually practical. Chapter 6 / Assessment of Nutritional Status 145 Acid-base balance is the other crucial factor that can affect enzyme func- tion and many other facets of biochemical activity. Naturopathic literature, as well as some of the metabolic typing methods, places great emphasis on acid-base balance, often suggesting that unhealthy diets produce unfavor- able acidic conditions in the body. The main determinant of blood and tissue pH is the blood carbon dioxide level, which is controlled largely by respiration. Contributions from other sources are minimal—about 1 mmol/kg from lactic acid with only 20 to 30 mmol from dietary protein. Individuals with transient or chronic hyperventilation may experience a significant respiratory alkalosis with widespread effects on metabolism. Individuals who are stressed frequently have alkalosis, and breath re-education is an absolute priority in their rehabilita- tion. In fact, other treatment methods will be of little value until a very faulty breathing pattern is corrected. Typical Day It is important to get a sense of the shape and content of daily life. A sim- ple chronological account from waking to retiring can be filled out with appropriate detail as necessary. It is particularly relevant to know whether a person eats regularly in a relaxed way or erratically in a rushed manner. Are there mini-breaks during the day or does the person plough through till the evening in a mad rush? Does the person have time for herself and her enjoyment, or is she over-focused and constantly moving on to the next task? Dement,11 who is probably the world’s leading authority on sleep disorders, has concluded that 50% of the North American population mismanage their sleep to the point at where it negatively affects health and safety. Dement also notes that Westerners tend to sleep 1 to 1¹⁄₂ hours less than their great-grandparents. He believes that the majority of individuals need 1 hour of sleep for every 2 hours spent awake. An individual’s biorhythmic style, whether that of a “lark” or an “owl,” may give some idea as to his or her resilience to seasonal changes and travel over different time zones. Larks seem to be able to adjust their clocks rapidly, whereas owls need extra help to adapt to a new rhythm; consequently they may experience more sleep, mood, and health problems with a change in season, especially during autumn and spring. Seasonal mood changes are, of course, very common, and it is essential to ask whether an individual expe- riences a lowering of mood during the winter months. One can draw conclusions about coping style and resilience as one gets to know the person concerned. Food Sensitivity Food sensitivity is an important and vast subject, and the summary here is only of an introductory nature. This section does not cover the areas of inhalant and chemical problems, but it is important to remember that diffi- culties in these areas can precipitate or exacerbate food sensitivity. The term food allergy describes an immediate reaction to small amounts of a food or food substance, and such reactions are usually immunoglobulin E mediated and persist for life. Individuals are usually well aware that they have the problem, and a limited number of foods such as fish, shellfish, eggs, nuts, milk, strawberries, and soy are involved. Food intolerance, on the other hand, tends to involve a larger number of foods and a delayed onset of symptoms. It involves foods consumed regularly in the diet, and symptoms will disappear if the food is avoided. There is a much broader range of clinical manifestations, and symptoms seem to fluctuate and affect different organ systems over time. Most of our discussion here concerns the phenomenon of food intolerance, although it should be said that the distinction between food allergy and food intolerance is not clear- cut. The incidence of food intolerance in the general population is unknown but may be up to 25%. There is increasing evidence from well-controlled investigations that food sensitivity plays a role in a wide spectrum of condi- tions. Particularly strong evidence is to be found in studies on irritable bowel syndrome, eczema, migraine, rheumatoid arthritis, and serous otitis media. However, it is important to remember that almost any medical condition may involve food intolerance as a contributing factor. Most individuals react to less than six or so foods, although there is a tendency for the phenomenon to general- ize. In the overall course of food intolerance, onset may be gradual, beginning with, for example, headaches and progressing to slow deterioration of general health with symptoms referable to different body systems. On the other hand, onset may be acute after a viral illness, administration of antibiotics, psychological stress, or inhalant or chemical exposure. Sometimes the problem disappears Chapter 6 / Assessment of Nutritional Status 147 even with continued exposure, and symptoms may disappear during child- hood only to reappear later in a different form. Food craving affects up to 50% of patients, and patients who experience craving are more likely to have a history of atopy. Clues to a food intolerance problem may be found in the family, child- hood, or medical history. Problem foods are those that are likely to be eaten regularly and that the individual would sorely miss during a fast. The definitive diagnosis of a food intolerance can only be achieved by elimination and challenge. There are a wide variety of approaches, varying from complete elimination in the form of a fast to a modest elimination in the form a whole-food diet in which excess dietary junk is eliminated. The fol- lowing diet is acceptable to most people: ● Fresh white fish ● Lamb ● Venison and rabbit ● Biodynamic rice (brown or white) ● Pears/pear juice ● Vegetables, but not the following, which have high amine/salicylate con- tent: cauliflower, broccoli, broad beans, eggplant, tomato, olive, capsicum, alfalfa, cucumber, onion, spinach, mushroom, and zucchini ● Mineral or filtered water. Some practitioners would exclude potatoes on the basis of their botanical relationship to the tomato-capsicum family. If a person is able to follow such a diet for 2 to 3 weeks, it forms one of the most useful tools we have in nutritional medicine. This strongly reinforces their per- sistence with such a regimen and the rather tedious process of food challenge that follows.

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