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Prognostic significance of metallothionein expression in correlation with Ki-67 expression in adenocarcinomas of large intestine gastritis diet buy doxazosin 4 mg amex. Potential role of p53 on metallothionein induction in human epithelial breast cancer cells gastritis diet 8i discount doxazosin online amex. Zinc deficiency potentiates induction and progression of lingual and esophageal tumors in p53-deficient mice gastritis upper back pain buy discount doxazosin on-line. Influenza virus infection induces metallothionein gene expression in the mouse liver and lung by overlapping but distinct molecular mechanisms hronicni gastritis symptoms 2 mg doxazosin free shipping. The prognostic value of molecular marker analysis in patients treated with trimodality therapy for esophageal cancer. Metallothionein promotes laminin-1-induced acinar differentiation in vitro and reduces tumor growth in vivo. Metallothionein expression in ovarian cancer in relation to histopathological parameters and molecular markers of prognosis. Laminin-1 and laminin-2 G-domain synthetic peptides bind syndecan-1 and are involved in acinar formation of a human submandibular gland cell line. An update on molecular diagnostics of squamous and salivary gland tumors of the head and neck. Immunohistochemical expression of metallothionein in benign premalignant and malignant epithelium of the larynx: correlation with p53 and proliferative cell nuclear antigen. Correlation of metallothionein expression with apoptosis in nasopharyngeal carcinoma. Proliferative potential in nasopharyngeal carcinoma: correlations with metallothionein expression and tissue zinc levels. Altered distribution and synthesis of laminin-5 (kalinin) in oral lichen planus, epithelial dysplasias and squamous cell carcinomas. Betel quid chewing, cigarette smoking and alcohol consumption related to oral cancer in Taiwan. A statistical study on oral carcinomas in Taiwan with emphasis on the relationship with betel nut chewing: a preliminary report. The upregulation of metallothionein 1 expression in areca quid chewing-associated oral squamous cell carcinomas. Modulation of gene expression in precancerous rat esophagus by dietary zinc deficit and replenishment. Metalloregulation of the tumor suppressor protein p53: zinc mediates the renaturation of p53 after exposure to metal chelators in vitro and in intact cells. Mitropoulos D, Kyroudi-Voulgari A, Theocharis S, Serafetinides E, Moraitis E, Zervas A & Kittas C. Role of lime in the generation of reactive oxygen species from betel-quid ingredients. Expression pattern of cisplatin-induced metallothionein isoforms in squamous cell carcinoma. Regulatory mechanisms controlling gene expression mediated by the antioxidant response element. Negative regulatory role of Sp1 in metal responsive element-mediated transcriptional activation. Ono Y, Nakanishi Y, Ino Y, Niki T, Yamada T, Yoshimura K, Saikawa M, Nakajima T & Hirohashi S. Clinocopathologic significance of laminin-5 gamma2 chain expression in squamous cell carcinoma of the tongue: immunohistochemical analysis of 67 lesions. Proceedings of National Academy of Sciences of the United States of America, (July 1992), Vol. Proceedings of National Academy of Sciences of the United States of America, (July 1998), Vol. Pastuszewski W, Dziegiel P, Krecicki T, Podhorska-Okolow M, Ciesielska U, Gorzynska E & Zabel M. Prognostic significance of metallothionein, p53 protein and Ki-67 antigen expression in laryngeal cancer. Metallothionein and p-Akt proteins in oral dysplasia and in oral squamous cell carcinoma: an immunohistochemical study. Hierarchical cluster analysis of myoepithelial/basal cell markers in adenoid cystic carcinoma and polymorphous low-grade adenocarcinoma. Impact of betel quid, tobacco and alcohol on three-stage disease natural history of oral leukoplakia and cancer: implication for prevention of oral cancer. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. The gamma2 chain of laminin-5 as an indicator of increased risk for recurrence in T1 stage tongue cancer. Surowiak P, Materna V, Maciejczyk A, Pudełko M, Markwitz E, Spaczyński M, Dietel M, Zabel M & Lage H. Nuclear metallothionein expression correlates with cisplatin resistance of ovarian cancer cells and poor clinical outcome. Immunohistochemical evaluation of metallothionein, Mcm-2 and Ki-67 antigen expression in tumors of the adrenal cortex. Szelachowska J, Dziegiel P, Jelen-Krzeszewska J, Jelen M, Tarkowski R, Spytkowska B, Matkowski R & Kornafel J. Correlation of metallothionein expression with clinical progression of cancer in the oral cavity. Szelachowska J, Dziegiel P, Jelen-Krzeszewska J, Jelen M, Tarkowski R, Wlodarska I, Spytkowska B, Gisterek I, Matkowski R & Kornafel J. Prognostic significance of nuclear and cytoplasmic expression of metallothioneins as related to 358 Oral Cancer proliferative activity in squamous cell carcinomas of oral cavity. Rapid Akt activation by nicotine and a tobacco carcinogen modulates the phenotype of normal human airway epithelial cells. Tobacco carcinogen-induced cellular transformation increases Akt activation in vitro and in vivo. Yamamoto M, Tsujinaka T, Shiozaki H, Doki Y, Tamura S, Inoue M, Hirao M & Monden M. Metallothionein expression correlates with the pathological response of patients with esophageal cancer undergoing preoperative chemoradiation therapy. Enhanced transcription of metallothionein genes in rat kidney: effect of uninephrectomy and compensatory renal growth. Oxidative dimerization in metallothionein is a result of intermolecular disulphide bonds between cysteines in the alpha-domain. Introduction the syndecan family is composed of four closely related proteins (syndecan-1–4) encoded by four different genes. In previous studies it has been noted that expression of syndecan-1 correlates with malignancy in various tissues including uterine cervix and esophagus. Several reports on head and neck carcinoma have suggested that reduced expression of syndecan-1 is associated with the prognosis of such neoplasms. No study has shown whether or not syndecan-1 is associated with mode of invasion, although invasion correlates to malignant behavior and prognosis. From the immunohistochemical staining pattern, the cases were divided into two groups based on expression of syndecan-1 at the supra peripheral cells of the tumor nest: Group A, completely or mainly positive; Group B, sporadically positive or negative. The number of cases where syndecan-1 expression was reduced was much greater in T3–4, and represented the majority of Group B (86. These results suggest that syndecan-1 directly contributes to the growth and invasive ability of these cells. It is apparent that alternations in cell adhesion can influence almost every stage of cellular transformation. The development of malignant epithelial neoplasm is associated with disruption of cell-to-cell and cell-to-matrix adhesion. Syndecans are family of heparan sulfate proteoglycan receptors that are thought to participate in both cell-to-cell and cell-to-matrix adhesion. The syndecans are composed of a core protein, to which sulphated and unbranched carbohydrate chains, glyosaminoglycans, are covalently attached. The core proteins contain an extracellular, a transmembrane and an intracellular domain, and their amino acid sequances are homologous, especially between the two last domains.

Syndromes

  • Aloin
  • Frequent urination
  • Inner ear (cochlear) implants
  • Thyroid hormone (T4)
  • Softening of the bones and kidney failure (itai-itai disease)
  • Gently squeeze the nipple, checking for discharge. Repeat the process on the left breast.
  • To keep yourself more active, even if you still have pain
  • Injury to the lung
  • An example of hormonal therapy is the drug tamoxifen. This drug blocks the effects of estrogen. Estrogen allows breast cancer cells to survive and grow. Most women with estrogen-sensitive breast cancer benefit from this drug.

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There are many studies of biomechanical responses to gastritis diet 40 order doxazosin us assess risks of fracture gastritis symptoms night sweats generic 2 mg doxazosin with mastercard, (Kemper 09) as well as failure of surgical fixation gastritis patient handout purchase doxazosin mastercard. Importantly gastritis diet buy 2mg doxazosin overnight delivery, these failure rates might be more important for patients with higher physical activities. Bending Failure Stiffness Calculated Between 10-30N* Plate Type Failure Stiffness Anterior-inferior Contourable Dual Reconstruction Compression Plate 4. Reconstruction plates for stabilization of mid-shaft clavicle fractures: differences between nonlocked and locked plates in two different positions. However, favorable results reported for healing disparate nonunion fracture types in uncontrolled studies (Nolte 01) and some evidence for other fractures (Busse 09) does suggest that there may be some role for low-intensity pulsed ultrasound for select clavicle fractures that has not yet been defined but, if successful, may involve more severe fracture types, risks for non-unions, or post-operative settings with risks of non-union. Author/Titl Scor Sample Comparison Results Conclusion Comments e Study e (0 Size Group Type 11) Clavicular Fractures: Comparison between Splints and Slings Andersen 4. Non-union in the clavicular shaft numbers in each Society clavicular Surgery within 2/62 (3. Knowles pin pseudorandomizatio superior for less n may not be a meperidine (p = 0. Recommendation: Early Mobilization for Clavicular Fractures There is no recommendation for or against early mobilization for clavicular fractures. Recommendation: Education and Exercises for Clavicular Fractures Education and exercise are recommended for select patients with clavicular fractures. Indications – Select patients with clavicular fractures, particularly the elderly or those with comorbidities or complicated fractures including other injuries. Strength of Evidence – Recommended, Insufficient Evidence (I) Rationale for Recommendations There are no quality trials evaluating early mobilization, exercise, education, therapy, and/or rehabilitation of patients with clavicular fractures. The prognosis for these fractures is generally good and supervised physical or occupational therapy is believed to be rarely required. There are no quality trials evaluating scapula fracture treatment; many scapular fractures can be managed non-operatively. Reported findings include histologic evidence of chronic inflammation, perivascular infiltration, fibrosis of the subsynovial layer, and sometimes associated subacromial bursitis. There is a 15-20% chance of having bilateral (not concurrent) adhesive capsulitis. There are three clinical phases – inflammatory (pain), stiff (pain and limited motion), and thawing (resolution). The majority of patients resolve with resolution of pain and recovery of close to normal motion. Additional tests are often performed largely to exclude other treatable conditions. X-ray is recommended and may be needed of both shoulders, particularly if there was a bilateral injury or need for comparison with the unaffected shoulder. Strength of Evidence – Recommended, Insufficient Evidence (I) Rationale for Recommendation X-ray is the main initial diagnostic test, particularly to help identify the presence and extent of any additional treatable conditions that might be contributing to adhesive capsulitis. However, some limitations are often needed, especially for more physically demanding work activities. Such limitations are gradually reduced as recovery progresses and may include limitations in heavy lifting and overhead activities. For patients with significant pain, over-the-counter analgesics and self-applications of heat and ice are recommended. Recommendation: Over-the-counter Analgesics and Self-applications of Heat and Ice for Treatment of Adhesive Capsulitis Over-the-counter analgesics and self-applications of heat and ice are recommended for treatment of significant pain from adhesive capsulitis. Recommendation: Slings and Braces for Treatment of Adhesive Capsulitis Slings and braces are not recommended for treatment of adhesive capsulitis. Strength of Evidence – Not Recommended, Insufficient Evidence (I) Rationale for Recommendations There are no quality trials evaluating analgesics, ice, heat, or slings and braces for management of adhesive capsulitis. One moderate-quality trial included heating pad treatments as a physical therapy treatment, but also included other treatments, (Leung 08) precluding an evaluation of efficacy of heating pads alone as self-treatment. One moderate-quality trial that included cryotherapy in one treatment arm did not find benefits compared with other treatments. Author/Title Scor Sample Comparison Group Results Conclusion Comments Study Type e (0 Size 11) Leung 5. In the few patients who undergo surgical procedures, post-operative rehabilitation can be considerable, particularly in older patients with other associated injuries such as rotator cuff injuries. In those cases, the patient may require therapy on a prolonged basis in order to recover as much function as possible. Other medications that have been used to treat adhesive capsulitis include glucosamine, chondroitin, methylsulfonylmethane, and topical agents such as capsaicin. Oral glucocorticosteroids have also been utilized for treatment of adhesive capsulitis. Recommendation: Opioids for Pain Management for Select Patients with Adhesive Capsulitis Judicious use of opioids is recommended for pain management for select patients with severe adhesive capsulitis. Indications – Patients with acute pain should meet all of the following: 1) Severe injury with a clear rationale for use (objective functional limitations due to pain resulting xxii from the medical problem. If parenteral administration is required, ketorolac has demonstrated superior efficacy compared with opioids for (190, 191) acute severe pain, although ketorolac’s risk profile may limit use for some patients. Parenteral opioid administration outside of obvious acute trauma or surgical emergency conditions is almost never required, and requests for such treatment are clinically viewed as red flags for potential substance abuse. Indications for Discontinuation – Resolution of pain, sufficient improvement in pain, intolerance or adverse effects, non-compliance, surreptitious medication use, consumption of medications or substances advised to not take concomitantly. Indications – Patients should meet all of the following: xxivExceptions such as acute, severe trauma should be documented. Meperidine is not recommended for chronic pain due to bioaccumulation and adverse effects. Patients should not receive opioids if they use illicit substances unless there is objective evidence of significant trauma or moderate to severe injuries. Opioid use is generally prescribed on a regular basis, at xxvGenerally, this should be sufficient to cover one week of treatment at a time during the trial phase. Lower opioid doses are preferable as they tend to have the better safety profiles, less risk (188) (112) (189) of dose escalation, less work loss, and faster return to work. Theoretical potential to improve short-term function impaired by a painful condition. Recommendation: Over-the-counter Nutraceuticals for Treatment of Adhesive Capsulitis There is no recommendation for or against the use of over-the-counter nutraceuticals (glucosamine, chondroitin, and methylsulfonylmethane) for treatment of adhesive capsulitis. Recommendation: Oral Glucocorticosteriods for Treatment of Adhesive Capsulitis Oral glucocorticosteroids are recommended for treatment of adhesive capsulitis. Premature discontinuation of medication is usually based on intolerance, although a lower dose is sometimes used to attempt to ascertain whether there is tolerance at a lower dose that might still be potentially effective. However, the moderate-quality trial that compared injection with oral steroids found substantially faster improvements in the injection group. As the speed of recovery appears substantially faster via the injected route, (Widiastuti-Samekto 04) oral glucocorticosteroids are recommended for patients © Copyright 2016 Reed Group, Ltd. There are no quality trials evaluating muscle relaxants and other medications used to treat chronic nociceptive pain; however, these medications may have limited roles in select patients who have more severe symptoms that are being insufficiently managed with other treatments, particularly for those who need nocturnal doses to facilitate sleep. Author/Title Scor Sample Comparison Group Results Conclusion Comments Study Type e (0 Size 11) Oral Glucocorticosteroids Widiastuti 6. All treated with physiotherapy on Day 4 with 12 sessions of active exercise, passive joint mobilization, ice or heat. Self-applications of heat or cryotherapies (Hamer 76) might be helpful for symptom modulation. Recommendation: Exercise, Education, and Therapy for Treatment of Adhesive Capsulitis Education, exercise, and therapy are recommended for treatment of adhesive capsulitis. Frequency of appointments varies based on condition severity, compliance, need for encouragement, comorbid conditions, and prior patient experiences. Options include weekly appointments to oversee and advance a home exercise program for several weeks until sufficient recovered for lower grade injuries and self motivated patients. Patients with a more severe disorder or need of supervision may require appointments 2 to 3 per week to initiate program exercises, tapering to 1 per week in approximately 4 weeks before being discharged to a home exercise program in approximately 2 months for more severe injuries. Indications for Discontinuation – Recovery, plateau in recovery, noncompliance, or intolerance.

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They have been compiled by the British Medical Ultrasound Society Professional Standards team and are presented as examples of best practice which it is hoped will be of value to gastritis disease definition cheap 1mg doxazosin otc departments gastritis diet generic 2mg doxazosin otc. Guidelines on vetting and justifying of ultrasound requests gastritis diet cheap doxazosin 4mg otc, reporting and audit are also included gastritis diet zaiqa buy doxazosin 2 mg mastercard. These Guidelines do not and cannot cover all elements of an ultrasound examination and ultrasound practitioners are advised to access additional published information and research in order to fully inform their own local departmental protocols and procedures when there are no nationally agreed ones available. Some departments and providers will also accept self-referrals for certain types of examination. A fully completed ultrasound request in either paper or electronic form will normally be required for every examination undertaken. Departments and providers should make clear within their local requesting protocols who may request an ultrasound examination, this may for example be restricted to a medically qualified person 25 or a qualified and registered healthcare practitioner. If self-referrals are accepted by the department or provider the circumstances when this may occur should be recorded within the local requesting protocols. The ultrasound scans themselves may be performed by a variety of staff, in a variety of locations, both in and out of normal working hours. It is essential that ultrasound departments are proactive in managing workload to ensure that the right scan is performed in the right place, by the right person and at the right time. Protocoling of ultrasound requests by an ultrasound practitioner is therefore important. To ensure that ultrasound scans are justified, that the correct scan has been arranged with the correct patient preparation. The request should be checked to ensure that it is filled out correctly and complies with individual department policies. The vetting practitioner should be confident that the ultrasound request provides sufficient clinical information and is appropriate to answer the clinical problem posed. There should be an agreed departmental mechanism for dealing with inappropriate requests and requests for which the vetting practitioner is uncertain. It is recommended that there is a procedure for flagging clinically urgent requests together with a mechanism for dealing with such requests. While the document is primarily aimed at primary care, the guidance is relevant for other referrer groups. It has been written with a pragmatic approach to managing referrals based on the panel’s expert opinion. This document can be used to assist and underpin any local guidelines that are produced. Reference is made to the evidence-based iRefer publication (Royal College of Radiologists) and should be used in conjunction with this. Local practice will dictate appropriate pathways following consideration of capacity and demand issues in each Trust. Suspected diagnoses must be clearly stated, not implied by vague, non-specific terms such as “Pain query cause” or “pathology” etc. Individual cases may not always be easily categorized and local arrangements for prompt access to specialist advice are essential. Local guidelines should include identification of who justifies the referral, timescales for vetting and appropriate training for individuals undertaking this process. Changes to guidelines and pathways should be approved by local trust governance processes. It is recommended that any referrals returned to the referrer have an accompanying letter explaining the rationale behind this. All actions should be documented and recorded on the local radiology information system. X Persistent or frequent occurring over 12 times  in one month, in women especially over 50. Presenting symptoms of any of the Ultrasound imaging in the first instance may be Local following: appropriate depending upon local pathways. Significant findings (including >5cm, fixed,  tender mass, increasing in size, overlying skin changes, etc) should either be scanned on an urgent basis or referred into a soft tissue sarcoma pathway (depending on local policy). Scrotal mass Any patient with a swelling or mass in the body  of the testis should be referred urgently. Suspected torsion requires urgent urological X referral which should not be delayed by imaging. Acute pain, in the absence of suspected torsion  is an appropriate ultrasound referral. Head and Neck Thyroid nodule Local guidelines may be in place but routine X imaging of established thyroid nodules/goitre is not recommended. Ultrasound may be required where there is doubt as to the origin of a cervical mass i. Salivary mass If there is a history suggestive of salivary duct X obstruction, sialography may be the more appropriate initial investigation, depending on local practice. In patients >50, the likelihood of pathology is  increased, and the request may be accepted, provided a specific clinical question has been posed. X Persistent or frequent occurring over 12 times  in one month, in women especially over 50 with a palpable mass. Persistent bloating with the addition of other  symptoms, such as a palpable mass/ raised Ca 125, is acceptable. Local pathways which include direct referrals into gynaecology under a 2 week wait are most appropriate. Biochemical evidence of hyperandrogenism with a raised free androgen index (the testosterone is often at the upper limit of normal). Imaging should be reserved for those in whom examination is equivocal or in some cases, when treatment for an expected pathology has failed. As equipment and training improve, more structures and pathologies are identified using ultrasound so this list may vary between imaging departments as there may be individual ultrasound practitioners locally with a special interest in a specific field which will increase their scope of practice. Where applicable it is good practice to include the statutory regulatory body and registration number of report author. Understanding clinical information Sufficient clinical information should be provided by the referring clinician or be available to allow relevant and appropriate interpretation of the images. The person interpreting the images and then producing the report must understand the referring clinician’s information and request. They should ensure that they fully understand the aim of the ultrasound examination in order to effect a clinically useful and relevant report. The diagnostic importance of the report in the clinical management of the patient should be understood. Technical knowledge Ultrasound is an operator-dependent technique and the diagnostic quality of the images is very dependent upon the skills of the operator. The person interpreting and reporting the images must be able to reflect critically upon the image quality and appraise the impact on diagnostic accuracy. It is recommended that any technical limitations of a scan are clearly recorded in the report. Observation To minimise the possibility of error in producing a report for the wrong patient, it is essential that the report author cross-checks the unique patient identification with the date and type of ultrasound examination performed. Observations may be sub-classified as: -normal findings; unequivocal abnormal findings, expected or unexpected; equivocal findings: may be normal or abnormal; normal variants. Analysis Detailed critical analysis of the images should be undertaken, taking into account the observations and clinical reasoning to formulate a clinical opinion and to consider its diagnostic implication. Examples: are the findings abnormal and do they directly relate to the clinical question? If the appearances represent active pathology, then further critical analysis is required to identify the most likely diagnosis and/or to provide a list of differential diagnoses. Medical interpretation the interpretation of the findings and subsequent report must be considered in the light of the wider clinical picture. In order to produce a relevant diagnostic report, review and understanding of any previous imaging or relevant investigations may be required. In this context, it is essential that the report author has extensive medical knowledge to reach a diagnosis or a series of ranked differential diagnoses on which clinical decisions can be made. Whether the report is produced by a medically qualified or non-medically qualified ultrasound practitioner it is essential that there are governance procedures in place to ensure that the individual does possess the knowledge, skills and competence to effect this duty without detriment to the patient outcome. In addition, there must be a failsafe mechanism to ensure that, when required, a radiological or equivalent expert opinion can be obtained promptly to allow issue of the report without undue delay.

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Lead exposure of women of child-bearing age can also adversely affect developing fetuses during pregnancy gastritis diet buy doxazosin 2 mg cheap. Typical sources of lead exposure may include painted or plastic toys; lead-based paint in older homes gastritis prevention discount doxazosin 1mg amex, which can chip or form a harmful dust; soil gastritis diet cheap 4mg doxazosin, vinyl and plastic products gastritis and duodenitis cheap 2mg doxazosin free shipping, imported candy, lead-glazed pottery, fishing tackle, and some home remedies, such as azarcan and greta; and drinking water pipes with lead-based solder. Discovery of lead in children’s toys, mini-blinds, candy, and other household products makes the testing of all children important, regardless of perceived risk. The following chart (Figure below) reflects the rate of 3 childhood lead screening for Orange County as compared with North Carolina state. The numbers are relatively low, and ranged from a high of five cases in 2007 and a low of one case in 2006 and 2009. Qualitative: Focus Group the focus group discussions did not mention concerns regarding lead hazards in the county. Current Initiatives and Activities the Orange County Health Department responds to reports of elevated blood lead levels in children under six by assuring that the health care provider conducts the required follow-up and by providing an environmental assessment of the child’s home and surroundings to identify and eliminate potential lead hazards. The Orange County Health Department notifies health care providers of special testing requirements for refugee populations. Interpretations: Disparities; Emerging Issues; Gaps and Unmet Needs; and Strategies People living in older homes built before 1978 can be more at risk of exposure to lead-based paint. Housing price-range alone may not be an accurate indicator of lead-based paint exposure. While it is typical for lower income housing to be considered a significant source of lead exposure, the risk can be prevalent in higher income historic districts where older homes may have multiple layers of lead based paint. In addition to exposure risks from lead-based paint, more and more household products and children’s toys are discovered each year that present lead hazards to children. Because housing alone does not determine lead exposure, it is important that parents follow the recommendations to have their children tested by their pediatrician at the recommended intervals. Surveillance data for Orange County has always shown target population screening rates below the state average. Even though the rates have risen over the last eight years, there is much room for improvement. One significant limitation of the tracking method used by the Division of Environmental Health is that the state allows medical providers to use a questionnaire to exempt certain patients from universal testing. If the patient is excluded from testing by using the screening questionnaire, this event is not tracked. Orange County has very few children who are detected with elevated blood lead levels. This could be attributed to several factors, including the low childhood screening rate, the prevalent age and type of housing in this area, or education and awareness levels of parents. The average (mean) blood lead levels for children under the age of six in Orange County is lower than the average statewide, and has declined every year since 2005. The 2010 data is not yet available through the Children’s Environmental Health Branch. This implies that even with the steadily declining average levels, Orange County should implement strategies to assure that the average blood lead levels will soon meet the Healthy People 2020 objective. Inventory of Community Resources (Alphabetical) 240 2011 Orange County Community Health Assessment Appendix A. Seonae Yeo Appendix C, List of Survey Volunteers 1 2011 Orange County Community Health Assessment Appendix D. Map of Survey Locations Figure 34: 2011 Community Health Assessment Sampled Survey Locations Appendix D, Map of Survey Locations 2011 Orange County Community Health Assessment Appendix E. Notification Letter Sent to Randomly Selected Households Appendix E, Notification Letter March 15, 2011 Dear Orange County Resident: I am writing to ask for your help in a Community Health Assessment study that the Orange County Health Department will be doing over the next two weeks. Over the next two weeks a volunteer will drop by your house and ask for your opinions or those of another adult ♦ living at your household. This is your chance to “talk” to policy makers like me and the board of health about things in Orange County that relate to your health. The results of this study will be used to pick health concerns Finance and Administrative that need more attention in our county. This means that your Dental Health Services name will not be connected to any of your answers. You can help us very much by taking a few minutes out of your day either this weekend or next to Environmental Health share your experiences and opinions about Orange County with our Services volunteers. Health Promotion and You will receive a small gift as our way of saying thanks for your help. Personal Health Services If you have any questions or comments about the study we would be happy to talk with you. Whitted Human a los servicios disponibles en el condado para mejorar la salud y el bienestar. Su dirección fue elegida completamente al azar de entre las personas que viven en el Condado de Orange. Durante las próximas dos semanas un voluntario va a ir a su casa y a pedir sus opiniones o la de los otros adultos que vivan en su casa. Los ♦ voluntarios llevarán su identificación oficial y una camiseta con una insignia del departamento de salud. Esta es su oportunidad de “hablar” con los que crean las políticas, como yo y la junta directiva de salud, sobre cosas en el Condado de Orange relacionadas con su salud. Los resultados de este estudio se usarán para elegir los Finance and Administrative asuntos de salud que necesitan recibir más atención en nuestro condado. Esto significa que su nombre no Dental Health Services va a estar conectado a ninguna de sus respuestas. Usted nos puede ayudar muchísimo al tomar unos cuantos minutos de su día, este o el próximo fin de semana, para compartir sus experiencias y opiniones sobre el Condado de Orange, con nuestros voluntarios. Environmental Health Services Usted recibirá un pequeño regalo como nuestra manera de agradecerle por su ayuda. Por favor guarde o ponga en un lugar seguro a sus mascotas por la seguridad del Health Promotion and personal que estará realizando la encuesta. Education Services Si tiene preguntas o comentarios sobre el estudio, estaremos encantados de hablar con Personal Health Services usted. Spanish Other: Phone Number (Call back to complete? We are conducting a survey of our community to learn more about the health and quality of life in Orange County. The Orange County Health Department and Healthy Carolinians of Orange County will use the results of this survey to help address the major health and community issues in our county. The survey is completely voluntary, and it should take about 40 minutes to complete. Unfortunately, we do not have a Spanish-speaking Interviewer available at this time, but if you would like to participate in the survey, please write your telephone number below and we can have a Spanish-speaking Interviewer call you later. Phone Number: Estamos realizando una encuesta de la salud de la comunidad. Desafortunadamente en este momento no tenemos disponible a un entrevistador que hable español, pero si usted desea participar de la encuesta, por favor, escriba su número de teléfono aquí abajo y un entrevistador que hable español puede llamarle más tarde. We are sorry that we do not have interviewers available today who speaks that language. If you would like someone to call you later, please write your phone number below. If you realize that you have already participated in this survey this year, let me know, and I can stop. In these questions, and all the ones that follow, there is no right or wrong answer. We are just interested in your honest opinion, based on what you have seen or experienced. I am going to read several statements about what it is like to live in Orange County. Please tell me how much you agree or disagree with each statement by saying: “Strongly agree”, “Agree”, “Disagree”, or “Strongly disagree” with each of these statements. Orange County has good resources for parents of young children including 4 3 2 1 affordable, quality child care. People living in Orange County are treated fairly regardless of their physical characteristics, economic status, 4 3 2 1 backgrounds or beliefs. People who live in Orange County have equal access to clean air, water, and well 4 3 2 1 maintained public spaces.

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