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Each individual unit (village arrhythmia natural remedies order zestoretic with amex, household or person) should have an equal chance of being included in the sample pulse pressure and kidney disease cheap zestoretic 17.5 mg without prescription. Rape Generally refers to heart arrhythmia xanax proven 17.5mg zestoretic sexual intercourse with another person (male or female) without that person’s consent hypertension stage 3 zestoretic 17.5mg free shipping. Legal definitions of rape will vary and depend on the nature of the relationship between the perpetra to r and the victim, the act perpetrated and other fac to rs. This should lead to the (rehabilitation) res to ration of pre-disaster conditions (repaired facilities, functioning Phase services, self-reliance etc). Recovery phase fi Recovery phase indicates the period during which normal activities are resumed; fi this may be divided in to categories such as economic recovery, psychological recovery, recovery of livelihood, and recovery of physical losses. Relapse Reappearance of clinical symp to ms and infection separated by an interval greater than that related to normal periodicity. The initial assistance in an emergency is usually the provision of food, clean water, shelter and protection. Representative A selected subset of a population that resembles the original or sample reference population in every way. Resistance Ability of a parasite or organism to multiply or survive in presence of drug concentrations that are normally lethal and destroy or prevent multiplication of most organisms of the same species. Results Outcomes of processes and necessary inputs for the target population as: fi Outputs — Direct results (products or services) a program delivers to a target population to produce the expected impacts. Public health guide for emergencies I 595 Annex 2 S Term Definition Sampling Selection of a specified number of persons in a population for study with the hope that they are representative of the entire population. Sanitation In this chapter, sanitation considers excreta disposal, vec to r control, solid and medical waste management and drainage. Clinical signs are poor wound healing, bleeding gums, fatigue, leg pain, and a rash on the legs. Secondary the early identification and treatment of a diseased person to prevent prevention the infection from progressing to a more serious complication or death. Sensitivity the proportion of true positives correctly identified by a screening test. Sexual Actual or attempted abuse of a position of vulnerability, differential exploitation power or trust for sexual purposes, including, but not limited to profiting monetarily, socially or politically from the sexual exploitation of another. Sexually Any disease that is communicated primarily or exclusively through Transmitted intimate sexual contact; can cause infertility through miscarriage, Disease/Infection prenatal deaths, and damage to male and female reproductive systems. Shock Shock chlorination is conducted by adding 5-10 mg/l of chlorine chlorination solution to water in a well and allowing it to sit unused for a number of hours. Social support All forms of support provided by other individuals and groups that help others to cope. A network of people that one trusts and seeks help from including family and extended family, neighbours, friends, religious leaders, teachers etc. Anxiety or depression might appear as fatigue, gastrointestinal complaints, headache, cardiac symp to ms, diffuse aches and pains, muscular and joint problems, or sexual dysfunction. Specificity the proportion of true negatives correctly identified by a screening test. Standard A measure of the dispersion or variation of a set of quantitative deviation measurements on either side of the mean. Standard case Standard case management procedures must be established to prevent management unnecessary treatment or investigations and wastage of limited resources (drugs, staff time, etc. These procedures include: fi Standard diagnostic pro to cols and case definitions; fi Standard investigative procedure; fi Standard treatment pro to cols; fi Standard admission criteria; and fi Standard referral criteria. Standard health Health cards or exercise books for each patient that are introduced and cards kept either at the registration office or by each family. These will help following-up patients as well as in moni to ring the quality of health care. Strategy the order of pursuing priorities and objectives based on relative effectiveness and consideration of constraints. Surveillance Ongoing, systematic collection, analysis and interpretation of health data for managers of public health programmes combined with feedback to all. Systematic collection, collation, and analysis of data and dissemination of resulting information so that action can result. Survivor/victim In this chapter, used interchangeably to refer to a person who has experienced gender-based violence. Susceptible host Person or animal not possessing sufficient resistance against a particular infectious agent to prevent contracting infection or disease when exposed to it. Suspected In an area where cholera is not known to be present: a person aged >5 cholera years with severe dehydration or death from acute watery diarrhoea with or without vomiting. In an area where there is a cholera outbreak: a person aged >5 years with acute watery diarrhoea with or without vomiting. To confirm a case of cholera: Isolation of Vibrio cholera O1 or O139 from a diarrhoeal s to ol sample. Sustainability Continuity of a program beyond termination of donor support due to increased local capacity. Different donors may define it differently, but all consider sustainability vital and push for it. Systematic A sampling method that uses a list to select after randomly picking sampling the first unit additional units at regular intervals. Public health guide for emergencies I 597 Annex 2 T Term Definition Target group A family, specific population group, or a community in a defined area of a country. Targeted Supplementary feeding to prevent severe acute malnutrition among supplementary the moderately malnourished and limit the need for therapeutic feeding feeding. Tetanus Adult tetanus: Either of the following signs 3–21 days following an injury or wound: fi trismus of the facial muscles or risus sardonicus fi painful muscular contractions. Neonatal tetanus: Any neonate with normal ability to suck and cry during the first 2 days of life who, between day 3 and day 28, cannot suck normally, or any neonate who becomes stiff or has spasms or both. Tertiary Aims to reduce permanent damage from disease such as a patient prevention offered rehabilitative services to lessen the effects of paralysis due to polio or land mine injuries). Although not trained to manage complications of pregnancy and childbirth, traditional birth attendants provide important referral services for problem cases. Training Transferring specific skills and competencies to individuals about to do a particular job. Transmission Any mechanism by which an infectious agent is spread from a source or reservoir to a person: fi Direct transmission — immediate transfer of infectious agents to a suitable portal of entry through which infection of a human or animal may take place (direct contact or projection). Trauma From the Greek word for wound, a term used freely to describe either physical or psychological injury caused by some extreme emotional event. Trench latrine A communal type of latrine often used when sanitation facilities are needed quickly and defecation fields are not appropriate. Triage In a disaster medical response, triage adopts the method of sorting and prioritising victims for medical attention according to the degree of injury or illness and expectations for survival. They consist of hand washing, use of protective clothing such as gloves; safe handling of sharp instruments; safe disposal of medical waste include sharps; and decontamination of instruments and equipment. Unmet need for A measure based on the number of women of reproductive age and in contraception a sexual union who report that they want to postpone or avoid childbearing and also report that they and their partner are not using contraception. Utilisation rates Utilisation rates are given in terms of visits to a health facility per person per year: Total number of visits in one week = visits/person/year Total population x 52 weeks these rates are not constant and may vary based on phase of the emergency, population demographics, season, etc. Utilisation rates generally increase among displaced populations and populations affected by other public health emergencies. V Term Definition Validity the degree to which a measurement actually measures what it is supposed to. Vec to r Any animal capable of transmitting disease pathogens from one host to another by its bite or bodily functions. Vec to r control Any measures directed against a vec to r of disease and intended to limit its ability to transmit disease. Vec to r-related Occur when vec to rs carrying disease pathogens from an animal, diseases human, etc. Vertical A term used very widely and loosely to indicate independent programme programs for either specific health issues or directed by staff who barely communicate or know one another. Public health guide for emergencies I 599 Annex 2 Virulence the ability of an infectious agent to invade and damage tissues of the host and/or cause death. Living on an ‘edge’ such that if something goes wrong or if part of the situation changes, then the ability to sustain life is endangered.

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The report concluded that the funds seem to blood pressure medication that doesn't cause dizziness buy zestoretic cheap be beneficial for women although employers did not believe that the fund had made them change their view on hiring women and also that more men seemed to blood pressure 60 over 0 buy zestoretic from india 94 take up leave as a consequence of receiving payment during leave arteria profunda femoris proven zestoretic 17.5 mg. Employers tended to blood pressure chart canada order zestoretic 17.5 mg amex be more positive to wards men taking leave than earlier and generally were positive to wards the fund. Around one third of employers were unaware of the possibility to receive reimbursement for 29 weeks – even in female dominated sec to rs and therefore failed to claim such reimbursement. Paternity leave (Ffidreorlov: see ‘note on terminology’) (responsibility of the Ministry of Labour) Length of leave fi Two weeks, to be taken during the first 14 weeks after birth. Eligibility fi Anyone in a recognised partnership, including same-sex partnerships. Thus, in a survey from 2006, 85 per cent of the fathers reported 92 receiving full earnings during Paternity leave (Olsen, 2007). Parental leave (Forfildreorlov: see ‘note on terminology’) (responsibility of the Ministry of Labour) Length of leave fi Thirty-two weeks, until the child is 48 weeks. This is an individual entitlement; however, although each parent can take 32 weeks of leave, each family can only claim 32 weeks of paid leave. Flexibility in use fi Between eight and 13 weeks can be taken later; any further period must be agreed with the employer. The benefit level is reduced over the extended leave period, so that the to tal benefit paid equals 32 weeks at the full rate of benefit. Three weeks of this Parental leave with pay is for the father, three weeks for the mother and three weeks for the parents to share the weeks for the mother and the father respectively were quotas and therefore lost if not used. If both parents work in the state sec to r they are now entitled to leave with full payment for 6+6+6 weeks after Maternity leave, in all 14 weeks of Maternity leave and 18 weeks of Parental leave, all with full payment, a to tal of 32 weeks. Six weeks is earmarked for the mother, six weeks for the father and six weeks can be shared. As presented in the section on take-up of leave, this earmarked leave for fathers seems to have resulted in a significant higher take-up among fathers working in the municipal sec to r. Other employment-related measures Adoption leave and pay fi For adoptive parents the same regulations for Parental leave apply as for other parents, with the exception that two of the 48 weeks must be taken by both parents to gether. Time off for the care of dependants fi One day to care for a sick child, two days for public employees, for every time a child is ill. Relationship between leave policy and early childhood education and care policy the maximum period of paid post-natal leave available in Denmark is 14 months, if parents take the option of a longer Parental leave period with a lower benefit payment; leave at 100 per cent of earnings subject to a ceiling lasts for 11 months. Changes in policy since April 2012 (including proposals currently under discussion) the government consisting of Social Democrats, the Social Liberal Party (De Radikale) and the Socialist People’s Party (Socialistisk Folkeparti) that came to power in Oc to ber 2011 had originally intended to introduce a three months father’s quota, inspired by the other 93 Nordic countries (Ministeriet for Ligestilling og Kirke, 2012). The government set up a committee in January 2013 to look at the possibilities for increasing fathers’ use of Parental leave. The committee is to look in to the experiences from other Nordic countries as it is believed that a father’s quota may make more fathers take up leave. Any policy recommendations must not result in increased expenditure for the state or employers, and the committee must also consider the related consequences for single parents and same-sex parents. The committee report is due in summer 2013, after which the government will decide whether or not to introduce a father’s quota in Denmark. Maternity leave the present statistics on leave take-up do not provide data on the proportion of mothers using Maternity leave. However, in a survey conducted in 2006 among parents of children born in 2005, 99 per cent of mothers had taken Maternity leave. In the same survey, nearly all mothers reported that they experienced no negative reaction from the employer when taking leave; 95 per cent reported that they experienced no problems with the workplace when they wanted to take leave. A few mothers reported that 93 Ministeriet for Ligestilling og Kirke [Ministry for Equality and Church] (2012) Redegorelse – Perspektiv og handlingsplan 2012. However, recent newspaper reports citing the major trade unions refer to an increase since the financial crisis in the number of women being made redundant during Maternity and Parental leave. Most of these cases end in a settlement where the woman is offered compensation, often six to nine months earnings. Paternity leave Statistics on fathers’ take-up of Paternity leave are equally limited. The most recent statistics from 2009 show that 61 per cent of Danish fathers take the two weeks Paternity leave they 94 are entitled to (Danmarks statistik, 2012). Parental leave Statistics on the share of fathers and mothers who take-up Parental leave is also not available; however recent statistics from 2010 and 2011 show that Danish fathers on 95 average only take 7. The 2006 survey data showed that among parents of children born in 2005, 24 per cent of fathers to ok Parental leave and 94 per cent of mothers. Twenty-three per cent of fathers started their leave before the Maternity leave expired, i. Two-thirds (68 per cent) of two parent families to ok all the 32 weeks of Parental leave to which they were entitled. Among single parents, 73 per cent to ok 32 weeks; as Olsen notes, this is interesting because single parents in the Nordic countries tend to take shorter leave periods, often due to the loss of income (Olsen, 2007). Among the men, public employees accounted for two-thirds (67 per cent) of Parental leave takers even though they only make up 48 per cent of those entitled to Parental leave. This may be because they receive full earnings during leave or because they are working in more gender-mixed workplaces; some men in the private sec to r only receive full earnings for part of the Parental leave period. Among those men who do not take leave, 88 per cent were employed in the private sec to r and this suggests that they have more difficulties taking leave and/or poorer rights. The take-up of leave seems in the survey related to the educational level of both men and women. In those families where the woman takes the greatest part of the leave, the mother tends to have a low educational level and the father is unskilled, or the reverse; in these families, women typically take 99 per cent of to tal Parental leave weeks. Self-employed workers, both men and women, tend in general to take fewer weeks of leave. This is confirmed in register data from Statistics Denmark, looking in to couples who became parents in 2006. The higher the educational level of the father, the more Parental leave he 94 Danmarks statistik (2012) Dagpenge ved fodsel 2011, Nyt fra Danmarks statistik no 120, marts 2012. Danmarks Statistik (2012b) Statistiske efterretninger: Dagpenge ved graviditet, fodsel og adoption 2011. Recent statistics show that fathers in management positions are the fathers taking most leave (Statistics Denmark, 2012). The 2006 survey suggests that along with educational level, wages, workplace culture and age also seem to be important fac to rs when men and women negotiate who should take Parental leave and these seem to be common fac to rs for both the public and private sec to rs. Moreover according to the survey, there seems to be agreement on the division of leave between men and women; 98 per cent of women and 98 per cent of men stated that they and their partner agreed on how to divide the leave period. They also seem to agree on what is important to consider when dividing leave between parents; among the considerations that affect the division of leave weeks, couples mentioned: their work/educational situation (men 45 per cent, women 30 per cent), their finances (39/28 per cent), the child (32/25 per cent), desire to reconcile work and family life (28/27 per cent), equality between parents (22/8 per cent), and day care of the child (11/5 per cent) (Olsen, 2007). Other studies, however, show that often the parents do not in reality negotiate the division of Parental leave; instead leave is often perceived as ‘for women’ and thus au to matically divided according to cultural 98 99 assumptions of gender and parenthood (Bloksgaard 2009, 2011). This indicates that Danish fathers’ limited leave take-up may be explained by a fear of leave having negative consequences or not being seen as ‘appropriate’ for men in work life. The possibility for flexibility in taking part-time leave or postponing leave may be attractive, especially for fathers. The 2006 survey found that 36 per cent of women on leave and 6 per cent of men on leave made use of some form of flexibility in the leave law: 21 per cent of women and 4 per cent of men postponed periods of leave to be taken later, 12 per cent of women and 3. The survey also revealed that 27 per cent of men and 42 per cent of women reported a lack of information on leave rights. This is supported by other studies, which conclude that the fact that leave entitlements are given by several different levels (law, collective agreements 97 Danmarks statistik (2008) Ffidre med hojere jobs holder lfingere barselorlov. Thirty seven per cent of men and 23 per cent of women in the survey from 2006 were in favour of the re-introduction of quotas in Parental leave. Olsen interprets this lower support among women as related to the fact that a father’s quota would require women to give up a number of weeks currently available to them. The higher support among fathers is related to a wish for more back-up when they discuss leave-taking with their employer or with colleagues (Olsen, 2007). Leave take-up in to tal In addition to the (relatively) limited statistics referred to above, the available statistics presenting the present leave situation look across the entire leave period (Maternity, Paternity and Parental leave) and the data are presented here. Data for the 102 period 2010-2011 show a small drop in the number of days that fathers take when both the mother and father take up leave, from 38 days on average in 2010 to 36 days in 2011. Mothers on the other hand increased their average number of leave days from 292 days in 2010 to 295 days in 2011, i. On the other hand, taking the perspective of the child, an increasing proportion of children experience both father and mother taking leave, 56 per cent in 2011 compared with 49 per cent in 2010; 25 per cent of children in 2011 experienced only the mother taking leave, 311 days on average. For 8 per cent of children only the father to ok leave, 36 days on average, Finally, 11 per cent of children had parents who had no entitlement to receive the cash 103 benefit (Danmarks statistik, 2013).

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Nach unserer Einschatzung ist jedoch die Chance heart attack heartburn buy genuine zestoretic on line, dass kleine Kinder durch eine Chemotherapie einen Vorteil gegenuber einer fruhzeitigen Strahlentherapie haben blood pressure 60100 purchase zestoretic master card, grofier blood pressure chart age 60 17.5 mg zestoretic otc, als dass ihnen mit dieser Therapie bleibend geschadet wird heart attack kurt buy zestoretic 17.5 mg. Da Chemotherapie wahrend einer Schwangerschaft zu Schadigungen der Frucht fuhren kann, muss bei konzeptionsfahigen Patientinnen zu Beginn einer Chemotherapie das Vorliegen einer eventuellen Schwangerschaft durch einen Schwangerschaftstest ausgeschlossen und fur die gesamte Dauer der Therapie der Eintritt einer Schwangerschaft zuverlassig verhindert werden. Minipille, hormonhaltiger Scheidenring, Hormonpflaster) sind unter Berucksichtigung des Einzelfalles gesondert zu besprechen. Die Nebenwirkungen der Chemotherapie Bei der Chemotherapie werden hochwirksame Zellgifte verabreicht, die den ganzen Organismus des Kindes und Jugendlichen treffen. Aufier Haarausfall konnen folgende Organe in ihrer Funktion ges to rt werden: Schleimhaute, Knochenmark (Blutbildung), Infektabwehr, Nieren, Gehor, Gehirn und Nervensystem, Leber, Lunge und Eiers to cke/Hoden. Bei bis zu 30% der Patienten kann sich zu irgendeinem Zeitpunkt der Therapie, meist erst in der Erhaltungstherapiephase (Konsolidierung), eine Allergie gegen Carboplatin entwickeln, die eine Weiterbehandlung mit diesem Medikament nicht erlaubt. Da eine Gesamtbehandlungszeit von 18 Monaten angestrebt wird, wird die Therapiefortsetzung mit alternativen Medikamentenkombinationen empfohlen. Cis-Platin und Cyclophosphamid sollen nach Auftreten einer Carboplatinallergie im Wechsel mit Vincristin bei Beibehaltung der Zyklusintervalle gegeben werden. Den moglichen Nebenwirkungen einer Chemotherapie wird durch eine Dosierung, die sich nach dem Alter und der Korperoberflache richtet und eine zeitlich genaue Abfolge der Medikamentengaben Rechnung getragen. Die Strahlentherapie Eine auf den Tumor gerichtete Bestrahlung wurde lange Jahre als einzige Moglichkeit gesehen, das Tumorwachstum niedrigmaligner Gliome zu s to ppen. Bei den oft grofien Tumoren mussten dabei grofie Felder bestrahlt werden, da erhebliche Sicherheitssaume um die Tumoren gezogen wurden. Dies fuhrte insbesondere bei den im Zwischenhirn gelegenen Tumoren zu den eingangs beschriebenen Spatfolgen. Es ist nun vorstellbar, dass durch neuere Anwendungsmoglichkeiten der Strahlentherapie bei gleich guter Tumorwirkung die Belastung des gesunden, umgebenden Gehirngewebes vermindert werden kann. Da die niedrigmalignen Gliome meist nur wenige Millimeter in umgebendes Gehirngewebe einwachsen, ist ein breiter Sicherheitssaum auch nicht erforderlich. Somit kann bei entsprechender Lagerung des Patienten und fester Haltung die heutige Strahlentherapie sehr zielgenau gegeben werden. Diese Bestrahlungstechniken sind daher ein besonderer Vorteil bei kleinen Tumoren und alteren Kindern. Bei kleinen Kindern kann in Ausnahmefallen bei Versagen der Chemotherapie eine Strahlentherapie mit ahnlicher vorgesehen werden. Die Frage, ob ein Tumor zusatzlich oder ausschliefilich durch radioaktives, implantierbares Material (interstitielle Radiotherapie / Brachytherapie) behandelt werden kann, hangt sehr stark von der Grofie des Tumors, seinem Sitz und dem Wachstumsverhalten des Tumors ab. Die Nebenwirkungen der Strahlenbehandlung Zu Beginn der Bestrahlung konnen durch die Reizung der Hirnhaute Hirndrucksymp to me auftreten, die sich durch Kopfschmerzen, Ubelkeit und Erbrechen aufiern konnen. Neben lokalen Reizerscheinungen der Haut im Bestrahlungsfeld, wie Trockenheit und Rotung, kommt es im Bereich der behaarten Haut zumeist zum Haarausfall. In Abhangigkeit von den Feldgrofien und der Lokalisation konnen auch andere Reizsymp to me auftreten. Die Knochenmarkfunktion kann bei Behandlung des gesamten zentralen Nervensystems (z. An strahlenbedingten Spatfolgen konnen altersabhangige Verkurzungen des Langenwachstums bei Bestrahlungen der Wirbelsaule auftreten, ferner sind auch Langzeitnebenwirkungen an den gesunden, jedoch mitbestrahlten Organen Gehirn, Auge, Ohr, Gefafie und Hirnanhang– sowie Schilddruse trotz optimierter Bestrahlungsplanung und exakter Dosierung nicht vollstandig auszuschliefien. Dies kann moglicherweise die lebenslange Einnahme von Medikamenten, psychointellektuelle Entwicklungss to rungen oder neurologische Einschrankungen einschliefilich Lahmungen zur Folge haben. Der verantwortliche Radiotherapeut wird zusatzlich ein studienbezogenes Informationsgesprach fuhren. Das Einverstandnis fur die Strahlentherapie muss mit den ublichen Aufklarungsbogen zusatzlich und getrennt eingeholt werden. Ziele dieser Therapiestudie Mit dieser Studie soll zunachst fur alle Kinder mit niedrigmalignen Gliomen von vornherein eine umfassende Therapieplanung moglich sein. Fur den grofien Teil der Kinder mit nicht vollstandig entfernbaren Tumoren sollen die Chancen, ohne schwere Langzeitschaden zu uberleben, verbessert werden. Bei Kindern, die einer Bestrahlung zugefuhrt werden, soll dies erreicht werden durch die Anwendung neuester Strahlentherapieplanungssysteme und Bestrahlungstechniken. Bei Kindern, die zunachst eine Chemotherapie erhalten, soll dies durch eine Verlangerung der Chemotherapie bei allen Kindern sowie die Prufung der Auswirkungen einer Intensivierung der Anfangstherapie erreicht werden. Insgesamt wird eine vergleichsweise geringe Rate und Auspragung moglicher Spatfolgen der Therapie mit einer gebesserten Lebensqualitat der Patienten angestrebt, besonders durch den Verzicht auf eine Bestrahlung bei jungeren Kindern. Eine Qualitatskontrolle der Behandlungsarten Operation, Bestrahlung und Chemotherapie, eine standardisierte Diagnostik und Nachsorge gewahrleisten fur alle Kinder eine hohe Behandlungsqualitat. Die Aspekte der Langzeitfolgen und Lebensqualitat sollen Informationen daruber liefern, wie sich die durchgefuhrten Behandlungsmafinahmen auf das weitere Leben der Kinder auswirken, da zu diesem Aspekt wenig systematische Untersuchungen vorliegen. Da vor allem die Prognose der jungeren Kinder auch mit Chemotherapie bezuglich der Tumorprogression mit ihren neurologischen Folgen noch unbefriedigend ist, erscheint es unter Abwagung der Belastungen und Nebenwirkungen gegen den potentiellen Nutzen einer Chemotherapie ethisch gerechtfertigt, den Wert der fruhen Behandlungsintensivierung in randomisierter Form zu prufen. Geeignete Uberwachungsinstrumente stellen sicher, dass eine Gefahrdung der Patienten durch die Studientherapie fruhzeitig erkannt wird und der entsprechende Therapiarm dann geschlossen wird. Bitte beachten Sie daher insbesondere die Hinweise zur Behandlung fur die Patientengruppe, der Sie / Ihr Kind zugeordnet wurden/wurde. Die sogenannten hypothalamisch-chiasmatischen Gliome oder Sehbahngliome sind eine relativ homogene Gruppe niedrigmaligner Gliome. Zusatzlich werden die kleine Anzahl von Tumoren der Basalganglien, des Thalamus und des Mittelhirnes hierzu gezahlt, da sie ahnliche therapeutische Schwierigkeiten darstellen. Es handelt sich meist um sehr kleine Kinder, so dass der grofite Teil behandlungsbedurftiger Patienten eine Chemotherapie erhalt. Die Zuordnung zur Standardinduktion oder intensivierten Induktion erfolgt durch eine zentrale Randomisierung. Eine solche zufallige Verteilung von Patienten durch Losentscheidung auf zwei Behandlungsarme, die miteinander verglichen werden sollen, ist erforderlich, um eine Verfalschung der Studienergebnisse durch aufiere Einflusse zu vermeiden. Es kann derzeit nicht vorausgesagt werden, ob das progressionsfreie Uberleben dieser Patientengruppe durch die intensivierte Induktion tatsachlich verbessert werden kann im Vergleich zur Standardinduktion. Sollte sich jedoch im Verlauf der Studie ein deutlicher Unterschied ergeben, der sowohl die Wirkung wie auch die Nebenwirkungen betreffen kann, wird die Randomisierung abgebrochen und alle Patienten werden in den erfolgreicheren/schonenderen Behandlungsarm aufgenommen. Im Standardinduktionsarm erhalten alle Kinder wochentliches Vincristin und 3-wochiges Carboplatin uber zehn Wochen. Zusatzlich wird gepruft, wie sich nach insgesamt 6-monatiger Behandlungszeit der Typ der Induktionstherapie auf die Reaktion im Tumor (Tumorresponse) auswirkt. Um diese Analysen durchfuhren zu konnen, ist die Randomisation von insgesamt 360 Patienten vorgesehen. Fur die anschliefiende Erhaltungstherapie (Konsolidierung) wird die Behandlung mit Carboplatin und Vincristin bis zur Gesamtbehandlungszeit von 18 Monaten fortgesetzt. Allerdings werden die Abstande zwischen den Carboplatingaben auf 6 Wochen verlangert und zusatzliche Vincristingaben an Tag 8 und 15 eines jeden 6-Wochen-Zyklus verabreicht. Mit dieser Konsolidierungstherapie soll die nach 6 Monaten erreichte Therapieresponse gehalten werden. Einige Tumoren zeigten in der Vergangenheit auch wahrend der Konsolidierungsphase noch eine Tumorvolumenverminderung. Als Nebenwirkung wahrend der langen Therapie kann eine Carboplatinallergie auftreten. In einem derartigen Fall wird der Wechsel auf andere Medikamentenkombinationen empfohlen (Vincristin / Cyclophosphamid und Vincristin / Cisplatin), die im Wechsel bei gleichem Rhythmus gegeben werden sollen. Bei Kindern mit Tumoren im Bereich der Grofihirnrinde oder des Kleinhirns kann in einem grofien Teil der Falle eine vollstandige Tumorresektion erreicht werden. Daher ist nur in Ausnahmefallen eine zusatzliche, nicht-chirurgische Behandlung erforderlich. Sie folgt den Empfehlungen fur Kinder mit Tumoren des Zwischenhirnes und wird ebenfalls in der Induktionstherapiephase randomisiert. In beiden Therapiegruppen sollten altere Kinder mit einer Strahlentherapie behandelt werden, die Altersgrenze wird aufgrund von Vorerfahrungen bei 8 Jahren festgelegt. Kinder mit Tumoren, die sich fur eine interstitielle Radiotherapie eignen konnen, konnen unabhangig vom Alter mit Brachytherapie behandelt werden. Die Neurofibroma to se ist eine genetische Erkrankung, zu deren Diagnose klinische Merkmale herangezogen werden. Genetisch handelt es sich um Veranderungen im sogenannten Neurofibromingen, das auf dem langen Arm von Chromosom 17 lokalisiert ist. Es ist bekannt, dass die Strahlentherapie bei Patienten mit Neurofibroma to se zu verstarkten Nebenwirkungen fuhrt.

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Derealization: An alteration in the perception of Alexithymia: Inability to pulse pressure is quizlet order 17.5 mg zestoretic with visa verbally describe one’s external world blood pressure chart per age buy cheapest zestoretic, so that the feeling of the reality of emotionally feelings blood pressure chart male cheap 17.5mg zestoretic free shipping. Ambitendency: Due to hypertension over 65 17.5mg zestoretic with visa ambivalence, tentative actions Disorientation: A disturbance in orientation in time, are made, but no goal directed action occurs. Ambivalence: Inability to decide for or against, due Distractibility: Inability to concentrate or focus to co-existence of two opposing impulses for the same attention. Echolalia: Repetition, echo or mimicking of phrases Anergia: Lack of energy for day- to -day activities. Anhedonia: Inability to experience pleasure in previ Echopraxia: Repetition, echo or mimicking of actions ously pleasurable activities. Anxiety: An unpleasurable emotional state, associated Ecstasy: Very severe elevation of mood (seen in with psycho-physiological changes in response to an delirious or stuporous mania); Intense sense of rapture intrapsychic confiict. Blunted affect: Severe reduction in the intensity of Elation: Moderate elevation of mood (seen in mania; affect. Emotional incontinence: Complete loss of control Cataplexy: Abrupt loss of muscle to ne without im over affect (represents an extreme form of emotional pairment of consciousness. Circumstantiality: Digression in to unnecessary Euphoria: Mild elevation of mood (seen in hypo details that distract from the central theme; however, mania); Increased sense of psychological well-being the patient returns back to the original theme after and happiness, not in keeping with on-going events. Euthymia: Normal range of mood, with absence of Confabulation: A false memory that the patient depressed or elevated mood. Deja entendu:A false sense of familiarity when hear Flight of ideas: Rapid speech with sudden shifts in ing something new. Appendices 247 Folie a deux: Delusions shared between two closely Panic: An acute, intense, overwhelming episode of connected persons. Also known are folie a trios, folie anxiety, often associated with feelings of impending a quatre, and folie a famille. Formication: A false sense of insects crawling on Perplexity: Puzzled bewilderment. Perseveration: Persistent repetition of words or Fugue: Physical and psychological fiight (wandering) themes beyond the point of relevance. Phobia: An irrational fear of an object, situation or Grandiosity: Excessive and exaggerated feeling of activity. Posturing: Voluntary assumption of an inappropriate Hallucination: A perception that occurs in the absence and often bizarre posture for long periods of time. Illusion: A misinterpretation of stimuli arising from Poverty of content of speech: the speech production external object(s). Incoherence: Thought process that is disconnected, Pressure of speech: Rapid production of speech disorganised, or incomprehensible. Insight: the ability to understand one’s own behaviour Rigidity (Cata to nic): Maintenance of a rigid posture and emotions. Somnolence: Inability to maintain a state of alertness Jamais entendu: A sense of unfamiliarity when hear without constant stimulation. Stereotypy: Odd, repetitive and non-goal directed Jamais vu: A sense of unfamiliarity with familiar movement (can also be verbal). Stupor: A clinical syndrome of akinesis and mutism, Judgement: An ability to assess a situation correctly with relative preservation of conscious awareness. Suicide: A human act of self-intentioned and self Labile affect: Rapid and abrupt changes in affect, infiicted cessation (death). Tangentiality: Sudden and oblique digression in to Loosening of associations: Thought process charac unnecessary details that completely distract from the terised by a series of ideas without apparent logical central theme; however, the patient never returns connections. Thinking: Normal thinking is a goal directed fiow of Mood: the pervasive feeling to ne which is sustained ideas, symbols and associations initiated by a prob (lasts for some length of time) and colours the to tal lem or a task, characterised by rational connections experience of the person. Negativism: An apparently motiveless resistance to Thought diffusion or Broadcasting: Subject experi all commands and attempts to be moved, or doing ences that his thoughts are escaping the confines of just the opposite. Neologisms: these are idiosyncratically formed new Thought echo: Voices speaking out thoughts aloud; words whose derivation cannot be unders to od easily. Verbigeration: Senseless repetition of same words Thought withdrawal: Thoughts cease and subject or phrases over and over again. Waxy fiexibility: Parts of body can be placed in experiences them as removed by external force. Task Force Report on Electroconvulsive Journal of Psycho-Analysis 1961; 42: 317-40. British Journal of Psychiatry Recommendations for Treatment, Training 1972;121:241. Catamnestic long-term studies on the 3rd edn, Churchill Livings to ne Elsevier, Edin course of life of schizophrenics. Some Must Watch While Some tional Handbook of Behavior Modification and Must Sleep. Mini to rs Associated with Course and Outcome of Mental State: A practical method for grading Schizophrenia. National 5th edn, Oxford University Press, New York, Mental Health Programme Booklet. Com tive Study on Strategies for Extending Mental prehensive Textbook of Psychiatry. American Journal of Psy pressed emotion in the families of psychiatric chiatry 1982;139:552. Mental Health: sification of Mental and Behavioural Disorders: New Understanding, New Hope, World Health Clinical descriptions and diagnostic guidelines. Vulnerability: A new view of An International Follow-up Study, Wiley, New schizophrenia. Vermetten Dit proefschrift werd mogelijk gemaakt met fnanciele steun van het Ministerie van De fensie ContentS Chapter 1 Introduction and general outline. Submitted for publication Chapter 3 Obstructive sleep apnea in combat-related post-traumatic stress 33 disorder; a controlled polysomnography study. European Journal of Psychotrauma to logy 2011; 2: 8451-5 Chapter 4 Sympathetic activity and hypothalamo-pituitary-adrenal-axis 45 activity during sleep in post-traumatic stress disorder; a study assessing polysomnography with simultaneous blood sampling. Submitted for publication Chapter 5 Decreased nocturnal growth hormone secretion and sleep 67 fragmentation in combat-related post-traumatic stress disorder; potential predic to rs of impaired memory consolidation. Psychoneuroendocrinology 2011;36(9): 1361-9 Chapter 6 Pharmacotherapy for disordered sleep in post-traumatic stress 87 disorder: a systematic review. International Clinical Psychopharmacology 2006, 21(4): 193-202 Chapter 7 Prazosin treatment for sleep disturbances in veterans with a post 109 traumatic stress disorder; a placebo-controlled pilot study using polysomnography. Subsequently, we will formulate our research questions and the general outline of this dissertation. Moreover, reactivation of neurons in the hippocampus during slow wave sleep enhances memory retention (Rasch et al. A wealth of literature shows the importance of sleep on learning in humans, suggesting neural plasticity during sleep (Wang et al. Animal studies have shown that sleep regulates neurogenesis and genes associated with neural plasticity (Cirelli and Tononi, 2000; Mueller et al. Sleep ensures us to wake up with a ‘slightly different brain’ than the night before. Firstly, because psychiatric disorders have been associated with a decrease in neurotrophic fac to rs (Lewis and Gonzalez-Burgos, 2008; Manji et al. Secondly, because disturbed sleep in psychiatric disorders may compromise treatment-effect (Troxel et al. Reduced synaptic plasticity during sleep may possibly act as a precipitating or a perpetuating fac to r in psychiatric disease. In most psychiatric disorders, decreased hippocampal volumes have been demonstrated (Geuze et al. Interestingly, insomnia severity is inversely related to hippocampal volume in patients with a posttraumatic stress disorder (Neylan et al. Reduced hippocampal activity during a memory task was also observed as a result of sleep deprivation (Yoo et al. The evidence of a relationship between plasticity and sleep on the one hand, and plasticity and psychiatric disorders on the other hand is emerging. So far, in psychiatric research the neurobiology and consequences of disturbed sleep on plasticity, learning and recovery are relatively rarely studied phenomena.