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Denominator: Women-years of exposure are calculated in exactly the same way as for adult age-specific mortality. See Calculation for this chapter presents indicators for the calculation of adult mortality rates for both sexes, and for both pregnancy-related and maternal mortality rates and ratios for women. Once the numerators and denominators are calculated, age-specific pregnancy-related and maternal mortality rates are obtained by the division of the numerators by the corresponding denominators and multiplying by 1000. The total pregnancy-related and maternal mortality rates (for age 15-49) are obtained by multiplying the age-specific mortality rates by the proportion of respondents in the five year age group and then summing the age distribution-adjusted pregnancy-related and maternal mortality rates. Handling of Missing Values Siblings whose maternal status at the time of death are unknown to the respondent or are missing are assumed not to be pregnancy-related or maternal deaths. If the response to whether the death was caused by an accident or violence is missing or the response was ?don?t know, the death is assumed to have not been due to an accident or violence. The adult and maternal mortality module is an optional module and data are only available for surveys that included this module. Women who intend to have an induced abortion may also not disclose their pregnancy status to family members. Pregnancy-related and maternal mortality rates are subject to high levels of sampling error due to their relatively rare occurrence. Age-adjusted pregnancy-related and maternal mortality rates are expressed per 1,000 women age 15-49 and represent the risk of pregnancy-related death or death due to maternal causes per 1,000 women. When comparing estimates over time, the pregnancy-related mortality estimates from surveys since 2015 should be compared with those labeled maternal mortality in survey reports prior to 2015. The changes include asking more questions to capture information about siblings who may have died, live elsewhere, or have a different father but the same mother. For each age group of siblings, the number of deaths of known maternal status was divided by the number of deaths of any status to get the proportion of maternal deaths. This proportion was then multiplied by the number of deaths of unknown status to calculate the number of deaths to add to the known maternal deaths to get the total number of maternal deaths in each age group. Indicators of age-specific rates are provided for the adult mortality rates and the pregnancy-related and maternal mortality rates, as well as age-standardized total rates. Denominator: Female deaths are tabulated in the same way as the numerator for the adult age-specific mortality rates for females (see Calculation for this chapter presents indicators for the calculation of adult mortality rates for both sexes, and for both pregnancy-related and maternal mortality rates and ratios for women. Indicators for the pregnancy-related mortality ratio and the maternal mortality ratio are given, as well as indicators for the lifetime risk or pregnancy-related and maternal mortality. The total proportion of female deaths that are pregnancy-related or maternal is calculated by dividing the total pregnancy-related mortality rate or maternal mortality rate by the general 15-49 adult mortality rate of women (see Age-specific pregnancy-related and maternal mortality rates, and total pregnancy-related and maternal mortality rate). Handling of Missing Values See Handling of Missing Values for Age-specific pregnancy-related and maternal mortality rates, and total pregnancy-related and maternal mortality rate. Note that the general fertility rate is age-standardized by multiplying the age-specific fertility rates by the proportion of women surveyed in each age group, and then summing the products. The general fertility rate is calculated for the same time period as for the pregnancy-related mortality rate and the maternal mortality rate.
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A recent study found the rate of substance use among adolescents with bipolar disorder was 6 times higher (24 percent compared to 4 percent) than among adolescents without mood disorders. Recent research also supports this approach, fnding that patients with bipolar disorder who abuse drugs or alcohol have more diffculty controlling the symptoms of the disorder than those who do not. These people are more likely to be extremely irritable, resistant to treatment, and to require hospitalization. In one study, lithium signifcantly reduced the risk of adolescents with bipolar disorder using substances of abuse. Lithium also improved the function of adolescents with bipolar disorder who had already developed an issue with substance use. Suicidal thoughts and suicide attempts are common among children and Parents must take adolescents with bipolar disorder. Research showed that during a one-year children and adolescents period, 44 percent of adolescents with bipolar disorder whose condition who talk about suicide, was untreated were suicidal at some point. The same research shows that 33 percent of children and adolescents with untreated bipolar disorder or who are acting out in had made a medically signifcant suicide attempt at some time during their a potentially harmful illness. Suicide is the sixth leading cause of death for 5 to should have phone number for emergency medical services and 14-year-olds. Although there is no cure for bipolar disorder, medicine along with psychoso cial treatment can play a critical role in helping manage the symptoms of this illness. While medication may lessen the symptoms of bipolar disorder, psychosocial treatment in the form of family and behavioral therapy is equally as important ?Before I started in helping the child manage their illness. In fact, a study of adults with bipolar treatment, my disorder found that people taking medications to treat bipolar disorder personal life was are more likely to get well faster and stay well longer if they also receive intensive behavioral therapy. Since holds true for children, especially for those with signifcant emotional and I was a kid, my behavioral issues. I didn?t fore, psychosocial treatment is a key element in helping to prevent a relapse realize I had bipolar and promote healthy emotional growth and development. My par year study found that psychosocial treatment that emphasized interpersonal coping strategies helped patients with bipolar disorder control the symptoms ents didn?t know of the disorder and function better in society. They just thought I was a In most cases, psychosocial treatment includes teaching parents techniques to bad kid. By far, suicide is the most dangerous consequence of leaving bipolar disorder untreated. In any given year, 44 percent of all adolescents with untreated bipolar disorder have been suicidal.
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Strategies towards improving access and adherence to evidence-based therapies can therefore be effective in reducing the personal and economic burden of asthma in all countries. Implementation of relatively simple measures within a systematic national or local strategy can improve early detection of asthma and provide effective preventive treatment. Asthma management guidelines are an essential part of successfully managing asthma and promoting the delivery of quality asthma care; these are widely available. Political commitment and action are required to make the burden of asthma a thing of the past. If an infant presents with frequent and/or severe episodes of recurrent wheezing they should be diagnosed and managed as asthma, unless there is evidence to the contrary. It aims to reduce asthma suffering by improving asthma care globally with a focus on low and middle income countries. Affordable in all countries 2018 children will be involved (13-14 year olds and 6-7 year olds), as well as parents/caregivers of each child. The network will achieve this through enhanced surveillance, research, capacity building, and access to effective asthma care, including quality-assured essential medicines. Stimulate and encourage Independence A world where no-one capacity building in low and suffers from asthma. The most recent revised and its prevalence is estimated typically experience ?wheezing, a high-pitched global estimate of asthma suggests to be increasing fastest in those whistling sound heard during breathing, especially when breathing out. There is no evidence that the studies to find out how the pattern of asthma is children were likely to have had asthmatic number of people with asthma in the world changing in children and adults (See Chapter 1). Using this approach the International were generally similar to the older children). The lowest prevalence (<5%) was observed in 1 4 yrs the Indian subcontinent, Asia-Pacific, Eastern Mediterranean, and Northern and Eastern 0 200 400 600 800 1000 Europe. The prevalence of asthma in younger adults the burden of asthma, measured by disability varies widely as it does in children. The World Health statistics and health survey data, where available, are taking treatment for asthma. However, for people in older standardised comparisons of asthma prevalence age groups, premature death due to asthma in the elderly. Is asthma becoming more or Key Recommendation Asthma has a global distribution with a less common? However, in most to research, intervention, and high-prevalence countries, the prevalence of Conclusion asthma changed little and even declined in a monitoring to reduce the burden few countries.
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Rhinitis medicamentosa is have been linked clinically to disease, avoidance of the triggering a syndrome of rebound nasal congestion that follows allergens is impossible, a commercial allergen extract is available, the overuse of intranasal a-adrenergic decongestants or and ef? In the past, antihypertensive medications (eg, reser 503,793 symptoms among sensitized animal workers. Immunotherapy is not appropriate to symptoms are often caused by a-receptor antagonists used in treat occupational rhinitis caused by low-molecular-weight chem treatment of benign prostatic hypertrophy (eg, prazosin, terazo 124 ical antigens. Phosphodiesterase-5?selective inhibitors used for treat 125 ment of erectile dysfunction can cause nasal congestion. Hormonal-induced rhinitis Phentolamine mesylate, an a-1 and a-2?selective adrenergic re ceptor antagonist, has been reported to cause rhinitis symptoms 27. Pregnancy rhinitis, when present, is Although oral contraceptives have long been implicated as associated with sigtni? Sinusitis the repetitive and prolonged use of topical a-adrenergic nasal has been reported to be 6 times more common in pregnant than decongestant sprays may induce rebound nasal congestion on 795 nonpregnant women. Benzalkonium chloride in vasocon 119 801 lergic rhinitis and increased sinusitis during pregnancy. The Nasal polyps have a prevalence of 2% to 4% in the general 143 nasal mucosa is often beefy red, appears in? Although previous studies showed a 2:1 male to female 133 142,144,145 ated epithelial cells leading to reduced mucociliary clearance. Frequently reported symp quences may occur with prolonged use of other vasoconstrictor toms are rhinorrhea (39%), nasal congestion (31%), and anosmia agents such as cocaine. The nasal cavities appear abnormally wide on ex phils, T cells, plasma cells, and mast cells are consistent? Klebsiella ozaenae and other bacteria including 698 rhinitis also have nasal polyps. The noses and sinuses of patients S aureus, Proteus mirabilis, and Escherichia coli may be causa with chronic rhinosinusitis and nasal polyps are frequently colo tive, although it is also plausible that these secondarily infect pre 812 138 nized with fungi (principally Aspergillus and Penicillium). A genetic association has also 804 Allergic fungal sinusitis is a distinct pathologic entity de? Although secondary atrophic rhinitis may be less tein and neutrophil elastase have been identi? There are no controlled trials evaluating therapies for the treatment and control of nasal polyps is challenging. Intranasal corticosteroids are giene?for instance, intranasal irrigations with saline or so effective in improving sense of smell and reducing nasal conges dium bicarbonate solution, and periodic debridement of the tion, and effects are optimized with twice-daily versus once-daily crusts, if necessary. For severe nasal polyposis, a short course of oral tis, adding antibiotics such as mupirocin to the lavage solution has been suggested for purulent secretions. Systemic antibiotics prednisone is effective in reducing symptoms and polyp size are indicated when an acute infection is present. Nasal polyps should always be considered in the dectomy, recurrence rates and rescue medication requirements in differential diagnosis of patients who present with invariant patients treated with montelukast were equivalent to those ob nasal congestion and/or anosmia and its sequelae. Allergy as served in patients receiving postoperative nasal beclometha a cause of nasal polyps has not been established, but nasal 154 sone.
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However, a high incidence of bowel and bladder meninges and spinal cord tissue protruding through a dorsal dysfunction resulting from a tethered spinal cord has been defect in the vertebrae. This defect may occur at any point noted in this population as well as subtle changes in distal leg along the spine, but is most commonly located in the lumbar and foot function, which is usually seen later in childhood or region. The sac may be covered by a transparent membrane 30,31 early adolescence, especially after a growth spurt. The lateral bor ders of the sac have bony protrusions formed by the unfused Embryology neural arches of the vertebrae. The defect may be large, with many vertebrae involved, or it may be small, involving only Spina bifda cystica, one of several neural tube defects, occurs one or two segments. Spina bifida occulta, myelocele, and lipomeningo crest becomes the peripheral nervous system, including the cele are less severe anomalies associated with spina bifda. This lesion is most commonly Over a period of 2 to 4 days, the cranial end begins to close located in the lumbar or sacral spine and is often an inci and this process is completed on approximately the 24th day dental fnding when imaging is done for unrelated reasons. Failure to close results in anencephaly, a fatal Spina bifda occulta may be distinguished externally by a condition. The caudal end of the neural tube closes on ap midline tuft of hair, with or without an area of pigmenta proximately day 26 of gestation. Between 21% and 26% of parents close at any point along the caudal border initiates the defect who have children with spina bifda cystica have been found of spina bifda cystica or myelomeningocele. Otherwise, spina bifda occulta has 17,24,26 cal signs of spina bifda include an absence of motor and sen only a 4. Unilateral motor and sensory loss has been seen and the However, a high rate of tethered cord, its associated neu pattern of loss may also be asymmetric, with a higher motor rologic problems, and especially urinary tract disorders in 27?29 or sensory level on one side compared with the other. Refer to additional functional defcits may be partial or complete, but they are information regarding tethered cord later in this chapter. The posterior cerebellum is Malformation herniated downward through the foramen magnum, with brainstem structures also displaced in a caudal direction. Traction on the lower cranial Paralysis of vocal cords nerves also occurs and is associated with the malformation. Among those with this malformation, the likelihood Facial palsy 34?37 Poor feeding of hydrocephalus developing is greater than 90%. At one time, the primary spinal Upper extremity weakness defect was thought to act as an anchor on the spinal cord, Seizures preventing it from sliding proximally within the spinal canal Abnormal extraocular movements as the fetus grew. Traction on the cord was thought to pull Nystagmus down the attached brainstem structures into an abnor mally low position. Hydrocephalus was believed to result solely from the hydrodynamic consequence of this block brain matures. In 1989, McLone and Knepper more closely linked extremity weakness, or opisthotonic postures may be seen.