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It consists of three parts: an introrise, melting of the polar ice caps and increased freduction, which presents the conceptual framework quency of severe fres, pests and storms are some used for the assessment (Chapter 1). Past observations of impacts, vulnerabilisee also Chapter 2 for a more extensive discussion ties and adaptations are discussed in Chapter 2. Some of these future environmental and socio-economic impacts phenomena have caused serious social stress and and vulnerabilities are discussed in Chapters 3 and have shown the need to be better prepared for future 4 respectively. Because of this, it is essential that individumeasures and policies are summarized in Chapter 5 als, societies and institutions are aware of the likely and a range of forest management and forest policy changes and have strategies in place to adapt to a options for adaptation are presented in Chapters 6 changing climate. Chapter 8 sums up the main conclusions, Forests and the goods and services they provide knowledge gaps and research needs. The assessment the report aims to provide knowledge for enof the likely impacts of climate change on forests and hancing the adaptive capacity of both forests and forest-dependent people and their vulnerabilities are people to the impacts of climate change. At the same thus important for enhancing climate change adaptatime, scientifc input into policy processes cannot tion. It also forms the basis for developing adaptation be limited to the production of a written report, but options to avoid harmful effects of climate change rather has to be seen as a socially interactive process and to take advantage of opportunities provided by (Guldin et al. Adaptation may be anticipaarise in the process of adaptation (Adger and Vincent tory or reactive, autonomous or planned. For example, planning to strengthen level of economic development have a higher adapwater works in anticipation of expected sea-level tive capacity. Actual adaptations societies demonstrates that the capacity to adapt in in forests and forestry practices are mainly reactive many senses depends more on experience, knowland autonomous (see Chapter 2) and depend on loedge and dependency on weather-sensitive resourccally experienced changes and vulnerabilities. This es: economically little developed forest-dependent report, however, stresses that the expected changes indigenous people in the south-west Amazon, for (Chapter 3 and 4) require planned anticipatory adexample, may have a greater adaptive capacity than aptation (Chapters 5, 6 and 7) partially based on the economically more sophisticated people living learned lessons and slight adjustments of current in the Andes, who rely on rain-dependent agriculpractices, but in other cases requiring new, out of tural practices. Many adaptation strategies focus on reducing for the Report vulnerability, or strengthening the ability to capture the benefts from the effects of change. AdaptaHumans use forests for many purposes, and the prodtion strategies oriented at reducing vulnerability can ucts derived from forests, and their benefts, are retherefore include (Adger et al. Altering the exposure of a system, through for exGenerally the services fall into four groups: supportample, investing in hazard preparedness and early ing, provisioning, regulating, and cultural services warning systems, such as seasonal forecasts. Reducing the sensitivity of the affected system Although forest goods are the result of provisioning (degree to which a system is affected, see glosservices, they are usually mentioned separately, besary) through, for example, planting hardier crops, ing more tangible than the other services. This value increasing reservoir storage capacity, or ensuring chain includes wood and wood products such as fuelthat infrastructure in food-prone areas is conwood, paper, charcoal and wood structural products, structed to allow fooding. Forest services systems, through specifc measures which enable refer to benefts provided to humans, many of which populations to recover from loss. The same forest area can for example provide wood, non-wood forest products such as wild berries, clean water and an environment for recreation.

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Primarily supportive; none specific isolated entity in children, but rather a symp2. Bronchodilators if accompanied by wheezing Bordetella pertussis, Chlamydia pneumoniae, 5. Inhaled steroids may be indicated for chronic and Corynebacterium diphtheria bronchitis 3. Initial phase includes symptoms of an upper cough is 10 to 14 days duration; children respiratory illness, such as rhinitis, nasopharwith chronic pulmonary disease other than yngitis, and conjunctivitis. Cough is the hallmark symptom; is initially dry exacerbations; consider pertussis if immunizaand brassy but may become productive as illtions incomplete ness progresses 7. Frequent hand washing with careful disrial involvement posal of nasal and oral drainage 4. Allergic disease/posterior nasal drainage ratory illness of young children and infants; 4. Gastroesophageal refiux and/or aspiration characterized by acute infiammation, edema, and 5. Exposure to irritants such as cigarette smoke necrosis of epithelial cells of the small airways, 6. Older family members may be the infection tion, peribronchial thickening, air trapping, source for young children, with older children patchy or subsegmental atelectasis and adults having a much milder illness 3. Those more likely requiring hospitalizadisease tion include premature or young infants 4. Careful monitoring of respiratory status, use not been breastfed, and with lower socioecooxygen therapy if hypoxemic nomic status 2.

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Meanwhile the two striking differences between rural and urban health service delivery are accessibility and affordability. Poor accessibility is due to time-consuming distance considerations, compounded with rationalisation of services and a maldistribution of health care professionals (Bidwell, 2001). The ability to afford to travel long distances, on roads of a lower standard, also impacts on people who are economically struggling and limits attendance at those health services still available. Cost in such situations becomes a major barrier (Averill, 2003; Ministry of Health, 2002a). It therefore remains a moral imperative to plan and deliver equitable, accessible and affordable rural healthcare. Conclusion Rural health care is not just a health service in a rural location but rather health care in a complex matrix of socio-cultural constructions that each require separate consideration (Bourke et al. Where geographical or conceptual boundaries between urban and rural are delineated, using descriptive, dichotomy, typology or indexing methods there remains no overarching international consensus. This lack of a conclusive, agreed defnition has been perceived to restrict development of appropriate services. Step two of the Rural Framework Wheel provides a visual representation of context. Analysis has revealed rural society and culture as a discernible but ever-evolving construct. This contextual information has laid the foundation to critically analyse how nursing practice is shaped by the rural context. Health perceptions, needs and behaviours of remote rural women of child bearing and child rearing age. Christchurch, New Zealand: National Centre for Rural Health, Department of Public Health and General Practice, Christchurch School of Medicine, University of Otago. The culture of rural communities: An examination of rural nursing concepts at the community level. Rural and remote social welfare practice: Differences and similarities in the Australian context. Locality and social representation: Space, discourse and alternative defnitions of the rural. New Zealand rural general practitioners 1999, survey part 3: Rural general practitioners speak out. Narratives of community and change in a contemporary rural setting: the case of Duaringa, Queensland.

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There is evidence, therefore, of a maximal upper range of intake for the cardioprotective efect of alcohol but no indication of a higher risk among the heaviest drinkers. The impact of drinking pattern has been addressed in fewer studies, but the majority of these fnd a non-benefcial or even harmful efect of a drinking pattern that involves drinking large amounts of alcohol per occasion (binge drinking). Due to the heterogeneity of the exposure in studies investigating the independent efects of drinking patterns, it is premature to make a frm conclusion of the exact measure of drinking pattern that most accurately captures the non-benefcial efect. These papers analysed the results of 16 studies on haemorrhagic stroke and 20 studies on ischemic stroke that included a total of 737,038 study participants. The results of the analyses show that high alcohol intake is consistently associated with an increased risk of both haemorrhagic and ischemic stroke. With moderate intakes of up to 3 drinks per day, the results are inconsistent; moderate consumption seems to be protective against ischemic stroke, but neutral or slightly detrimental for haemorrhagic stroke. Congestive heart failure A meta-analysis and review (13) included six prospective cohort studies with a total of 164,479 study participants. A J-shaped relationship between alcohol and all-cause mortality was found in adjusted analyses of both men and women. Risk reductions were somewhat lower in analyses adjusting for age, socioeconomic status, and dietary markers and were apparent at up to 3 drinks per day for men and up to 2 drinks per day for women. The calculated reversion point (the dose of alcohol at which the protection against mortality was 314 not statistically signifcant at the 99% confdence level) was 30 g per day in the adjusted model. Because the relative incidences of alcohol-related diseases and outcomes difer by age, the J-shaped association between alcohol and all-cause mortality also difers by age. The nadir (representing the alcohol intake at the lowest risk of mortality) is achieved at a lower intake at younger ages. In a British study, the lowest mortality risk among women 16 to 34 years old and men 16 to 24 years old was observed among the non-drinkers (15). Hence, a benefcial efect of alcohol is not observed among the young, and instead alcohol is directly associated with mortality in this age group. Results from studies regarding the role of drinking pattern consistently imply an increased mortality risk associated with drinking large amounts of alcohol per session, or binge drinking (16). Furthermore, there is good evidence that the protective efect of alcohol on cardiovascular disease only occurs if the pattern of drinking is not a binging pattern (16). Hence, the J-shaped association between alcohol intake and all-cause mortality depends upon the drinking pattern. Because the association between alcohol and all-cause mortality represents the sum of the numerous diseases and outcomes that are related to alcohol, the shape and nadir of the risk curve depends upon the distribution of other variables such as age, relative incidences of diseases, the prevalence of drunk-driving, etc. Thus, the association between alcohol and all-cause mortality does not have the same causal interpretation as associations between alcohol and singular endpoints. In conclusion, light to moderate drinking is not associated with increased mortality risk and is at best associated with a lower risk among middle-aged and older adults who do not engage in episodes of heavy drinking.

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