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Retrieved from McMaster University Centre for Health Economics and Policy Analysis website daughter medicine order endep pills in toronto. Promoting environmental justice through community-based participatory research: the role of community and partnership capacity medications used to treat depression buy endep american express. Declining industrial emissions treatment for pink eye cheap generic endep canada, improving air quality medicine 7 year program buy endep line, and reduced damage to vegetation. The pub, the people, the place, the passions and the principles: the social and personal context of engagement in a collective action. From barren rock to lush forests: Restoring the Sudbury Basin to its original state. A systematic literature review of the effectiveness of occupational health and safety regulatory enforcement. About the Authors Desre Kramer is the associate director of the Occupational Cancer Research Centre at Cancer Care Ontario and adjunct professor at the School of Occupational and Environmental Health at Ryerson University in Toronto. Keith McMillan is a research associate at the Occupational Cancer Research Centre. Linn Holness is an occupational medicine physician and professor at the Dalla Lana School of Public Health and Department of Medicine at the University of Toronto. The high school students recorded their perceptions of their experience by answering a series of questions in their journals after each teaching session. Results indicated that the majority of high school students (n = 45) wanted to participate in service learning in the future and that they were learning about teaching, setting goals with children, and learning about themselves as leaders. Future research should examine the long-term impact of the service experience for the high school students. Social transactions between teachers and adolescents providing services in their communities can foster civic engagement and learning (Zeldin, Christens, & Powers, 2013). Adolescents bring perspectives, experiences, and information into the partnership, which can greatly benefit the community they are serving. This relationship can empower adolescents and enhance their involvement in community projects. If adolescents participate in a leadership role when delivering services, the experience can promote their growth and enhance its meaning for them (Zeldin, et al. In the current study, adolescents volunteered to teach young children about healthy eating and exercise, and they gained experience as teachers working with elementary school-age children. A unique partnership was built between the adolescents and the adults who taught them the curriculum, prior to their working with the children. Additionally, a partnership was built between adults, adolescents, and the children they served to address a critical community issue, which is at the heart of civic development in youth/ adult partnerships. Service-learning activities that connect adolescents with others in their community have the potential to enhance their development as leaders as well as contribute to their social and emotional learning (Colby, Ehrlich, Beaumont, & Stephens, 2003; Chung & McBride, 2015; Flanagan & Christens, 2011; Zeldin et al. When adolescents can learn about a program and then teach it to others, they have opportunities to share knowledge and are empowered as teachers as they promote positive change within communities (Camino, 2000; Wong, Zimmerman, & Parker, 2010; Zeldin et al. Through their involvement in service, adolescents may become inspired to be future community leaders and continue civic engagement to address key community problems (Colby et al. The current project extended the notion of service partnerships by teaching high school-age youth (our coaches or service providers), who became involved with elementaryage youth to teach them about improving healthy eating and exercise behaviors through an existing obesity prevention program. Reflective Journaling After working with the children, the high school students solidified their knowledge through reflective journaling and their reflections are the foundation of the current study (Giles & Eyler, 1994). Reflection on service-learning experiences can help students understand the meaning of their work, when they respond to questions that assist them in critically examining their experiences (Bringle & Hatcher, 1999). We also expected that students who were involved in the project would want to participate in further service in the future, such that participating in service would ". A university instructor and the leader of the service project educated high school students about the obesity prevention program and reviewed the "lesson for the day" for the adolescent coaches before they worked with one to three elementary school-age children. This study also sought to determine what children learned from working to develop healthy eating and exercise goals with their high school-age coaches. This was a verification check to determine that one-on-one coaching by high school students was occurring. Thus, qualitative data analyzed for this study included written reflections from daily journals completed by the high school students.

It is a subjective experience and a part of the human need for both intimacy and privacy symptoms queasy stomach discount 25 mg endep visa. Simultaneously medications when pregnant discount endep 25 mg visa, sexuality is a social construct treatment 7 generic endep 25mg overnight delivery, most easily understood within the variability of beliefs professional english medicine purchase endep on line, practices, behaviours and identities. The expectations that govern sexual behaviour differ widely across and within cultures. Certain behaviours are seen as acceptable and desirable, while others are considered unacceptable. This does not mean that these behaviours do not occur, or that they should be excluded from discussion within the context of sexuality education. Sexuality is present throughout life, manifesting in different ways and interacting with physical, emotional and cognitive maturation. Education is a major tool for promoting sexual well-being and preparing children and young people for healthy and responsible relationships at the different stages of their lives. Defining sexual health: Report of a technical consultation on sexual health, 28­31 January 2002. For example, failure to discuss menstruation can contribute to the persistence of negative social and cultural attitudes towards it. This may negatively impact the lives of girls, contributing to lifelong discomfort about their bodies and leading to reticence in seeking help when problems arise. Silencing or omitting these topics can contribute to stigma, shame and ignorance, may increase risk-taking and create help-seeking barriers for vulnerable or marginalised populations. Quality professional learning that builds both teacher competency and comfort level with the subject matter is associated with an increased likelihood that teachers will deliver health and well-being education programmes with the high fidelity and quality that is associated with positive impact on health behaviours (Stead et al. A lack of high-quality, age- and developmentally-appropriate sexuality and relationship education may leave children and young people vulnerable to harmful sexual behaviours and sexual exploitation. This choice includes the right to abstain, to delay, or to engage in sexual relationships. Numerous studies have shown that learners, regardless of sex, want to know more about relationships and feelings (Pound et al. Using scientific evidence and rooting the content in gender equality and human rights standards and frameworks helps address sensitive issues. Many young people go through puberty whilst at school as well as experiencing their first relationships, including possible sexual ones. Over the past few decades, new approaches have been developed that show that learning always builds upon knowledge that a student already possesses, and that learners construct their own knowledge on the basis of interaction with the environment and the inputs provided (Giroux, 1994). Based on this perspective, learning is more than receiving and processing information transmitted by teachers. Students learn best when they are allowed to construct their own understanding of information and material by critically engaging with personal experiences and information. Learner-centred approaches allow learners to actively participate in learning processes and encourage distinctive learning styles. Because learning can be seen as a form of personal growth, students are encouraged to utilize reflective practices to critically think about their own lives. In addition to schools, tertiary educational institutions can also play a significant role. Many people reach tertiary education without having received any sexuality education. As places of teaching, learning and personal development, schools provide an existing infrastructure, including teachers that are likely to be skilled and trusted sources of information, and long-term programming opportunities provided by formal curricula. For example, in some parts of the world, it is forbidden for teachers to conduct condom demonstrations in classrooms, but not in most communitybased settings; and in the community lessons are not limited to typical 40-minute class sessions. Healthy habits, and the understanding of how to maintain good health, begin in early childhood. However, for boys, the shift of puberty is much more explicitly linked to sexual feelings in a positive way, whereas for girls this moment often marks the beginning of conflicting messages about sexuality, virginity, fertility and womanhood.

I am engaged in a variety of scienti c outreach projects treatment eczema discount endep express, am excited to be at the stage in my career that I am advising students chapter 7 medications and older adults buy endep 10mg with visa, and love integrating teaching with my research medicine lake mt buy endep line. As a new assistant professor medications 4h2 generic endep 10 mg visa, I nd a constant push and pull among the variety of tasks that need to get done. While it does not a ect my day-to-day work, I certainly recognize the lack of women in my specialty (speci cally, in permanent positions-the leaky pipeline). In some ways, this atmosphere is quite challenging, as it leaves a dearth of mentors and can sneak its way into my own con dence. I think the culture of academia is slowly changing and heading in a positive direction, not only for women but also for society as a whole. This beautiful scene is from Skyline Divide in the North Cascades, taken by her husband, Robert Driscoll. My hallway at Scripps Institution of Oceanography is now packed with women faculty and researchers. When my mind wanders in meetings, I routinely calculate the ratio of women to men in the room. Now, as o en as not, women outnumber men, and the issues that concern us are more readily heard. Nonetheless, puzzles remain: for a recent faculty search, the ratio of male to female job applicants was about four to one, and I wondered how that could be, given that women comprise roughly half of our students and postdocs. We share responsibilities for our two boys (ages eight and 11), and we o en lament the ine ciency and duplication associated with sharing responsibilities. My research group focuses largely on the Southern Ocean, where research cruises can test the duration limits of the research eet, sometimes running 50 to 60 days. Working with someone I know so well is tremendous fun- but also di cult, because he and I tend to lose any remnant veneer of politeness when we collaborate. Our initial husband-wife project has grown in scope, and my research group is excited about the recent launch of the RapidScat ocean vector wind instrument aboard the International Space Station, because its orbit will give us new perspective on diurnal wind variability. When I started 25 years ago, I could not have predicted the future trajectory of my life in oceanography with any accuracy. I was fascinated by popular science articles about the ocean "conveyor belt," I loved traveling and being at/on/in the sea, I was excited whenever the chance to explore something presented itself, and I Mirjam Glessmer onboard R/V Knorr in 2011. Photo credit: Rob McGregor could not imagine anything else would make me more happy and ful lled. So I dived into the world of ocean sciences, did my PhD and a postdoc, I now work at a Center for Teaching and Learning at and went on adventures I always had dreamt of, including a German university, where I support teaching sta in research cruises at least once every year. We stayed at sea for mechanical and ocean engineering by developing new metha month or two at a time, and when we saw land, it would be ods, discussing student misconceptions, or collaborating on Greenland, Jan Mayen, Cape Verde, or other exotic places. I also document my "adventures We spotted the abundance of sea life, ranging from whales, in oceanography and teaching" on my blog, where I share polar bears, penguins, to ying sh; saw the northern lights instructions for hands-on experiments, information about and witnessed the green ash. Most importantly, I did excithow education research can help us improve our teaching of ing research with great people on topics I am passionate oceanography, and other useful tidbits I pick up along the about: double-di usive mixing, tropical oxygen minimum way. Investigating how people learn, especially how they zones, and freshwater in the Nordic Seas. I traveled to conlearn about the physical processes governing the ocean, and ferences to meet the most amazing and inspiring people to empowering the oceanographic community to do an even discuss my work and share ndings with a wider audience, better job at supporting others to learn about the ocean we and most recently I published in Nature Geoscience. Several years of teaching oceanography at the university level and being involved in many outreach activities have only intensi ed my interest in how people learn about the ocean. Whether to the general public or to students of oceanography, conveying the knowledge, skills, and wonder, and also the open questions, of the ocean sciences is a very important task. However, spending a substantial amount of time communicating science le less time for actual research, and at some point I had to decide between research and teaching. Harmful algal blooms as well as nutrient pollution and eutrophication are increasing everywhere, and the science we do is not just ivory tower. It used to be di cult to explain what I studied to my nonscientist friends and relatives; now, they read headlines about water quality issues and algal blooms frequently.

Postural changes in blood pressure and pulse may be evidence of autonomic neuropathy and therefore require adjustment of blood pressure targets medicine zolpidem order cheap endep on-line. Orthostatic blood pressure measurements should be checked on initial visit and as indicated medications causing hair loss order genuine endep on line. Home blood pressure self-monitoring and 24-h ambulatory blood pressure monitoring may provide evidence of white coat hypertension medicine 93 5298 buy discount endep 75mg on line, masked hypertension symptoms kidney failure dogs safe endep 10 mg, or other discrepancies between office and "true" blood pressure (17). In addition to confirming or refuting a diagnosis of hypertension, home blood pressure assessment may be useful to monitor antihypertensive treatment. Moreover, home blood pressure monitoring may improve patient medication adherence and thus help reduce cardiovascular risk (20). Treatment Goals Recommendations adverse effects of antihypertensive medications, and patient preferences. E Randomized clinical trials have demonstrated unequivocally that treatment of hypertension to blood pressure,140/90 mmHg reduces cardiovascular events as well as microvascular complications (21­27). Therefore, patients with type 1 or type 2 diabetes who have hypertension should, at a minimum, be treated to blood pressure targets of,140/90 mmHg. The benefits and risks of intensifying antihypertensive therapy to target blood pressures lower than,140/90 mmHg. Notably, there is an absence of high-quality data available to guide blood pressure targets in type 1 diabetes. Randomized Controlled Trials of Intensive Versus Standard Blood Pressure Control Hypertension, defined as a sustained blood pressure $140/90 mmHg, is common among patients with either type 1 or type 2 diabetes. Some investigators have argued that the divergent results are not due to differences between people with and without diabetes but rather are due to differences in study design or to characteristics other than diabetes (31­33). Meta-analyses of Trials To clarify optimal blood pressure targets in patients with diabetes, meta-analyses have stratified clinical trials by mean baseline blood pressure or mean blood pressure attained in the intervention (or intensive treatment) arm. Based on these analyses, antihypertensive treatment appears to be beneficial when mean baseline blood pressure is $140/90 mmHg or mean attained intensive blood pressure is $130/80 mmHg (17,21,22,24­26). Taken together, these meta-analyses consistently show that treating patients with baseline blood pressure $140 mmHg to targets,140 mmHg is beneficial, while more intensive targets may offer additional (though probably less robust) benefits. Individualization of Treatment Targets Patients and clinicians should engage in a shared decision-making process to determine individual blood pressure targets (17). This approach acknowledges that the benefits and risks of intensive blood pressure targets are uncertain and may vary across patients and is consistent with a patient-focused approach to care that values patient priorities and provider judgment (35). Extrapolation of these studies suggests that patients with diabetes may also be more likely to benefit from intensive blood pressure control when they have high absolute cardiovascular risk. This approach is consistent with guidelines from the American College of Cardiology/American Heart Association, which advocate a blood pressure target,130/80 mmHg for all patients, with or without diabetes (38). Patients with older age, chronic kidney disease, and frailty have been shown to be at higher risk of adverse effects of intensive blood pressure control (41). In addition, patients with orthostatic hypotension, substantial comorbidity, functional limitations, or polypharmacy may be at high risk of adverse effects, and some patients may prefer higher blood pressure targets to enhance quality of life. In such patients, a blood pressure target of,140/90 mmHg is recommended, if it can be safely attained. Pregnancy and Antihypertensive Medications Since there is a lack of randomized controlled trials of antihypertensive therapy in pregnant women with diabetes, recommendations for the management of hypertension in pregnant women with diabetes should be similar to those for all pregnant women. A 2014 Cochrane systematic review of antihypertensive therapy for mild to moderate chronic hypertension that included 49 trials and over 4,700 women did not find any conclusive evidence for or against blood pressure treatment to reduce the risk of preeclampsia for the mother or effects on perinatal outcomes such as preterm birth, small-for-gestational-age infants, or fetal death (43). For pregnant women who require antihypertensive therapy, systolic blood pressure levels of 120­ 160 mmHg and diastolic blood pressure levels of 80­105 mmHg are suggested to optimize maternal health without risking fetal harm. Lower targets (systolic blood pressure 110­119 mmHg and diastolic blood pressure 65­79 mmHg) may contribute to improved long-term maternal health; however, they may be associated with impaired fetal growth. Pregnant women with hypertension and evidence of end-organ damage from cardiovascular and/or renal disease may be considered for lower blood pressure targets to avoid progression of these conditions during pregnancy. Antihypertensive drugs known to be effective and safe in pregnancy include methyldopa, labetalol, and long-acting nifedipine, while hydralzine may be considered in the acute management of hypertension in pregnancy or severe preeclampsia (42). Diuretics are not recommended for blood pressure control in pregnancy but may be used during late-stage pregnancy if needed for volume control (42,44). Long-term follow-up is recommended for these women as they have increased lifetime cardiovascular risk (45). B Lifestyle management is an important component of hypertension treatment because it lowers blood pressure, enhances the effectiveness of some antihypertensive medications, promotes other aspects of metabolic and vascular health, and generally leads to few adverse effects. Lifestyle therapy consists of reducing excess body weight through caloric restriction, restricting sodium intake (,2,300 mg/day), increasing consumption of fruits and vegetables (8­10 servings per day) and low-fat dairy products (2­3 servings per day), avoiding excessive alcohol consumption (no more than 2 servings per day in men and no more than 1 serving per day in women) (46), and increasing activity levels (47).

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