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By H. Sibur-Narad. Brevard College. 2019.

Establishing and utilising effective health communication channels including new media Identified challenges included: • Increasing importance of social media levlen 0.15 mg amex birth control junel fe 120. At European level participants noted some institutions across the European region are investing in the development of health communication order levlen 0.15mg mastercard birth control pills ortho tri cyclen. Education and training should be further strengthened in: • national governments; • local communities; and in • other sectors such as tourism generic 0.15mg levlen fast delivery birth control 99 effective, industry order levlen 0.15mg on line birth control pills zenchent, education, social services, etc. Availability of funds and sustainability Limited funding and resources due to the economic climate: • In some cases this issue may threaten the sustainability of ongoing projects and activities. Health communication messages and the political environment Communicators need to be very sensitive to possible political repercussions of communication messages: Institutes which form part of ministries may be obliged to have messages vetted from a political point of view. Vaccination strategies • Conflicts between effective vaccination strategies and anti-vaccination campaigners. Opportunity for more sharing, coordination, collaboration and development of strong partnerships both within countries (e. Opportunity through favourable communication landscape Increased levels of interest by the public, media and politicians in all issues relating to health could provide the opportunities to: • place communicable disease issues on the agenda; • have discussions and increased media coverage; • close the gap between the scientific knowledge and information communicated by the media; • improve the knowledge of communicable diseases among journalists and media professionals via training and education. A few examples of inaccurate information on communicable disease disseminated by the media were provided by participants. Opportunity through new media Participants noted that websites and applications as well as social media such as Facebook, Twitter, and YouTube offer many opportunities to reach the public and specialists. A future opportunity is to develop the use and application of new media for health communication and communicable disease issues; this should include the development of social media strategies and the sharing of best practices. Opportunity for strategic development of health communication The following were outlined as strategic opportunities for the future development of health communication: • Professionalise communication activities on communicable diseases. Better cooperation amongst medical doctors and between political and professional institutions was cited as being crucial for successful communication. For example, most countries develop their own campaign for the influenza vaccination rather than sharing these resources. Participants highlighted that ‘sharing’ for health communication in the prevention and control of communicable diseases could potentially: • limit costs; • facilitate cross-border approaches for common challenges (e. Health and health communication should be integrated into all policies and particularly public health policies and strategies • Health should be included in all policies in order to address the social determinants of health. Health communication is currently a neglected field, and integration of health communication into all policies was seen as desirable for the future: • Many countries acknowledged that health communication is a rather neglected field. Improved communication Improved communication between decision-makers and experts for communicable diseases: • Most of the important actions needed for the development of health communication result from decisions of key stakeholders, including decision-makers. Improved communication between medical doctors: • Enhanced communication and effective communication channels for medical doctors. Increased capacity for health communication in the prevention and control of communicable disease • Training of people working in the areas of health communication and communicable diseases. Government communication on health should: • learn how to engage actively with the public through social media; and • become more active in monitoring and detecting new trends and topics. Investment in the following specific health communication areas would be desirable for the future: • Ethics: observe ethical boundaries • Transparency: expand transparency • Accountability: strengthen accountability in such fields as privacy, risk assessment and health impact assessments • Health literacy: the promotion of health literacy is critical to active and informed participation in health and healthcare • Developing international recommended guidelines, validated interventions, and a network of focal points • Evidence-informed health communication messages and applying this evidence to policy and practice. Have effective and successful vaccination campaigns This was seen as important and desirable due to: • a lack of understanding of vaccination complexity among the general population • a strong and increased anti-vaccination lobby in recent years, which has an influence on public opinion, particularly through the media. Support and undertake research (including evaluation) • Supporting a research agenda (including evaluation) that would give priority to health communication. Create a health communication platform for public health stakeholders to exchange and discuss communicable disease • Should be developed within formal structure such as a public health authority or ministry of health. Convene a multidisciplinary communication team to plan and implement a holistic health communication strategy for communicable diseases • Should be convened under the auspices of a formal structure such as a ministry of health. Conduct education and training courses specifically on health communication Promote community advocacy and the citizen’s role when using health communication • Improving citizen empowerment • Sustained health communication Place health communication experts at government level • In order to facilitate evidence-informed decision-making while taking account of health communication practice. Develop a network of focal points at hospitals and healthcare centers • This would allow better sharing of results and successful case studies. The following were outlined in order to enhance and support the sustainability of health communication in the prevention and control of communicable diseases over the next five years: • Adequate human and financial resources and support. Participants from across the primary information gathering [1, 2] and online consultation [3] activities identified the value of improved collaboration, partnership development, coordination and sharing of experiences, knowledge and best practices concerning the most effective use of health communication for communicable diseases. In today’s highly connected society where accurate and inaccurate information moves with equal velocity, establishing and utilising effective health communication channels with target audiences was seen as both a challenge and opportunity for health communication practice, specifically in relation to new media. It was felt by stakeholders that there is the beginning of a shift from expert driven, one-way communication to one of dialogue and exchange with the recognition of the centrality of citizens to the process. In addition, interacting and communicating with key audiences was highlighted as a challenge, in particular with regard to the importance of policymakers and the media in the development of health communication activities. It was also evident from the consultations that there is great variability between countries in the range and level of health communication activities undertaken; substantial variability also exists in the levels of capacity for the effective application of health communication for the prevention and control of communicable diseases. Gaps identified included: a lack of education and training; underuse of evaluation; and limited resources to develop, effectively use, and evaluate health communication in the prevention and control of communicable diseases [1, 2]. Furthermore, the role of evidence as a foundation for effective health communication developments and as a basis for building public trust was recognised in this consultation, highlighting the need for the evidence base in Europe to be strengthened. This is supported by previous project outputs, specifically the synthesis of evidence which identified that there is a limited evidence base focusing on health communication for the prevention and control of communicable diseases in the European context [4-12]. The results provide valuable insights concerning the potential for capacity development at a European level. Perceived priorities of key public health stakeholders in Europe on the use of health communication for the prevention and control of communicable diseases. Evidence review: social marketing for the prevention and control of communicable disease. A literature review on health information-seeking behaviour on the web: a health consumer and health professional perspective. A literature review of trust and reputation management in communicable disease public health. Health communication campaign evaluation with regard to the prevention and control of communicable diseases in Europe. A literature review on effective risk communication for the prevention and control of communicable diseases in Europe. Systematic literature review of the evidence for effective national immunisation schedule promotional communications. Systematic literature review to examine the evidence for the effectiveness of interventions that use theories and models of behaviour change: towards the prevention and control of communicable diseases. The chapter draws together the key findings and issues that were identified by European key stakeholders in the consultation phases of the Translating Health Communication Project [1-3] and the reviews of the evidence base [4-12]. A capacity development framework is used to consider future strategic actions required for strengthening capacity in Europe to develop evidence-informed health communication for communicable diseases. Capacity development can contribute to health gain through the development of sustainable skills, organisational structures, resources, and commitment to health improvement [17]. Capacity development amounts to more than training or technical assistance and looks to develop knowledge, skills, commitment, structures, systems, and leadership to improve health. Actions have been identified in order to improve health across the levels of: advancing knowledge and skills among practitioners, expanding organisational infrastructure and support, and developing community partnerships for health [18]. These dimensions are: organisational structures, partnerships, financial resources, leadership and governance, knowledge development, and workforce. Capacity development Organisational structures The infrastructural ability of the system to effectively, efficiently and sustainably exercise its functions and contribute to the goals of those involved in health communication activities. An organisation’s structures, processes and management systems all influence the extent to which the organisation can contribute to capacity-building [20]. The institutional capacity for health communication for communicable diseases is hampered by a lack of clarity as to where the responsibility for this lies in each country, and organisations concerned with health communication may also operate at a national and/or a transnational or European level. It was also noted during the consultation that stakeholders may have different political priorities on the same issues at a national and European level, which can result in a difficult politicised environment [1].

Lead time and frequency of orders The length of time between placing an order and receiving the items is called the lead time (or the delivery time) levlen 0.15mg amex birth control pills effect on period. The less frequently you place an order order levlen 0.15 mg without a prescription birth control pills quitting, the larger the quantities of each item you need to order to maintain stocks until the next delivery order 0.15 mg levlen free shipping birth control 28 day pack. On the other hand purchase levlen 0.15 mg on line birth control and breastfeeding, if orders are placed frequently, you need to order less to maintain stock levels between deliveries. Stock levels The stock level is the quantity of an item that is available for use in a given period of time. The reserve stock (sometimes also called safety stock or buffer stock) is the lowest level of stock for each item, and quantities should not be allowed to fall below this level. Your reserve stocks are essentially extra supplies to ensure that there are no stockouts if there is an unexpected increase in demand or a delay in receiving supplies. The quantity of reserve stock depends on the average monthly consumption and the lead time. It takes account of seasonal variations in demand and is calculated using the following formula: Average monthly consumption = Total quantities issued in the time period Number of months in the time period Using Table 2. The minimum stock level (sometimes called the re-order level) is the stock level that indicates you need to place an order to avoid running short of supplies. The minimum stock level can change over time, so check it regularly and make any necessary adjustments to the stock card and your orders. To calculate the minimum level, use the formula: Minimum stock level = Reserve stock + Stock used during lead time The order quantity is the quantity of items that is ordered to be used in one supply period, and it depends on the length of time between orders (i. If, for example, you place an order every 6 months, the quantity ordered should maintain stocks above the reserve stock level until the next Section 2 Procurement and management of supplies and equipment 15 supplies are received i. To calculate the order quantity, in other words how much you need for the supply period, use the formula: Order quantity = Time between orders x Average monthly consumption The maximum stock level is the maximum amount of any item you should have in stock at any time. You will usually only have the maximum level in stock just after receiving a delivery. This level can change over time, so check it regularly and make any necessary adjustments to the stock card and your orders. To calculate the maximum stock level, use the formula: Maximum level = Reserve stock level + Order quantity for one supply period Table 2. Try to learn to use this method, because it is an important approach to help you manage stock and purchasing. If the above method is too difficult, a simpler method is to calculate the quantity to be ordered by adding the annual amount required to the annual reserve stock and then adjusting the total to the supply period. Again using the 5ml disposable syringe example, the annual amount required is 480, and the annual reserve stock (if the order period is every 6 months, 2 x 40) 80 = 560 packs. Divide 560 by 12 months to calculate the amount required for 1 month and then multiply by 6. Calculating for an increase or decrease in order quantity To calculate changes in the quantity of an item to order, for example, where an item’s rate of use is increasing or decreasing you need to know the order quantity, minimum level and the stock balance. The formula to calculate how much extra or less stock should be ordered is: Quantity to be ordered = Order quantity + Minimum order level – Stock balance Use this formula, when there is a substantial difference between minimum order level and the stock balance at the time new supplies are being ordered. The Maximum and Minimum (Max/Min) system is a common system for keeping the right amount of supplies and to make sure that you never run out of stock. There are several variations of the Max/Min system and there are also different ways of calculating the maximum, minimum, and order quantity. In some systems, you have to make orders according to a regular schedule, for example once a year or periodically. Use the following to help you decide whether or not to place an order: • If you place orders on a regular basis, order additional supplies if the stock balance is equal to, or less than, or even greater than the minimum stock level. Remember that some items such as syringes and needles, cotton wool and other supplies that are used every day need frequent re- ordering to keep stock at adequate levels. If you do not review these stock levels, you may run short of fast-moving items and/or overstock slow-moving items. As a general rule, the stock balance should not fall below 1 month’s supply or exceed 2 month’s supply at any time. However, you still need to monitor actual consumption, in case kit quantities are not sufficient so that you can order additional supplies. Estimating costs Before you place an order, you need to do a cost estimate, to check you are within budget. Also as part of the cost estimate you should budget at least an additional 5-7% of the purchase price of capital items of equipment to cover the cost of maintenance and running costs. If the total cost is more than your budget, the best approach is to decide which of the ‘not so essential’ items you can do without. Section 2 Procurement and management of supplies and equipment 17 Freight and insurance charges for imported goods Freight charges vary enormously, depending on the volume and weight of the items ordered, the type of goods (for example, hazard or heat-sensitive goods), mode of transport (sea, land or air) and distance. The value of freight is based on the weight or volume of the goods rather than on the value of the goods. Hazardous or heat-sensitive goods can cost considerably more to transport and may be restricted to particular modes of transport. For example, laboratory reagents, which are flammable, require special packing and documentation, and vaccines, which must be kept cold during transport, require an effective cold chain. A freight contract that includes insurance is more expensive, but insuring goods against loss or damage is very important. If you insure goods, you can make a claim if they are lost or damaged during freighting. When you are putting together a budget add approximately 20-30% of the cost of the order to cover the cost of freight and insurance. Ask your supplier or freight forwarders for estimates of freight and related insurance costs before placing the order. You need to check current procedures with your national customs department, as well as with your supplier. The prices charged by international suppliers may seem to be lower, but imported products often have additional costs, such as import duties, freight, handling and insurance. Whenever possible, obtain quotations (a request for a price) from at least three suppliers so that you can compare prices. Although equipment may be supplied with a guarantee or warranty, check that the manufacturer or supplier is liable for repairs and maintenance. If there is no authorised agent or representative in your country, you may find you have to send the item back to the manufacturer and this could be very costly. After you have selected a supplier, monitor their performance to ensure that they continue to provide good service. Certain conditions may be attached to funding for equipment and supplies from donor agencies. Some health facilities use requisition forms or books for ordering supplies from district or national stores. When placing an order or re-ordering: • Check the stock records to find out the stock balance and decide what items and how much of each item you need to order. If you are ordering from a catalogue, write down the catalogue code number for each item. For example, if you need 34 rolls of crepe bandage and a pack contains 12 rolls, order 3 packs. It is important to provide suppliers with a clear and complete description, to make sure that you receive the specific item you require. It is usually better to write generic specifications that describe items by type rather than by brand name. However, there may be times when you need to specify an exact model or manufacturer, for example, for particular products such as microscopes. Remember that while some equipment uses standard supplies, other equipment requires specific supplies, and you will need to order accordingly.

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Massive infections can cause biliary stasis due to obstruction of the duct generic levlen 0.15mg free shipping birth control pills viorele, atrophy of the liver discount levlen 0.15mg otc birth control pill 72 hours after intercourse, and periportal cirrhosis generic levlen 0.15 mg overnight delivery birth control pills zovia 135e. The most common manifestations during acute fascio- liasis cheap 0.15mg levlen visa birth control methods, when the young parasites migrate across the hepatic parenchyma, are abdom- inal pain, fever, hepatomegaly, eosinophilia, and mild anemia. In a study of 53 patients with eosinophilia of probable parasitic origin, 30 of the cases proved to be due to fascioliasis (el Zawawy et al. This parasite was also found in 24% of 187 patients with fever of unknown origin (Abdel Wahab et al. In the chronic phase, which occurs once the parasite has become localized in the bile ducts, the common signs are biliary colic and cholangitis. The acute-phase eosinophilia usually persists, although sometimes the chronic infection can be asymptomatic (el-Nehwihi et al. In a study of 47 patients in Chile, the main symptoms were abdominal pain, dyspepsia, weight loss, diarrhea, and fever. In Spain, the most common symptoms in 6 fas- cioliasis patients were eosinophilia (100% over 1,000 cells/mm3), abdominal pain (100%), fever (83%), weight loss (83%), and generalized myalgia (67%) (de Gorgolas et al. As they pass through the peritoneal cavity, the larvae may be diverted to aberrant sites in different parts of the body. The acute form occurs when the sheep ingests a large number of metacercariae at once, with consequent invasion of a multitude of young parasites in the hepatic parenchyma. The migrating parasites destroy the hepatic tissue, causing hemor- rhages, hematomas, necrotic tunnels, and peripheral inflammation. In massive infec- tions, the affected sheep may die suddenly without any clinical manifestations, or they may exhibit weakness, loss of appetite, and pain when palpated in the hepatic region and then die a couple of days later. In less acute cases there may be weight loss and accumulation of fluid in the abdomen (ascites). The chronic form occurs when the host ingests moderate but sustained doses of metacercariae. Instead of sudden, massive invasion and destruction of the liver, the parasites accumulate over time and eventually reach a pathogenic number after they are already localized in the bile ducts. The symptoms are progressive anemia, weak- ness, loss of appetite, submandibular edema (“bottle jaw”), ascites, diarrhea, and weight loss. In sheep, 200 to 700 parasites cause chronic disease and in some cases death, while 700 to 1,400 cause subacute disease and certain death. In cattle, the manifestations of fascioliasis are usually constipation, diarrhea in extreme cases, weakness, and emaciation, espe- cially in young animals. Cattle are more resistant than sheep and can tolerate a larger parasite burden without having any significant clinical manifestations: about 1,400 parasites will cause symptoms in 60% of the animals and a few deaths (Barriga, 1997). The animals’ condition worsens when pasturage is scarce and improves when it is abundant, but they are never cured, and the parasitosis has a cumulative effect over the years. In swine, fascioliasis is usually asymptomatic and becomes clinically apparent when debilitating factors, such as malnutrition or concurrent illnesses, are present. Both acute and chronic forms are seen in sheep, but cattle have only the chronic form. Source of Infection and Mode of Transmission: The ecology of fascioliasis is linked to the presence of water, which enables the snails that serve as intermediate hosts to survive, and appropriate temperatures, which allow the parasites to com- plete their life cycle. Physiographic characteristics, soil composition, and climatic factors determine the reproduction rate of Lymnaea and hence the epidemiologic dynamics of the disease. Specimens of Lymnaea, as well as cases of fascioliasis, can be found in pasturelands in widely diverse settings throughout the world, from sea level flatlands to Andean valleys at elevations of over 3,700 meters. From the eco- logic standpoint, the habitat of Lymnaea can be divided into two broad types: pri- mary foci, or reservoirs, and areas of dissemination. They begin to lay their eggs in springtime when temperatures rise above 10°C and continue to do so as long as the thermometer remains above this level. At 9°C the eggs hatch in one month; at 17°C to 19°C, in 17 to 22 days; and at 25°C, in 8 to 12 days. Since new snails begin to lay eggs at 3 weeks of age, they can produce up to three generations in a single season as long as they have enough water. Many snails die during dry, hot summers, but a few of them estivate and resume their development when the temperature falls and moist conditions return. Many of them also die during very cold winters, but some go into hibernation and resume their development when temperatures once again rise above 10°C. The snails that manage to survive dry conditions, heat, and cold are the seeds for the next season’s crop of snails. Themperature above 10°C is a key factor in the epidemiology of fas- cioliasis because when it is any colder the Fasciola eggs fail to develop, the snails do not reproduce, the stages do not develop inside the snail, and the cercaria do not encyst. Areas of dissemination are characterized by the alternation of flooding and droughts, and they have large concentrations of Lymnaea. Snails may reach these areas directly from original foci carried by rising waters, or they may be reactivated after estivation during dry spells. Seasonal foci of this kind turn pastures into enzootic areas in which serious outbreaks occur. Fasciola eggs transmitted by infected animals in springtime and early summer develop inside the snails and pro- duce cercariae and metacercariae until the end of summer. The animals that ingest them begin to show signs of the disease at the end of autumn and during winter. The eggs transmitted by these animals infect more snails, but eggs do not develop until sufficiently warm temperatures return in the spring. Hence the metacercariae from this new cycle appear at the end of spring or in early summer. When ingested by ani- mals, these metacercariae produce symptoms in summer and autumn. It has been estimated that a sheep with a mild subclinical infection can contaminate a pasture with more than 500,000 eggs a day, and one with a moderate infection can shed 2. Sheep are followed in importance by cattle, but their production of Fasciola eggs declines rapidly. Many other species of domestic and wild herbivores, including lagomorphs, can also serve as definitive hosts. However, studies done in Australia suggest that some of these latter animals are only temporary hosts and cannot main- tain the cycle by themselves for any length of time. Such would be the case with rab- bits, which do not contaminate pastures to any significant extent. Man is infected mainly by eating watercress (Nasturtium officinale) infested with metacercariae. In France, where watercress is a popular salad ingredient (10,000 tons are consumed each year), human infection is more frequent than in other European countries. Sometimes raw lettuce and other contaminated plants that are eaten raw can also be a source of infection, as can water from irrigation ditches or other receptacles. Alfalfa juice has also been implicated in places where people drink this beverage. The infection cycle in nature is maintained between animals (especially sheep and cattle) and snails of the family Lymnaeidae. The epidemiological picture of human fascioliasis appears to have changed in recent years. In the last two decades, the number of human cases has increased in places that are geographically unrelated to areas in which the animal disease is endemic. Diagnosis: The disease is suspected on the basis of clinical manifestations (painful and febrile hepatomegaly coupled with eosinophilia) and is confirmed by the finding of characteristic eggs in feces.

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