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Painful swelling of the scrotum hypertension and pregnancy purchase 25mg aldactone with amex, acute or gradual in onset prehypertension in 30s buy 25 mg aldactone mastercard, with or without dysuria or frequency blood pressure young adults generic 25mg aldactone with visa. Less common than prostatitis or epididymitis and usually caused by a viral infection arteria d8 order line aldactone. The history should focus on the timing of events, risk factors, comorbid conditions, medication allergies, and recent antimicrobial therapy. Pyelonephritis tends to also have an acute onset but patients may or may not recall preceding lower urinary tract symptoms. Urethritis may demonstrate as vaginal discharge in women and a visible penile urethral discharge in men. Hematuria (the presence of blood in the urine) is also commonly associated with cystitis. The vulva and glans penis should be cleaned by using three swabs with soap and sterile water. In the evaluation of prostatitis, quantitative cultures of urine samples obtained before and after prostate massage can be helpful in isolating a particular pathogen. The glans penis should be cleaned by using three swabs with soap and sterile water. The midstream sample should be collected in a sterile container and transported to the laboratory immediately. Acute prostatitis can be treated with agents appropriate for cystitis, pending results from urine culture to guide therapy. In the case of empiric therapy failing in the setting of cystitis, midstream urine collection should be sent for culture and sensitivity testing to identify the appropriate organism. Negative routine cultures with recurrent or persistent cystitis symptoms should raise concern for mycobacterial infection, or noninfectious causes of cystitis, such as malignancy or interstitial cystitis. Women who have recurrent cystitis without evidence of the aforementioned complications (malignancy, mycobacterial infection, interstitial cystitis) may be candidates for prophylaxis, or self-treatment. With the exception of topical estrogen therapy in postmenopausal women, cranberry juice and D-mannose (bacterial adhesion blocker) have no proven role in reducing recurrent cystitis. In general, a 6-month trial is provided with daily bedtime dosing of the following agents: 1. Nitrofurantoin 50 to 100 mg (long-term continuous exposure with this agent can be associated with pulmonary hypersensitivity, hepatitis, and peripheral neuropathy) 2. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. This condition would be considered as a complicated pyelonephritis and can be associated with renal scarring and systemic hypertension, most commonly in children. This is the most common mechanism and results from the migration of bacteria from lower urinary tract upward to the kidneys. Infection of the kidney resulting from seeding of circulating bacteremia, from a distant site of infection. Similar to cystitis, or lower urinary tract infection, risk factors (see Chapter 29, Urinary Tract Infections) include: 1. Sexual intercourse (homosexuality and anorectal intercourse are also a risk factor for men) 2. New sexual partner within the past year (vaginal colonization with typical pathogens) 3. Pseudomonas spp can rarely cause pyelonephritis but are commonly associated with urinary tract instrumentation or surgical procedures. May include Staphylococcus saprophyticus, Enterococcus faecalis, and Streptococcus agalactiae (group B streptococci). Most commonly results from dissemination from a primary site of infection such as the lung or gastrointestinal tract (see Chapter 14, Tuberculosis). Symptoms and signs of pyelonephritis can vary based on patient age and comorbid conditions, and the clinical presentation can range from a silent illness. A complete and chronologically accurate history should be obtained in all patients suspected of an upper urinary tract infection. The history should focus on the timing of events, risk factors, comorbid conditions, medication allergies, and recent antimicrobial therapy. While a complete physical examination should always be performed, the physical examination should emphasis these areas: a. Routinely ordered and has traditionally indicated both the severity of illness and response to therapy. Hematuria (the presence of blood in the urine) is also commonly associated with cystitis and pyelonephritis. All patients should have a urine culture with antimicrobial sensitivity testing performed (steps to obtain a midstream cleancatch urine sample for culture can be found in Chapter 29). Requirements for imaging studies should be assessed depending on the severity of the patient presentation. A widely available and cost-effective imaging modality that is not associated with iodinated contrast or ionizing radiation. It is especially useful for evaluation in pregnant women but is limited due to patient body habitus and operator dependence. The initial management for pyelonephritis is based on the requirements for hospitalization. Although antimicrobial therapy should always be guided by available urine culture and sensitivity data, empirical therapy regimens, based on treatment setting, include: 1. Patients who do not require hospitalization can be successfully treated with the oral regimens listed previously under the switch therapy category. If symptoms have resolved upon completion of therapy, posttreatment urinalysis and culture are not recommended. Pregnant women with pyelonephritis do require posttreatment management with either monthly urine cultures or antimicrobial suppression therapy with nitrofurantoin 100 mg daily (long-term continuous exposure with this agent can be associated with pulmonary hypersensitivity, hepatitis, and peripheral neuropathy) until 4 to 6 weeks post partum because of increased risk of recurrence and adverse effects on the fetus. Most intrarenal abscesses are the result of either a metastatic spread of infection from a distant site. This abscess commonly results from rupture of a cortical or corticomedullary abscess through the renal capsule. Most commonly involves Escherichia coli but may also include Enterobacter spp, Klebsiella spp, Proteus spp, Citrobacter spp, Serratia spp, and Pseudomonas spp. Clostridium spp, Bacteroides spp, and Actinomyces spp may occasionally be associated with renal abscesses. Uncommon, severe form of chronic infection, most commonly as the result of obstruction due to a staghorn calculus, of the renal parenchyma in which destroyed tissue is replaced with lipid-laden macrophages. A complete and chronologically accurate history should be obtained in all patients suspected of a renal abscess. A renal abscess should be included in the differential diagnosis of all patients with a fever and prior urinary tract infection that has not responded to appropriate antimicrobial therapy within 72 hours. A complete physical examination should always be performed with focus areas the same as for pyelonephritis. Treatment of renal abscesses depends on comorbid medical conditions, medical allergies, and the location and size of the abscess. Most intrarenal abscesses respond to antimicrobial therapy alone and rarely require surgical measures. Empirical antimicrobial therapy should be directed at the most likely pathogen but tailored to the renal function and antimicrobial susceptibilities obtained with culture data. While antimicrobial therapy is the same as for intrarenal abscesses, surgical measures may require assisted percutaneous drainage, open surgical drainage, or nephrectomy. Diffuse or advanced-stage xanthogranulomatous pyelonephritis almost always requires nephrectomy. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Uncomplicated urinary tract infection in adults including uncomplicated pyelonephritis. A urinary tract infection is an infection involving any part of the urinary system, including urethra, bladder, ureters, and kidney.
Clinical policy: critical issues in the evaluation and management of adult patients presenting to pulse pressure cardiac output trusted aldactone 100mg the emergency department with acute headache arteria carotida interna order generic aldactone. Lack of clinical relevance of routine chest radiography in acute psychiatric admissions blood pressure 3020 buy aldactone visa. The role of the generalist obstetrician-gynecologist in the early detection of ovarian cancer blood pressure medication raynaud's disease buy cheap aldactone 25 mg on-line. Calcifcations in thyroid nodules identifed on preoperative computed tomography: patterns and clinical signifcance. Journal Club: incidental thyroid nodules detected at imaging: can diagnostic workup be reduced by use of the Society of Radiologists in Ultrasound recommendations and the three-tiered systemfi Iannaccone R, Laghi A, Catalano C, Rossi P, Mangiapane F, Murakami T, Hori M, Piacentini F, Nofroni I, Passariello R. Approach to management of intussusception in adults: a new paradigm in the computed tomography era. We achieve this by collaborating with quality, safety, and science of radiology and radiation physicians and physician leaders, medical trainees, oncology. Lyme testing in the absence of these features increases the likelihood of false positive results and may lead to unnecessary follow-up and therapy. Exceptions include patients with high disease activity and poor prognostic features (functional limitations, disease outside the joints, seropositivity or bony damage), where biologic therapy may be appropriate frst-line treatment. Initial screening for osteoporosis should be performed according to National Osteoporosis Foundation recommendations. Items were generated by a group of practicing rheumatologists in diverse clinical settings using the Delphi method. Based on member input related to content agreement, impact and item ranking, candidate items advanced to literature review. The Top 5 Task Force discussed the items in light of their relevance to rheumatology, level of evidence to support their inclusion, and the member survey results, and drafted the fnal rheumatology Top 5 list. Guidelines for clinical use of the antinuclear antibody test and tests for specifc autoantibodies to nuclear antigens. Evidence-based guidelines for the use of immunologic tests: Antinuclear antibody testing. Tozzoli R, Bizzaro N, Tonutti E, Villalta D, Bassetti D, Manoni F, Piazza A, Pradella M, Rizzotti P. Guidelines for the laboratory use of autoantibody tests in the diagnosis and monitoring of autoimmune rheumatic diseases. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: Clinical practice guidelines by the Infectious Diseases Society of America. There is no evidence that autoantibody panel testing in the absence of history or physical exam evidence of a rheumatologic disease enhances the diagnosis of children with isolated musculoskeletal pain. Difuse arthralgias, myalgias or fbromyalgia alone are not criteria for musculoskeletal Lyme disease. In the absence of data to support clear beneft, radiographs should be obtained by the pediatric rheumatologist only when history and physical exam raise clinical concern about joint damage or decline in function. Items were generated by a group of practicing pediatric rheumatologists using the Delphi method. Antinuclear antibody, rheumatoid factor, and cyclic-citrullinated peptide tests for evaluating musculoskeletal complaints in children. Persistent antinuclear antibodies in children without identifable infammatory rheumatic or autoimmune disease. The outcome of children referred to a pediatric rheumatology clinic with a positive antinuclear antibody test but without an autoimmune disease. Identifying children with chronic arthritis based on chief complaints: absence of predictive value for musculoskeletal pain as an indicator of rheumatic disease in children. An evaluation of autoimmune antibody testing patterns in a Canadian health region and an evaluation of a laboratory algorithm aimed at reducing unnecessary testing. Magni-Manzoni S, Rossi F, Pistorio A, Temporini F, Viola S, Beluf G, Martini A, Ravelli A. Prognostic factors for radiographic progression, radiographic damage, and disability in juvenile idiopathic arthritis. Radiographic measures to assess patients with rheumatoid arthritis advantages and limitations. American College of Rheumatology 2008 recommendations for the use of nonbiologic 4 and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Hepatotoxicity in patients with juvenile idiopathic arthritis receiving longterm methotrexate therapy. Guidelines for blood test monitoring of methotrexate toxicity in juvenile idiopathic arthritis. Antinuclear antibody-positive patients should be grouped as a separate category in the classifcation of juvenile idiopathic arthritis. Committees of Pediatric Rheumatology of the Brazilian Society of Pediatrics and the Brazilian Society of Rheumatology. We achieve this by collaborating with rheumatic diseases, and rheumatologists physicians and physician leaders, medical trainees, are the specialists in the treatment of those health care delivery systems, payers, policymakers, diseases. Sentinel node biopsy is proven efective at staging the axilla for positive lymph nodes and is proven to have fewer short and long term side efects, 1 and in particular is associated with a markedly lower risk of lymphedema (permanent arm swelling). When the sentinel lymph node(s) are negative for cancer, no axillary dissection should be performed. When one or two sentinel nodes are involved with cancer that is not extensive in the node, the patient received breast conserving surgery and is planning to receive whole breast radiation and stage appropriate systemic therapy, axillary node dissection should not be performed. However, the signifcance of radiation exposure as well as costs associated with these studies must be considered, especially in patients with low energy mechanisms of injury and absent physical examination fndings consistent with major trauma. Avoid colorectal cancer screening tests on asymptomatic patients with a life expectancy of less than 10 years and no family or personal history of colorectal neoplasia. Avoid admission or preoperative chest X rays for ambulatory patients with unremarkable history and physical exam. Obtaining a chest radiograph is reasonable if acute cardiopulmonary disease is suspected or there is a history of chronic stable cardiopulmonary diseases in patients older than age 70 who have not had chest radiography within six months. This approach is cost-efective, reduces potential radiation risks and has excellent accuracy, with reported sensitivity and specifcity of 94 percent in experienced hands. Association of occult metastases in sentinel lymph nodes and bone marrow with survival among women with early-stage invasive breast cancer. Stengel D, Ottersbach C, Matthes G, Weigeldt M, Grundei S, Rademacher G, Tittel A, Mutze S, Ekkernkamp A, Frank M, Schmucker U, Seifert J. Accuracy of single-pass 2 whole-body computed tomography for detection of injuries in patients with blunt major trauma. Quantitative assessment of diagnostic radiation doses in adult blunt trauma patients. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the U. Use and accuracy of diagnostic imaging by hospital type in pediatric appendicitis. Interrater reliability of clinical fndings in children with possible appendicitis. We achieve this by collaborating with surgeons that was founded in 1913 to raise physicians and physician leaders, medical trainees, the standards of surgical practice and to health care delivery systems, payers, policymakers, improve the quality of care for surgical patients. Its achievements have understanding of professionalism and how they can signifcantly infuenced the course of scientifc surgery in America and have adopt the tenets of professionalism in practice. The beneft of fuoride-containing toothpaste arises from its topical efect on dental enamel by interrupting enamel demineralization caused by 1 bacterial acids and enhancing remineralization of the enamel surface. Anti-caries (anti-cavities) beneft begins with eruption of the frst primary tooth. Use of recommended amounts of fuoride toothpaste minimize risks of fuorosis, a whitish discoloration of enamel. Avoid restorative treatment as a frst line of treatment in incipient (non-cavitated) occlusal caries without frst considering sealant use.
Purchase 25mg aldactone with visa. How Diabetes and Hypertension Can Lead To Chronic Kidney Disease.
It is therefore proposed to blood pressure medication excessive sweating discount aldactone 100 mg with mastercard conduct a multicentre randomized trial in Latvia arteria vesicalis cheap aldactone 100 mg visa, Belarus 1 5 buy cheap aldactone on line, and the Russian Federation arteria humana de mayor calibre order discount aldactone online, areas with a high burden of the disease, with the main objective of evaluating whether H. The proposed trial will also investigate retrospectively whether biomarkers of chronic atrophic gastritis can select groups of subjects who require treatment to achieve comparable gastric cancer reduction. Ultimately, this study will have the potential to find effective prevention strategies through identifying appropriate target groups that could derive the most benefits from the treatment. Objectives the aim of this study is to search for new intervention strategies to decrease mortality from gastric cancer in high-risk areas, either by testing in screening settings already established 148 methods or by searching for new biomarkers with potential application in gastric cancer screening. To determine retrospectively whether biomarkers of chronic atrophic gastritis or other related conditions can select the group of subjects who require treatment to achieve gastric cancer reduction comparable to the primary objective. To evaluate the rationale for volatile marker testing in exhaled breath for early identification of lesions in the stomach as well as other conditions related to increased risk. To evaluate the role of diet, lifestyle factors, and environmental factors in the development of gastric lesions. Methods Approximately 30 000 men and women will be recruited into a randomized study. For eligible participants who agree to participate and sign the informed consent, a risk factor questionnaire will be administered and a complete medical evaluation will be performed at baseline. From subjects in this group, breath samples will also be collected by research nurses or junior physicians, for the study of volatile markers. During the follow-up period, this group will be offered a consultation with a specialist when required due to clinical symptoms. All the trial participants, including those in Group 2, will be followed up at least for 15 years to collect systematic information on medical conditions, in particular gastric cancer and cause of death. A follow-up telephone call or alternative communication will be made every 5 years for outcome assessment. On completion of the pilot phase, the required infrastructure and tools planned in the general study will be adapted accordingly. End-points the primary end-point for this trial will be the difference in mortality from gastric cancer between Group 1 and Group 2 at 15 years or when enough cases have accumulated to demonstrate a statistical difference between the groups. Statistical analysis the estimates of differences in gastric cancer-related mortality between the groups have been based on the cancer incidence in eastern Europe. All the procedures described for the main study will be implemented during the pilot, except the long-term follow-up. The general objectives of the pilot study are to test the assumptions, the appropriateness of the chosen tools, and the infrastructure before the launch of the general study. To test the assumptions defined for the study, as far as the short-duration pilot can address these. The number of cases that could be recruited by a stationary or mobile recruitment centre per day or per week 5. The prevalence of alarm symptoms or other exclusion factors for the study in the study population 6. The rationale of gastrin-17 test use for identification of atrophy in the antral part of the stomach in the general study 9. The rationale of cancer autoantibody test panel use for identification of gastric cancer cases in the general study 10. The acceptance rate to undergo upper endoscopy if the pepsinogen test is positive 12. In contrast to the general study, the pilot will also include a gastric-cancer specific autoantibody panel and detection of gastrin-17. Also, the performance of different pepsinogen tests (different methods) will be compared in the pilot study. For the purpose of measuring the sensitivity and overall accuracy of the non-invasive tests, a group of controls with normal blood test results will be also referred for upper endoscopy. Screening for gastric cancer and surveillance of premalignant lesions: a systematic review of costeffectiveness studies. The validity of a biomarker method for indirect detection of gastric mucosal atrophy versus 152 standard histopathology. Sensitivity and specificity of mass screening for gastric cancer using the measurement of serum pepsinogens. Design and planned analyses of an ongoing randomized trial assessing the preventive effect of Helicobacter pylori eradication on occurrence of new gastric carcinomas after endoscopic resection. Validation of the pepsinogen test method for gastric cancer screening using a follow-up study. Cancer high-risk subjects identified by serum pepsinogen tests: outcomes after 10-year follow-up in asymptomatic middle-aged males. The role of serum pepsinogen and gastrin test for the detection of gastric cancer in Korea. Serological analysis of human tumor antigens: molecular definition and implications. Tumorassociated autoantibody signature for the early detection of gastric cancer. A nanomaterial-based breath test for distinguishing gastric cancer from benign gastric conditions. In the most recent statistics, from 2010, gastric cancer remains the leading cause of cancer in the Republic of Korea and is the third leading cause of cancer death in men (agestandardized incidence rate, 62. In the Republic of Korea, the seropositivity rate of Helicobacter pylori in 2005 was 59. Strongly supported by data from the literature, these guidelines consistently recommend H. The second Asia-Pacific guidelines recommended a screen-andtreat strategy for H. However, guidelines for the Republic of Korea, which were revised in 2013, do not provide any statement regarding H. Based on the available evidence, these guidelines only provided a strong recommendation for H. Meanwhile, bismuthcontaining quadruple therapy, which is recommended as a secondary regimen for H. Possible adverse events caused by antibiotic treatment as well as the role of environmental and host genetic factors in the development of gastric cancer and its precursors, and as modifiers of the treatment, will also be assessed. All participants will be followed up for at least 10 years to assess the gastric cancer incidence in both the intervention and placebo groups, as well as in the H. Therefore, the hypothesis is that the risk of gastric cancer can be reduced by eradication of H. To assess differences in gastric cancer incidence and mortality between the groups with successful eradication and with persistent H. To investigate the role of cofactors for gastric cancer development among untreated H. Eligible participants who agree to participate and sign informed consent will provide a medical history, undergo a physical examination, and be administered a detailed lifestyle questionnaire. The subjects will be excluded if they meet any of the following criteria: (i) a previous history of gastric cancer, (ii) a family history of gastric cancer in a first-degree relative, (iii) other organ cancers within 5 years, (iv) indication of H. All participants will undergo upper endoscopy at entry, and a standard collection of gastric biopsies will be performed for histology and H. For those assigned to Group 1, an eradication treatment with a 10-day course of a bismuth-based quadruple therapy will be provided. Randomization will be performed using a permuted block design stratified by sex and the centre location. Data will be entered into the Internet-based eVelos system operated by the National Cancer Center, which serves the research team through a centralized platform. Gastric cancer cases will be identified during a biennial endoscopic followup appointment for those who participated in the screening programme. For those lost to endoscopic follow-up, gastric cancer cases will be identified through a record linkage with the Korea Central Cancer Registry. At the first follow-up visit during routine screening, two biopsies will be collected (antrum and body) for blinded assessment of the presence of H. After 10 years, at the end of the study, endoscopic biopsies to assess the presence of precancerous lesions will be obtained, and interviews and specimens similar to those obtained during the enrolment visit will be obtained.
Prepared by the University of Ottawa Evidence-based Practice Center under Contract No heart attack zippo lighter discount aldactone amex. The prevalence arteriovenous shunt buy generic aldactone 100mg, distribution hypertension medication guidelines cheap aldactone line, and mental health correlates of perceived discrimination in the United States blood pressure chart in canada purchase 25 mg aldactone free shipping. Social Class Disparities in Risk Factors for Disease: Eight-Year Prevalence Patterns by Level of Education. Refning the Association between Education and Health: the Effects of Quantity, Credential, and Selectivity. Overcoming Obstacles to Health: Report from the Robert Wood Johnson Foundation to the Commission to Build a Healthier America. Relative Infuences of Individual, Social Environmental, and Physical Environmental Correlates of Walking. Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. 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The association of television and video viewing with fast food intake by preschool age children. Increasing exercise among blue-collar employees: the tailoring of worksite programs to meet specifc needs. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996. Comparison of health promotion and deterrent prompts in increasing use of stairs over escalators. Behavioral risk factor and illness day changes with workplace health promotion: two-year results. Impact on exercise and physical ftness in a health promotion plan after 24 months. Applying a theory of change approach to the evaluation of comprehensive community initiatives: progress, prospects, and problems. New approaches to evaluating community initiatives: theory, measurement, and analysis. The Community Tool Box-Implement Best Processes for Community Change and Improvement. The Relationship of Patient Reading Ability to Self-Reported Health and Use of Health Services. Fruit and Vegetable Intake among Adults in 16 States: Results of a Brief Telephone Survey. Education, Information, and Smoking Decisions: Evidence from Smoking Histories, 1940-2000. Social Support and Health: A Review of Physiological Processes Potentially Underlying Links to Disease Outcomes. Characteristics of Socially Isolated Patients with Coronary Artery Disease Who Are at Elevated Risk for Mortality. In: Measuring and Intervening in Social Support, Cohen S, Underwood L, Gottlieb B (eds). Social Networks, Host Resistance, and Mortality: A Nine-Year Follow-up Study of Alemeda County Residents. The Role of Psychological Characteristics in the Relation between Socioeconomic Status and Perceived Health. Control Constructs: Do They Mediate the Relation between Educational Attainment and Health Behaviourfi Perceived Control in Relation to Socioeconomic and Behavioral Resources for Health. Review of Self-Effcacy and Locus of Control for Nutritionand Health-Related Behavior. Ethnicity and Nativity Status as Determinants of Perceived Social Support: Testing the Concept of Familism. The Big Payoff: Educational Attainment and Synthetic Estimates of Work-Life Earnings. Excess Mortality of Unemployed Men and Women During a Period of Rapidly Increasing Unemployment. Health and Labor Market Disadvantage: Unemployment, Non-Employment, and Job Insecurity. Socioeconomic Status and the Occurence of Fatal and Nonfatal Injury in the United States. Socioeconomic Status and Health: A Micro-Level Analysis of Exposure and Vulnerability to Daily Stressors. Elementary and Secondary Schools: Equalizing Opportunity or Replicating the Status Quofi Neighborhood Characteristics Associated With the Location of Food Stores and Food Service Places, Am J Prev Med. Data to manage the mortality crisis: Recommendations to the Substance Abuse and Mental Health Services Administration. QuickStats: Delayed or Forgone Medical Care Because of Cost Concerns Among Adults Aged 18-64 Years, by Disability and Health Insurance Coverage Status National Health Interview Survey, United States, 2009. Muskie School of Public Service and Kaiser Commission on Medicaid and the Uninsured. Rural urban differences in usual source of care and ambulatory service use: analyses of national data using Urban Infuence Codes. Race and place: urban-rural differences in health for racial and ethnic minorities. Health behaviors, health status, and access to and use of health care: a population-based study of lesbian, bisexual, and heterosexual women. Disparities in Smoking Between the Lesbian, Gay, and Bisexual Population and the General Population in California. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Battering victimization among a probability-based sample of men who have sex with men. Health promotion for people with disabilities: the emerging paradigm shift from disability prevention to prevention of secondary conditions. Rethinking prevention for people with disabilities, part I: a conceptual model for promoting health. Health Promotion for People with Chronic Illness and Physical Disabilities: the Connection between Health Psychology and Disability Prevention. Action Plan to Reduce Racial and Ethnic Health Disparities A National Free of Disparities in health and health care. Guidance for Integrating Culturally Diverse Communities into Planning for and Responding to Emergencies: A Toolkit, Recommendations of the National Consensus Panel on Emergency Preparedness and Cultural Diversity February 2011. The Impact of the Aging Population on the Health Workforce in the United States: Summary of Key Findings. Assessment of the health of Americans: the average health-related quality of life and its inequality across individuals and groups. Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 1992. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General.