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An Assessment of Menstrual Hygiene Management in Schools 3 Methods Research setting the assessment was conducted from 31 July–15 December 2012 in Masbate Province in Central Philippines and Metro Manila in the National Capital Region symptoms stiff neck buy cheap kemadrin 5 mg line. Masbate is historically one of the poorest provinces in the Philippines medications hyponatremia purchase genuine kemadrin on line, with 44 per cent of families living below the poverty line [15] symptoms your having a girl purchase on line kemadrin. Among Masbate’s 21 municipalities medications via endotracheal tube generic kemadrin 5 mg with visa, 19 are classifed as ‘waterless’, with less than 50 per cent of households having access to water [16]. The province is composed of three major islands, and the economy is dominated by the cattle industry, which is controlled by a handful of landholding and political families. The other primary source of income is fshing, which has degenerated for the majority of small-scale fshers over the years due to depletion of the marine resources in municipal waters. In terms of education, Masbate Province has one of the country’s highest school-leaving rates among primary-level public schools, at 12 per cent, with higher incidence among boys (13 per cent) than girls (10 per cent). This translates to a cohort survival rate that is among the lowest in the country at 54 per cent, with boys also more disadvantaged [17]. These fgures indicate a great loss of opportunity for education and self-development for both boys and girls, which, in turn, contribute to the inter-generational poverty in the province. The National Capital Region is highly urbanized and shares in the relatively greater economic opportunity and access to basic services that are available in Metro Manila. Poverty incidence in Metro Manila is the lowest in the country, at 4 per cent [15]. In terms of education, the school leaving rate in primary-level public schools is 6 per cent [17], which is much lower than the rate in Masbate but still considered high for the Department of Education’s zero drop-out standard. In absolute numbers, these indicators translate to a considerable population that is undereducated. Outdoor classrooms in Masbate Province (left) and adolescent girls in Metro Manila are shown above. The research team, Plan Philippines and Save the Children Philippines jointly selected schools for inclusion. Schools were selected purposively to ensure that a range of characteristics was represented. The following selection criteria aimed to balance diversity in the sample while maintaining enough consistency to allow comparisons and validate data from each school: Age and grade – students 11–18 years old were included in order to gather perspectives from girls who just recently started menstruating, as well as those who had been menstruating for several years. Type of school – both public schools and private Catholic schools were included in order to assess differences in girls’ ability to manage menstruation at each school type. Rural or urban location – schools in rural and urban settings were selected to capture differences in each context, particularly regarding the availability of resources and information. Details on the location, number and type of schools included in this assessment are shown in table 2. Questions for qualitative data collection were created to investigate and understand the range of personal challenges and needs girls had during menstruation in schools, from the girls’ own perspectives as well as their family members, peers and teachers. At each school, focus group discussions and individual in-depth interviews were conducted with girls, individual key informant interviews were conducted with principals and teachers, and observations were made of the school environment. In select schools and communities, focus group discussions were also held with boy students and mothers. Girls were asked to discuss their personal experiences with menstruation, specifcally what they knew about menstruation and where the information came from. In all activities, participants were invited to make recommendations on how the school, community and local government could improve girls’ experiences at school during menstruation. Local research assistants received training on how to facilitate activities with students and mothers, primarily in Tagalog. Interviews with school staff and health professionals were performed in English by the Emory researcher. Training A one-week training workshop was held for research assistants involved in data collection. During the training, research assistants adapted tools to the Masbate or Metro Manila context and translated them into Tagalog. Research assistants transcribed all voice recordings verbatim in Tagalog and translated them into English after each school visit. Transcripts were then reviewed prior to the next school visit, and tools were adjusted to improve the quality of subsequent data. After a preliminary review of data collected, three schools were revisited for follow-up questions. An Assessment of Menstrual Hygiene Management in Schools 7 Training sessions for research assistants and assessment partners provided a chance to share knowledge. Photo credit: © Jacquelyn Haver, 2012 Participant selection the assessment team worked closely with staff at Plan Philippines and Save the Children Philippines, as well as principals and female teachers at each school, to identify girls, boys and mothers or female guardians who would participate in the focus groups and interviews. A total of 132 participants from 10 schools and their surrounding communities were engaged in research activities, as shown in table 3. All participants were informed of the objectives of the assessment and that their participation was voluntary. Written parental consent was obtained from parents or guardians of all participants under age 18. Protocols were approved by the Emory University Institutional Review Board and the Philippine Department of Education. The determinants of those challenges are also described, and the impacts and potential risks of menstrual hygiene challenges are explored. Quotations from the research discussions appear throughout the fndings section as a complement to the main text. A case study focusing exclusively on data collected from Metro Manila is included in the fndings section. Weakness and functioning hand-washing facilities managing dizziness menstruation c. Defcient information provided and fear of leaks prior to and at frst period and stains b. Teasing, Potential risks guidance about behaviours during menstruation shame and 1. Variable access to support from discomfort and experiences teachers in school fatigue 2. Poor accessibility to preferred defciency materials An Assessment of Menstrual Hygiene Management in Schools 9 Challenges girls face during menstruation Attending school during menstruation can often be challenging for girls. Challenges have been identifed as the experiences girls have at school during menstruation that make this time more diffcult than other days at school. Girls were asked what their experiences were generally like at school during their period and how days at school during menstruation might be different than other days. Other participants were asked about their perceptions of girls’ experiences at school during menstruation. During the frst three days of menstruation girls are instructed to only bathe with three dippers of water. Challenges are further articulated in the following section within the context of determinants. Determinants of menstruation-related challenges Challenges girls face while attempting to manage menstruation at school are determined by factors that are largely preventable. Determinants are the factors that contribute to girls’ challenges at school during menstruation and were identifed through conversations with participants. If specifc challenges were noted and not elaborated, follow-up questions were asked by the research team. Poor sanitation conditions, including: insuffcient number of toilets ft for use; poor facility maintenance; lack of privacy; and limited access to facilities c. Without adequate facilities, girls cannot discreetly manage menstruation, contributing to problems with leaks, stains, odour and teasing, and causing anxiety and embarrassment. Schools that lack water, well-maintained and private sanitation facilities, disposal systems and proper hand-washing facilities do not meet girls’ needs. To avoid feeling ashamed and to ease the challenges associated with managing menses in school, girls often went home rather than using the school toilets. The photos above illustrate the frequent maintenance issues, such as lack of water for fushing the toilets, that were observed in schools.
This description began with a rationale for this study medications not to take with grapefruit purchase cheap kemadrin, which outlined the need for an increased focus on the caregiver experience symptoms constipation best kemadrin 5mg, especially in the context of a developing country such as South Africa medications zoloft side effects buy generic kemadrin 5mg line. The relevance of this topic in the context of rural South Africa was also discussed by arguing that caregivers in this context might encounter unique barriers and facilitators that have not yet been identified in studies that have been conducted in developed countries medications during labor order kemadrin without a prescription. The research design that was incorporated in the present study – an exploratory qualitative design – was also described. This was followed by a discussion of participant characteristics, as well as the procedures that formed part of sampling and data collection. Furthermore, the procedures that were used to conduct thematic analysis were also outlined. To conclude the chapter, the means to maintain trustworthiness and the ethical considerations of the present study were discussed. The next chapter will present the results and key findings that were obtained during this study. Although there were differences in factors including the age of the child or children being cared for as well as the years of caregiving experience, several common themes were identified during analysis of the 15 semi-structured interviews. The list of themes and sub-themes that were identified during thematic analysis can be found below in Table 5. During thematic analysis, themes and sub themes were first grouped as either barriers or facilitators to caring; thereafter, they were categorised according to the five levels of the Social Ecological Model (individual factors, interpersonal processes, community factors, institutional factors, and societal factors) (McLeroy et al. These themes are reported from the most specific to the broadest level of the Social Ecological Model, and are not reported in any order of importance. These barriers included the consequences of caregiving, difficulty adjusting to caregiving duties, environmental conditions, lack of access to healthcare services, lack of respite services, and perceptions towards disability. The main themes and sub-themes that were identified as barriers to caregivers are presented in Table 5. The first main theme that emerged was that participants experienced several personal challenges that were associated with their caregiving duties. These challenges included emotional concerns, physical concerns, and financial burden. At the time of their child’s diagnosis, many of the caregivers noted that they had no choice but to accept their child’s condition and their role as a caregiver since their child needed them: Ek het nie geweet ‘n mens moet. These caregivers were suddenly forced to accept that their previously healthy child would not be the same again: Ek het net gedink die feit dat hy was ‘n gesonde kind. Hulle verduidelik vir my aanmekaar as ek daar kom, daar is niks wat hulle kan doen nie, hy sal vir die res van sy lewe so bly (F10). Another emotional challenge that emerged during the interviews was that caregivers often worried about their child’s future. This concern appeared more prominent among the older caregivers who expressed concern for the time when they would no longer be present to care for their child. Participant code: F = Female, M = Male; 1 = Number of interview Stellenbosch University scholar. The only male caregiver in this study also expressed concern that he was aging and that his wife would struggle to lift and carry their child without his assistance, as she already struggled when he was not present in the home: I’m so worried. The daily demands that were required by caregivers also caused them to experience a variety of physical concerns. Almost all of the caregivers who participated in this study were females who had to perform duties such as lifting and carrying their child. These duties were acceptable when the child was younger, however, as the child aged and grew bigger, it became more difficult for the caregivers to perform their duties and numerous caregivers expressed that they had begun to experience physical pain: Ja my rug, ja sy’s baie swaar my rug kry nogal seer dis hoekom ek haar moet terug sit. Dit pyn, daar’s tye as ek op my bed kom dan lyk dit vir my ek kan nie opstaan nie. Soos gisteraand toe kon ek nie opstaan nie want my rug, toe pyn dit, dit pyn the veel (F3). Names have been changed to pseudonyms throughout to protect participants’ identities. That is why it is so difficult for me to go to the clinic because I have to carry her to the clinic (F14). These caregivers had thus begun to work together to make the task of lifting and carrying easier, however, they noted that it became problematic when there was no one available to assist them: There’s one who’s 18 and she’s heavy, and there’s one who’s 16, she’s also heavy. Also my sister has pain because we are lifting, and sometimes when I’m not around she picks them up alone (F15). Since many of the caregivers did not have assistance from their family or spouse at night, a number of participants reported that they experienced sleep difficulties due to the demanding nature of their caregiving duties, which often required them to roll their children during the night and to ensure that they were not being suffocated by their blankets: When you’re with them you are not sleeping well. You make your rounds during the night, because sometimes even the blanket can suffocate them and so you’re supposed to check whether the blanket doesn’t suffocate them and are they not getting cold at nightYou are not sleeping. During the night I must wake up then she will cry then I will roll her over (M13). Moreover, several participants also reported that they did not have any time to themselves, as they were always occupied with their child’s care. One caregiver reported that the only time she was able to rest was when she was asleep, as her son and her chores would keep her busy during the day: Nooit nie, ek kan dit nooit doen nie. Daar is nie rus kans nie, want ek krap sommer die plek om en maak ek reg en skoon, onder die kooie, ek sit nie sommer stil nie. In addition to emotional and physical challenges, the caregivers in the present study also experienced financial hardships. Since caregiving was a full time obligation for the majority of the participants in this study, a common challenge that these individuals encountered was the inability to secure a stable occupation. One of the participants explained her situation as follows: If I could find a job I would be fineMy life has changed because it’s difficult for me to do a lot of things; for example I used to sell duvets but since looking after him I’ve not been able to do that again (F5). This challenge appeared to also impact the caregivers who had a child enrolled in a creche or day-care facility. Although these services provided the participants with a short break from their caregiving duties, the time away was not enough for them to find work, as they would need to be available when their child returned in the afternoons. In the following extracts, two of the participants explained their unemployment situations: What makes it difficult is when I have found a job. He can come back anytime even at two o’clock and that makes it impossible for me to go to work (F6). But you see there are times, it’s so, I think we take her by nine, and by two o’clock she’s back here. Although fourteen of the participants in the present study were receiving a grant from the state in order to assist them with their caregiving duties, several caregivers reported that they still experienced financial difficulties despite this financial assistance due to the expenses that their child and family incurred: Ek sal nie s dit is genoeg nie, want daar is net daai wat ek kry. Daar is niks moelikheid nie, maar ek sukkel ‘n biejie baie met sy kimbies, hulle is duur nou (F9). Not enough because I have a family who are depending on the grant and also other kids, I have three kids she is the eldest one and then middle one, the boy, and the younger one (F15). Another participant explained how it was not always possible to attend her child’s appointments at the end of the month since the grant money was used to support the child as well as the rest of the family: I really struggle when it’s his appointment because I usually only have money from the first of the month until now, but in the middle of the month I really struggle. Sometimes we don’t even make it because with his grant money I must feed him, clothe him and pay for his school feels as well as buy things for the older one (F6). Another financial hardship that the caregivers experienced was the long waiting period to receive their funding from the state. Multiple caregivers reported that the process of applying for the grant was simple; however, the waiting period to receive the funds was found to range anywhere between a few months to a year: Dit was nou na ‘n jaar toe kry hy eers die geld, eers ‘n jaar gewees het. Ek het gedink hy gaan van die begin stadium kry, maar toe s hulle ek moet wag vir ‘n jaar (F9). This challenge appeared to be particularly problematic for the participants who were employed as full-time carers, as they relied on financial aid to operate their care facilities. One caregiver explained how foster children would be brought to the home for a trial period of three months, during which the carers would rely on the limited resources that Stellenbosch University scholar. And then after they are happy with the way you treat these kids they will leave those kids to us, but if they are not happy they will remove the kids from this centre to another centreSo we are still waiting for the social grant for the new kids that have been here for three months already (F11). The second main barrier to caregiving concerned how certain aspects of caregiving made it difficult for the participants to adjust to their daily duties. Difficulty adjusting to caregiving duties was often increased by the severity of the child’s symptoms, feeding difficulties, as well as a lack of social life. One participant explained the frustration that she felt when her foster child was first placed in her care, as the child had arrived in a sickly state that she struggled to remedy: Toe Angela by my gekom het van jare gelede was sy baie siek, sy was ‘n siek kind. Ek moes baie insit om vir haar the help beter word, sy het opgegooi en sy was ‘n koffiemoer baba. Dit het baie gekos om vir my met Angela reg the handel want Angela was verwaarloos, sy was baie agteruit. Since many of the children present at the home were often sickly, another challenge that these participants experienced was the death of children in their care.
The named person initiates planning at this stage but responsibility may transfer to symptoms 6 days post iui generic kemadrin 5mg overnight delivery a lead professional depending on the agencies involved in the delivery of the Child’s plan medications made easy discount kemadrin 5 mg. When a learner is being supported at the multi-agency planning stage treatment ketoacidosis kemadrin 5 mg with visa, it remains important to medications starting with p kemadrin 5mg on line consider their learning needs within the context of the Getting It Right wellbeing indicators. Safe, Healthy, Achieving, Nurtured, Active, Respected, Responsible, Included), and this means that when there are concerns that a child or young person may have dyslexia, assessment information should be considered, actions for support should be agreed, and identification of dyslexia should take place (where appropriate) using the same approaches as outlined for single agency planning. Emphasis should always be placed on meeting the needs of a learner, rather than providing a label. When it is agreed that a child or young person has dyslexia, given that the process involves an educational assessment, it is important to refer to identification of dyslexia, rather than diagnosis which is a medical term, and is used following a medical assessment. For the reasons noted above, the traditional view of an ‘expert’ being required to identify dyslexia is misguided. Where adequate assessment information has been gathered to explore whether an individual presents with needs that meet the definition of dyslexia outlined on page 5, then a member of staff within school who feels they have a sufficient overview of the assessment process, and sufficient understanding of dyslexia, can identify a child or young person as having dyslexia. This may be achieved by convening a meeting to agree a single agency plan, and including a discussion about dyslexia at this meeting. When identification of dyslexia is being considered during the single agency planning stage, it may be helpful to complete the ‘assessment collation form’ at Appendix 9, either prior to or at the meeting itself. This will allow those in attendance at the meeting to consider whether sufficient assessment information has been gathered to ascertain whether a child or young person has dyslexia. If consideration of the assessment information leads to agreement that the learner has dyslexia this can also be added to the record of the meeting. For example, if a summary of discussion is noted, a variation of the following sentence may be added: “Collation of assessment information indicates that
Parietal abdominal endometriosis following Menstrual Dissemination of Endometrial Tissue into the Venous Cesarean section treatment plantar fasciitis purchase generic kemadrin canada. Surgical treatment of deep the painful symptoms of endometriosis: a 24-week treatment 32 buy kemadrin amex, randomized mueller sports medicine order kemadrin 5mg, endometriosis and risk of recurrence symptoms of a stranger discount kemadrin american express. Relationship between site and medical management of primary bladder endometriosis size of bladder endometriotic nodules and severity of dysuria. The lesions of ureteral endometriosis can Ultrasound is the initial imaging modality used to diagnose be classifed as extrinsic or intrinsic. Occasionally a nodule of invasive bladder endometriosis may appear only as a superfcial hemorrhagic change, and traction must be placed on the bladder peritoneum to expose the underlying nodule infltrating the bladder wall. A high recurrence rate has been reported for lesions treated by transurethral resection. Ureteral stenting prior to resection is indicated if the lesion is less than 2 cm from the orifce. Consequently, affected kidneys may show signifcant function impairment in the radionuclide nephrogram by the time of diagnosis. Surgical treatment of ureteral obstruction from Posttherapeutic follow-up relies on ultrasonography. Surgery for bladder a radionuclide study 6–12 weeks after the conclusion of endometriosis: long-term results and concomitant management of 1, 8 associated posterior deep lesions. Intramural vesical nephrectomy as cystic masses, usually with associated endometriosis. Ureteric obstruction secondary to the lesions reveal glandular fragments and cuboidal epithelium endometriosis. Endometriosis of the Urinary Tract: Symptoms, Diagnosis and Treatment; Available from: 5. Pathophysiology of urinary and bleeding stage is accompanied by infammation, which tract obstruction: Benign Pelvic Abnormalities: Endometriosis. Whether this involvement is extrinsic or intrinsic is Praxis der Urologie, 3rd ed. All patients with pelvic endometriosis Research Trends 2012; Available from: should undergo upper tract imaging. Ureterolysis alone may be suffcient to resolve ureteral obstruction in patients with extrinsic lesions, with documented success rates of 85 %. Furthermore, endometriosis is both an enigmatic disease and the risk of severe complications that may arise and complex disease. For that reason, treatment should be tailored to lack of consensus among experts concerning the defnition each patient as determined by clinical presentation, personal and treatment of the disease, as well as the absence of expectations and the potential risks of surgical treatment, prospective and randomized studies, all these issues account which must be carefully addressed in the informed consent for the fact that management of endometriosis poses a real discussion with the patient. Ureteral endometriosis is a rare condition, but occurs more frequently than assumed in patients with severe endometriosis. To investigate the presence of ureteral involvement, a the presence of a recto-vaginal nodule larger than 3 cm. Differentiation between these pathological Because of the absence of specifc urinary symptoms and entities cannot be made preoperatively or at surgery since the risk of silent loss of the affected kidney, assessment of an histological examination is required. In case of intrinsic disease, ectopic endometrial tissue has infltrated the muscularis or even the Physical Exam If a large endometriotic nodule is revealed during a physical exam of the rectovaginal septum, this fnding may indicate to ureteral involvement. Imaging Techniques the diagnostic value of these techniques in providing accurate information on the extent of disease and on the infltration of the ureteral wall is limited and there seems to be no clear evidence as to which is the ideal diagnostic imaging modality to be used. Historically, open surgery has been the frst diagnosis) because this modality is generally suggested to line surgical approach for extensive endometriosis. Despite inherent cases of ureteral resection with end-to-end anastomosis, limitations, intravenous pyelography, coupled with retrograde and particularly in cases with ureteroneocystostomy, most of pyelography, is currently the exam most frequently used to the patients are nonetheless treated by laparotomy. Medical treatment is geared toward modulating the Surgical Procedure endometrial tissue response to hormonal stimulation. The legs should that reason, medical management is considered a palliative assume a semi-fexed position to give the assistant optimal modality for the treatment of deep endometriosis. In some cases, endometriosis and are usually associated with suboptimal compliance and surgery can take longer than planned, which is why proper safety issues. Probably, the ideal candidates for medical patient positioning is a crucial part of the surgical procedure treatment are postmenopausal women. In this manner, the ureter is lateralized thereby Adequate exposure of the operative site is mandatory when adding safety to the procedure. The surgery begins by adequately restored and both ureters have been identifed, the trying to restore the normal pelvic anatomy. For that purpose, surgical technique deemed to be most appropriate for treating adhesiolysis is subsequently performed starting at the the patient’s specifc state of disease can be applied. Ureterolysis is considered to be complete when subdivide the anticipated technique in two groups: the ureter has been freed from fbrotic tissue and when a normal-looking ureter is visible proximally and distally to the conservative techniques that include ureterolysis (exposure stricture. During dissection, ureteral devascularization must of the ureter) and nodule removal with partial thickness be avoided, trying not to harm the ureteral adventitia. The technique of ureterolysis is used as a frst-line therapeutic option in the treatment In some cases of ureteral nodule removal, a partial breach of of extrinsic, nonobstructive disease with surrounding the ureteral wall may occur and the defect must be repaired fbrosis8, 10, 17, 60 (Fig. The main indications for this approach changing its normal lateral course in a medial direction. The anastomosis is performed over the ureteral stent by placing four interrupted 4-0 stitches at 3, 6, 9 and 12 o clock to approximate the proximal and distal ureteral segments using an intracorporeal knotting technique. Endometriosis of the ureter and bladder are not use of a double-J stent and a bladder catheter. Before retrieving the bladder catheter, adults – analysis of a modifed technique and timing of repair. Persistent bilateral ureteral obstruction secondary to endometriosis despite treatment with an the injury is detected intra-operatively, a simple suture can aromatase inhibitor. Severe ureteral endometriosis: Ureteral endometriosis is an uncommon condition that is the intrinsic type is not so rare after complete surgical exeresis of deep endometriotic lesions. Nevertheless, explicit attention must be paid to the fact that complications can occur, even in 14. Urol Clin North is necessary to compare the pros and cons of various surgical Am 2002;29(3):625–35. Ureteral endometriosis: a complication of rectovaginal endometriotic (adenomyotic) nodules. Urinary tract endometriosis: clinical, renal function: mechanisms and interpretations. Hum Reprod medroxyprogesterone acetate compared with leuprolide acetate 2009;24(10):2504–14. A multidisciplinary, minimally invasive approach for complicated deep infltrating endometriosis. Traditionally reported in about 1–2% of women with symptomatic endometriosis, 1, 9, 36 urinary tract 5. Increased thickness in the posterior wall of the bladder can be appreciated as well. This is characteristic of bladder endometriosis; however differential diagnosis includes a bladder tumor. Surgical resection of such lesions is challenging and will require extensive dissection in the a b vesicouterine plane (b). The location of the lesion is in close proximity to the ureteral reluctant to surgical treatment. These can include chronic cystitis due to Typically, surgical resection can be carried out either infectious bacterial and parasitic organisms, post radiation laparoscopically or with a laparotomy. A urine culture with cytology and cystoscopy helps rule out these conditions in most cases. Other suture or the like, though single layer closure has also been than the usual complications that could occur with anesthesia, described. The largest cohort is cystoscopically, followed by suture closure of the bladder composed of 75 women followed for 60 months with over defect via conventional or robot-assisted laparoscopy. After removal of the endometriotic tissue, the bladder is reconstructed and reapproximated in two layers using a running suture. Endometriosis of the ureter and bladder are not management, and proposal for a new clinical classifcation.
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