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There is usually an associated skull fracture of the parietal or temporal bone diabetes mellitus ketones purchase pioglitazone master card, often caused by a direct blow — for example diabetes symptoms high blood pressure discount pioglitazone 45 mg with mastercard, being hit over the side of the head by a baseball bat diabetes diet oranges buy pioglitazone line. The typical picture is loss of consciousness (concussion) diabetes symptoms vaginal discharge cheap pioglitazone 45 mg overnight delivery, fol lowed by a lucid interval. The patient initially develops a con striction of the pupil on the affected side, which then begins to dilate up (Hutchinson’s pupil). The fixed dilated pupil on the Trauma, Shock, Head Injuries and Burns 65 affected side is usually accompanied by a hemiparesis on the oppo site side (remember the corticospinal fibres cross over). As the pressure continues to increase, the opposite pupil dilates up and eventually the brain stem ‘cones’ through the foramen magnum. Neurosurgical advice should be sought and the patient transferred if necessary for surgical evacuation of the clot. This is much more common than an extradural haemorrhage, and occurs in about 30% of severe head injuries. It is usually due to rupture of a bridging vein between the cerebral cortex and the dura (but it can also be due to laceration of the cerebral cortex), and is often caused by a rotational injury. The elderly are more susceptible, as their brains are often shrunken and hence the bridging veins are put under tension. The bleeding is typ ically less brisk than an extradural haemorrhage, but clinically it can present with symp to ms of an expanding mass as above. This can be associated with trauma, although it is usually due to hypertension and bleeding from berry aneurysms. These injuries are therefore similar to strokes, and surgery cannot help the patient. Assessment of Severe Head Injuries As the patient is brought in to casualty you should attempt to get some his to ry, finding out as much as possible about the incident. If they are uncon scious, the his to ry is taken from witnesses or the ambulance crew, etc. It is divided in to three parts: assessing the best mo to r response, the best eye-opening response and the best verbal response. It was devised to allow comparisons to be made (if necessary by different observers) to see if the patient’s consciousness has improved or deteriorated. Remember that although bleed ing from a scalp wound can cause shock, bleeding in to the skull cannot, and therefore never assume that hypotension is due to an intracranial bleed or to brain injury (as this is a terminal event on failure of the medullary centres). The Cushing response is a combination of progressive hypertension, bradycardia and a decreased respira to ry rate (the opposite of hypovolaemic shock). Hypertension alone or with hyperthermia suggests central au to nomic dysfunction caused by diffuse brain injury. If the airway, breathing and circulation are under control, then the minineurological examination can be performed in the primary survey; otherwise it is performed in the secondary survey. The purpose of this is to detect those with a severe head injury who are likely to need surgery. Remember that the initial neurological examination is only a baseline for comparing the results of repeated examinations, in order to determine deterioration or improvement of the patient’s condition. If the haemoglobin is low, a transfusion may be required to improve the oxygen-carrying capacity. Raised Intracranial Pressure this may be due to a mass lesion or brain oedema and should be treated. To do this it is usually necessary to intubate and ventilate the patient and so early involvement of an anaesthetist is essen tial. Intravenous fluids may be needed in the management of other prob lems, such as shock, and the risk is that overhydration may make cerebral oedema worse. Therefore, iso to nic fluids such as Hartmann’s should be administered rather than hyposmolar fluids such as dextrose. Diuretics such as manni to l are often used to reduce intracranial pres sure and are given if a mass lesion is suspected whilst awaiting transfer to a neurosurgical unit, although a neurosurgical consultation should be obtained prior to giving any diuretics (if diuretics are used, a urinary catheter is required to aid fluid balance measurement). Management of Mild to Moderate Head Injuries the problem for a casualty officer when he sees what appears to be a minor head injury is in deciding who needs admitting for observation. Falls from a height should be taken very seriously, as they have a much greater risk of an intracranial bleed than road traffic accidents. For a fall, Trauma, Shock, Head Injuries and Burns 69 inquire about the height of the fall and whether it was on to concrete or grass, etc. If the patient was driving a car, inquire about the speed of the car and whether a seat-belt was worn, whether any of the other passengers were injured or dead and whether alcohol or drugs were involved. Has the patient regained con sciousness since the accident or have they remained unconscious ever sincefi Has the patient fitted since or complained of visual disturbances, dizziness or a worsening headachefi Document the amnesia, for the events that led up to the incident (ret rograde amnesia) or for the events that followed the incident (anterograde amnesia). The length of anterograde amnesia has been shown to be a good indica to r of the severity of the head injury (less than 1 h — mild; 1–24 h — moderate; more than 24 h — severe), although this is not much help in the initial assessment, which takes place soon after the incident. With children it is also worth noting whether they cried immediately, as this is a good sign. Examination is essentially the same as above; however, in some cases it is difficult to decide what investigations are needed and whether or not you can safely send the patient home. For example, let us say the patient has walked in to the department after a head injury sustained in an assault where he was hit over the head by a brick. His speech is slurred from drink and he has a bump on his forehead, but there is no focal neurology to find on examination (within the limits of the cooperation of this patient). X-rays may help in deciding who will be admitted for observation, but not much else. Statistically, if there is a skull fracture, then the risk of an intracranial bleed is significantly higher. Rough Risk of Intracranial Haema to ma in Adults No Skull Fracture Skull Fracture Fully conscious 1/1000 1/30 Depressed consciousness 1/100 1/4 70 Surgical Talk: Revision in Surgery Indications for performing a skull X-ray include (but do check the pro to col at your hospital): 1. Difficulty in assessing the patient (young/old, drunk, postepileptic) the indications for admission are 1. If the patient is not admitted, they should be sent home with head injury instructions (go to your casualty department and get a copy) and accompanied by a responsible adult who will bring him back should his condition deteriorate. Toddlers tend to be scalded, for example, by pulling the kettle wire or the pan off the s to ve, kids tend to set their clothes on fire and the old tend to suffer Trauma, Shock, Head Injuries and Burns 71 domestic accidents at home. The majority of adult burns however, are associated with industrial accidents (or are drug or alcohol-related). The superficial burn causes vasodilatation with diffuse erythema, kinins are released and pain is felt. As the depth increases, the capillaries become damaged and therefore more permeable, leading to blistering and oedema formation. As the dermis becomes involved, the nerve endings which lie here are damaged and sensation is lost. Once the germinal layer is damaged, the skin will never regrow, and these burns heal with fibrosis and contractures. The damaged necrotic tissue lying in a protein-rich exudate is an ideal medium for infection. The increased capillary permeability can lead to the exudation of protein-rich fluid from the surface of the burn and oedema in to the surrounding tissues. Friction Chemical burns result from exposure to acids, alkalis or petroleum products. In general, alkali burns are more serious than acid burns as they penetrate more deeply. The chemical should be flushed away from the skin with copious amounts of irrigation with water (20–30 min). The patient 72 Surgical Talk: Revision in Surgery can also develop cardiac disturbance due to acidosis and changes in potas sium concentration. The patient will have dark urine due to the myoglobin and require large amounts of fluids to ensure a high urine output. If necessary, manni to l can be used to maintain a diuresis and flush out the myoglobin. Management of the Burns Patient the management of the burns patient, as with any trauma patient, is to exclude any life-threatening injuries first.
Labora to metabolic disease you get from ticks order pioglitazone visa ries are also required to diabetes type 2 long term effects order pioglitazone with a mastercard report positive results of Escherichia coli O157:H7; shiga to diabetes education materials buy pioglitazone visa xin-producing; or sorbi to diabetes mellitus hypersecretion or hypersecretion order generic pioglitazone pills l negative E. Healthy People 2020 Goal the Healthy People 2020 Goal for shiga to xin-producing Escherichia coli 0157 is 0. As shown in Figure 4, age-specific rates were highest among preschoolers aged 1-4 years (5. You can learn more about Escherichia coli by visiting the following Web sites. During the past two decades, Giardia infection has become recognized as one of the most common causes of waterborne disease (found in both drinking and recreational water) in the United States. Because the parasite is protected by an outer shell (cyst), it can survive outside the body and in the environment for long periods of time. Concentrations of chlorine used in routine water treatment do not kill Giardia cysts. From 1997-2000, an average of 665 cases of giardiasis was reported in Indiana every year. Giardia is passed in the s to ol, and people become infected by ingesting feces from an infected animal or person (fecal-oral route). There are several ways to become infected with Giardia: • Having contact with an infected person’s s to ol: o Not washing hands after contact with s to ol from a contaminated surface or diaper/linen and ingesting the bacteria. Large community outbreaks have occurred from drinking treated but unfiltered water. Smaller outbreaks have resulted from contaminated food, person- to person transmission in day care facilities, and contaminated recreational waters. Public Health Significance Symp to ms of giardiasis can include diarrhea, gas, greasy s to ols that tend to float, bloating, s to mach cramps, nausea, and constipation. Symp to ms usually begin within 7-10 days (range of 3-25 days) after exposure and last 2-6 weeks. These symp to ms may lead to weight loss and dehydration, but some persons infected may have no symp to ms. Infected people may carry Giardia in their bodies for weeks or months without symp to ms and unknowingly infect others. While medications are available to treat giardiasis, they are not needed if the person does not have diarrhea. In general, giardiasis can be prevented by strictly adhering to the following guidelines: • Practice good hygiene: o Thoroughly wash hands with soap and water after using the restroom; after assisting someone with diarrhea and/or vomiting; after swimming; before, during, and after food preparation. Epidemiology and Trends In 2011, 324 cases of giardiasis were reported in Indiana, for a rate of 4. Table 1: Giardiasis Case Rate by Race and Sex, Indiana, 2011 Cases Rate* 2006 2010 Total Indiana 324 4. Table 1: Giardiasis Case Rate by Race and Sex, Indiana, 2011 Cases Rate* Indiana 324 4. Census Bureau’s population data as of July 1, 2010 Disease incidence was greatest during the summer months (Figure 2). As shown in Figure 3, age specific rates were greatest for preschoolers aged 1-4 (17. The incidence rates were highest among the following counties reporting five or more cases: Allen (14. You can learn more about giardiasis by visiting the following Web sites. Humans are the natural host, with up to 80 percent of healthy individuals colonized with the nontypeable form. Prevention of infection through immunization is the most effective way to reduce transmission of H. Before the widespread use of vaccines, Hib was the leading cause of bacterial meningitis in children. Since the introduction of the conjugate Hib vaccine in 1990, the incidence of Hib disease in children has decreased dramatically in both the U. Serotype information also is needed to measure the sensitivity of the surveillance system and to detect the emergence of invasive disease caused by types of H. In 2011, one case of Haemophilus influenzae type b disease occurred in Indiana in a child less than 5 years of age for whom isolates were submitted for testing. Table 1: Haemophilus influenzae Case Rate by Race and Sex, Indiana, 2011 2007 2011 Cases Rate* Total Indiana 117 1. Census Bureau’s population data as of July 1, 2010 Figure 1 shows reported cases of H. The highest incidence rate among counties reporting 5 or more cases was in Vanderburgh County (3. Table 2: Percent of Reported Haemophilus influenzae Cases by Serotype, 2011 Type Number Percent a 1 0. The main route of transmission for humans is breathing air contaminated with the virus. The disease was first described as a clinical syndrome, and the causative agent was identified as the Sin Nombre virus in the Four Corners area (Utah, New Mexico, Colorado, Arizona) in 1993. However, 12 states east of the Mississippi have reported cases, including Indiana. Since 1993, two hantavirus cases have been reported in Indiana, resulting in one death. Public Health Significance the initial symp to ms of hantavirus include fever, tiredness, headache, and fatigue. As the disease progresses, symp to ms may include shortness of breath and coughing due to lungs filling with fluid (pneumonia). People most at risk for becoming infected with hantavirus include those who visit or reside in closed spaces where infected rodents live, including campers and hikers and those who work or play outdoors. In addition, housecleaning activities such as sweeping or vacuuming can release contaminated particles in to the air. Epidemiology and Trends No hantavirus cases were reported in Indiana in 2011 or during the five-year reporting period 2007-2011. You can learn more about hantavirus by visiting the following Web site. For this reason, the virus is easily spread in areas where there are poor sanitary conditions or where good personal hygiene is not practiced. Persons are at risk for hepatitis A infection if they have: • Exposure to contaminated food or water, such as: o Consuming untreated water. Public Health Significance An acute hepatitis A case is characterized by positive test for immunoglobulin M (IgM) antibody to hepatitis A virus, and an acute illness with a) discrete onset of symp to ms (enteric symp to ms. Symp to ms of hepatitis A usually occur suddenly and include diarrhea, nausea, vomiting, tiredness, s to mach pain, fever, dark urine, pale or clay-colored s to ol, loss of appetite, and sometimes jaundice. People are most contagious from about two weeks before symp to ms begin until two weeks after. Some people, especially children, may have no symp to ms but can still spread the virus to others. Symp to ms usually begin 28-30 days (range of 15-50 days) after exposure and usually last less than two months. However, people will eventually recover, and there is no long-term carrier state with hepatitis A infection. People who have had hepatitis A develop lifelong immunity and cannot get hepatitis A again. Candidates for vaccination include persons at increased risk for hepatitis A infection or its consequences including: • Persons with chronic liver disease or clotting fac to r disorders • Men who have sex with men • Injecting drug users • Persons traveling to or working in countries where hepatitis A infection is endemic • Persons who work with hepatitis A virus in a research setting • Children who live in communities with consistently elevated rates of infection Post-exposure prophylaxis with hepatitis A vaccine or hepatitis A immune globulin is effective if received within two weeks of exposure. Indiana met this goal in 2009 and 2010, but did not meet in 2007, 2008, and 2011 for the five-year reporting period 2007-2010 (Figure 1). Epidemiology and Trends In 2011, 24 cases of hepatitis A were reported in Indiana for a rate of 0. Table 1: Hepatitis A Case Rate by Race and Sex, Indiana, 2011 Cases Rate* 2006 2010 Total Indiana 24 0. Census Bureau’s population data as of July 1, 2010 Figure 2 shows the number of reported cases per year for 2007-2011. You can learn more about hepatitis A by visiting the following Web sites. An acute hepatitis B illness can range in severity from a very mild illness with few or no symp to ms to a serious condition requiring hospitalization, which is characterized by multiple symp to ms such as nausea, anorexia, fever, malaise, headache, myalgia, right upper quadrant abdominal pain, dark urine, skin rash and jaundice. The time variation is related to the amount of virus transmitted, the mode of transmission, and host fac to rs.
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Acorus calamus (Calamus). Pioglitazone.
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Based on the individual homoeopathic constituents of Tartephedreel diabetes medications starting with g buy cheap pioglitazone 45 mg on line, therapeutic possibilities result for the treatment of catarrh of the respira to treatment of diabetes generic 30mg pioglitazone free shipping ry tract diabetes mellitus zitate pioglitazone 15mg visa. Iaryngitis diabetic diet 1200 calorie meal plans order pioglitazone 15mg mastercard, tracheitis, bronchiolitis, especially with a decrescent tendency, bronchitic asthma. Adjuvant in (broncho)pneumonia, tubercular and pleuritic irritating coughs, catarrh of the other mucosa, including gastric, intestinal and of the urogenital system. The same applies for the influenza virus which, through the inflamma to ry process, is broken down and eliminated. Catarrh, therefore, should not be suppressed but its course promoted and accelerated, in order to purify the to xic condition. The individual constituents of Tartephedreel give rise to the anti-inflamma to ry, excre to ry and de to xicating action of the preparation. The dosage is adjusted according to the disease, the clinical picture and the stage of the illness: for continuous treatment 10 drops 3(-4) times daily. In acute disorders, massive initial-dose therapy with alternating remedies, 10 drops every 15 minutes until an improvement is observed. The following prescription has proved effective in bronchial asthma: Husteel 5-8 drops at 8 a. Indications: Stimulation of organ functions in cases of dystrophia adiposogenitalis (among males), ejaculatio praecox, impotentia virilis, nocturnal enuresis, dystrophia musculorum progressiva, exhaustion, induratio penis plastica, osteomalacia (among males), diabetes mellitus and in other various metabolic disturbances, damaged liver. Pharmacological and clinical notes Testis suis (testicle) Revitalizing fac to r, impotentia virilis, conditions of exhaustion. Embryo suis (embryo) For revitalization in cellular phases, arteriosclerosis, muscular dystrophy. Glandula suprarenalis suis (suprarenal capsule) Conditions of exhaustion, adrenal insufficiency. Cortisonum aceticum (cortisone acetate) Impairment of the cortex of the suprarenal gland, pituitary gland and connective tissue. Vitex agnus-castus (chaste tree) Sexual weakness, painless leucorrhoea, mental depression. Selenium (selenium) Sexual weakness, possibly also ejaculation praecox, prostatic adenoma (1st stage) with trickles of urine after micturition, lack of concentration, neurasthenia. Strychninum phosphoricum (strychnine phosphate) Symp to ms of exhaustion, sleeplessness, irritability, hyperhidrosis, chorea minor, paresis of various kinds. Curare (arrow poison) Paralysis or weakness of the musculature, especially after over-exertion, dyspnea, vertigo. Conium maculatum (spotted hemlock) Vertigo upon every change of position, strangury, poor memory, neoplasm phases, geriatric remedy. Lycopodium clavatum (club-moss) Impotence, prostatic adenoma, diseases of the liver, gall bladder and bile duct; uric acid diathesis, polyuria. Phosphorus (phosphorus) Remedy for affections of the parenchyma, glomerulonephritis with haematuria. Magnesium phosphoricum (magnesium phosphate) Neuralgia, tendency to wards cramps, conditions of exhaustion. Ferrum phosphoricum (iron phosphate) Feverish and inflamma to ry conditions, enuresis. Manganum phosphoricum (managanese phosphate) Conditions of exhaustion with anaemia. Zincum metallicum (zinc) Conditions of irritation of the central and peripheral nervous system. Based on the individual homoeopathic constituents of Testis compositum, therapeutic possibilities result for the stimulation of the organ functions in dystrophia adiposogenitalis (men), ejaculatio praecox, impotentia virilis, enuresis nocturna, progressive muscular dystrophy, conditions of exhaustion, induratio penis plastica, osteomalacia (men), diabetes mellitus and for various other metabolic disturbances, also as auxiliary remedy in hepatic damage as well as geriatric remedy. The range of action of Testis compositum extends to the male sex glands and, in combination with the stimulating action on various organ and glandular functions, and in joint action with homoeopathic single remedies, brings about an improvement in the sexual functions, activating the connective tissue. In this connection, the additional administration (alternating injections) of suitable Composita. Testis compositum, therefore, should be administered not only for the abatement of masculine to nicity and the disorders arising from this such as prostatic adenoma, hyper to nia, peripheral circula to ry disturbances and disorders of the hepatic function, but also as intermediate remedy for affections in the sphere of degenerative phases, possibly with Thyreoidea compositum in pronounced neoplasm phases, in which cases this therapy should be started at the earliest possible moment. If the stimulating action alone should not be sufficient, for the purpose of far-reaching stimulation of the de to xicating system, not only of the lymphatic apparatus but also of the suprarenal glands, and especially of the connective tissue function, also intermediate injections of Tonsilla compositum are indicated. The dosage is adjusted according to the disease, the clinical picture and the stage of the illness: at the start of treatment 1 ampoule i. Indications: Stimulation of the central regula to ry functions in degenerative diseases and neoplasia. Pharmacological and clinical notes Thalamus opticus suis (optic thalamus) Stimulation fac to r of the central control functions. Corpus pineale suis (epiphysis) In neoplasm phases, antagonistic functions such as inhibition of growth, antitumorous activity. Glandula suprarenalis suis (suprarenal gland) Conditions of exhaustion of the suprarenal glands. Based on the individual homoeopathic constituents of Thalamus compositum, therapeutic possibilities result for auxiliary treatment for the stimulation of the central control functions in neoplasia and degeneration phases. In neoplasia, with increasing gravity of the disease, atrophy of the suprarenal glands is found, as well as necrotic foci in the thalamus opticus, particularly in the region of the nucleus pallidus and corpus striatum (“Pallido-Striatum“), which lead to the assumption of defective central control. Now specific stimulative therapy can be applied effectively, similarly live-cell or frozen-cell therapy (Niehans, Winkler, Reckeweg, etc. Between the lenticular nucleus and the caudate part of the nucleus caudatus (caudate nucleus) the pars pallida and corpus striatum are situated in which, i. From these, possibly neural disturbances, provoked at a distance, of a regula to ry nature or of signalling action, emanate (which, among other things, are responsible for what are known as pigmental spots in the iris, which can be observed after re to xication processes [re to xic impregnation]). While the hypophysis cerebri stimulates the growth processes (through the somatropic hormone) and is therefore contraindicated in neoplasia live-cell therapy, the corpus pineale possesses certain antagonistic functions such as growth inhibition, anti-tumour activity and an influence on asthma and phases to the right of the biological section. The dosage is adjusted according to the disease, the clinical picture and the stage of the illness: 1 ampoule i. Pallido-Striatum: nucleus pallidus and corpus striatum (in the thalamus opticus) appear, when diseased to be the loci of the central pathological defective control of the incidence of cancer. Indications: Thyroid dysfunction; stimulation of the glandular functions, as well as of the defensive system and the functions of the connective tissues, particularly in precancerous stages, carcinomas and sarcomas, hypernephroma, dystrophia musculorum progressiva, myxoedema, induratio penis plastica, adipositas, bronchial asthma, naevi, sclerodermitis, elephantiasis, osteochondrosis, arthrosis. Intravenous administration may cause hypersensitivity reactions and sudden drop of blood pressure. Pharmacological and clinical notes Glandula thyreoidea suis (thyroid gland) Stimulating fac to r, struma parenchyma to sa et colloides. Thymus suis (thymus gland) Stimulating fac to r, disturbances of growth and development, neoplasm phases. Splen suis (spleen) Stimulating fac to r, especially of the defences against infection; anaemic conditions. Medulla ossis suis (bone marrow) Stimulating fac to r, anaemic conditions, therapeutical damage, osteomalacia, osteomyelitis chronica, exos to sis. Funiculus umbilicalis suis (Whar to n’s jelly [umbilical cord]) Stimulating fac to r, damage to the connective tissues, osteochondrosis, intervertebral neuralgia, cervical syndrome. Hepar suis (liver) Stimulating fac to r, stimulation of the de to xicating hepatic function. Galium aparine (goosegrass) Precancerous and neoplasm phases, dysuria, nephrolithiasis, cystitis, derma to sis. Conium maculatum (spotted hemlock) Vertigo upon each change of position, strangury, debility, ascending paralysis, concretions and nodules hard as s to ne, neoplasm phases, remedy for senile conditions. Spongia (roasted sea sponge) Glandular swellings, struma colloides et parenchyma to sa, palpitations. Acidum sarcolacticum (sarcolactic acid) Acid-base regulation in the connective tissue. Calcium fluoratum (calcium fluoride) Caries of the bone, glandular swellings (of s to ny hardness). Colchicum autumnale (meadow saffron) Gastro-enteritis, muscular and articular rheumatism, pericarditis, endocarditis, adjuvant in neoplasm phases. Viscum album (mistle to e) Sudden attacks of vertigo; headaches, particularly frontal; constitutional hyper to nia, pruritus sine materia, precancerous conditions and neoplasia. Cortisonum aceticum (cortisone acetate) Damage to the cortex of the suprarenal gland, pituitary gland and connective tissue. Acidum fumaricum (fumaric acid) Active fac to r of the citric acid cycle and of redox systems, conditions of exhaustion. Acidum alpha-ke to glutaricum (a-ke to glutaric acid) Active fac to r of the citric acid cycle and of redox systems, feeling of exhaustion.
Breast and cervical cancer the prevalence of breast cancer in Romania in 1996 was 35 free diabetes test las vegas order pioglitazone in india. Environmental fac to diabetes symptoms drunkenness generic pioglitazone 45mg rs worsen the health of children by increasing the incidence of enteric and respira to what causes diabetes type 2 yahoo cheap pioglitazone 45mg on-line ry diseases due to blood sugar imbalance buy 45mg pioglitazone overnight delivery problem of quality of water and control of pollution. A survey on youth reproduction health (1996) was carried out with a sample of people aged 15-24 years. Data analysis showed that 77% of women stated they have been pregnant at least once, that almost a quarter were pregnant before 18 years old. The percentage of undesired pregnancies was higher for women in urban area and for those aged 20-24 years. The percentages among both variables were significantly higher for unmarried women. Since 1993, the time of the last survey, the level of accidental pregnancies was practically unchanged for women aged 15-19 years and slightly decreased for those of 20-24 years old. The survey also revealed that among both men and women, the age of initial alcohol consumption was low. Areas for action and policy changes • A further development and improved efficiency of the family planning programme; • Development of a national reproductive health policy; • Strengthening obstetrical care services; • Reducing maternal mortality by taking actions on reducing abortions, haemorrhage and infections; • Developing and improving the prevention action and care of children’s health, including ante and post natal care; • Restructure and re-equip child institutions and retrain staff; • Reduce low-birth weight to 6% by 1999; • Strengthen consumer demands for contraceptives rather than for abortions; • Assistance to adolescent health projects needed, particularly health promotion and youth counselling and education services. With the exception of two hospitals and two polyclinics in the whole of Slovakia, all hospitals and polyclinics are publicly run. The health professionals take up different functions in reproductive health service provision. Gynaecologists, sexologists, gene to logists and urologists work in out-patient departments or in hospitals, diagnosing and treating reproductive health problems. This includes infertility, prenatal genetic diagnosis, prenatal and obstetrics care. Psychologists work in counselling centres providing psychological support for men and women with partnership problems. Family planning the implementation of the national programme of family planning was commenced in 1992. However, family planning does not appear to be a priority programme of the government as yet. There is no specific advisory group oriented to ward the programme of family planning. There is, however, an advisory group oriented to ward the national programme of health support works. Family planning counselling is offered free of charge in Slovakia by gynaecologists. Adolescents under the age of 15 need an authorization to receive family planning services in Slovakia. The Slovak Family Planning Association is actively involved in the national programme of family planning. Contraception the main method of fertility regulation in Slovakia is as yet clinical abortion. It is estimated that the cost of one cycle of oral contraceptives is equivalent to 1. There appears to be an availability of emergency contraception in the obstetric and gynaecologic departments. Abortion Clinical abortions are only performed in hospitals at an average cost of 36% of a monthly salary. The curettage and vacuum aspiration techniques are used, as well as the method of prostaglandin in the second trimester on the basis of genetic indications. The parts of the reproductive health care that has been privatised in the country are primary gynaecological care in out-patient departments. Both these institutions and special services in hospitals offer reproductive health care services to adolescents. As yet no steps have been taken to implement social marketing in to the national reproductive health care services. Antenatal care It is estimated that 98% of women in Slovakia are given antenatal care. There is, however, no systematic data on what percentage of obstetric and gynaecological admissions are due to abortion. Neither is there any systematic data on what percentage of women attending antenatal care show a positive syphilis serology. There does not seem to exist data on the number of facilities that have functioning basic and comprehensive obstetric care per 500 000 population. Breast and cervical cancer There appears to be no present systematic data on the prevalence of breast and cervical cancer of women in Slovakia, despite the increase of overall cancer mortality. Breastfeeding is supported by all hospitals by a programme which introduced rooming-in system and educates the public about the benefits of breastfeeding. On the one hand, the economic transformation, development of entrepreneurial activities, reconstruction of economics and other facts have led to the creation of an increased economic independence of families; on the other hand, the risk of economic instability has increased among young persons and families due to the decline of their living standard and rise of social dependence. The Ministry of Education deals with the problems of young people within the frame of its competence. There are also centres of diagnostics that take care of problem juveniles and those with mental or physical handicaps. Marriage at a very young age (16, 17 years) and childbirth up to 15 years are not widespread in Slovakia. Since 1989 till the end of 1998 there were 384 live births, on the average 38-39 children a year among 12-14 year olds, one live-birth per 1. The to tal consumption of alcoholic drinks in Slovakia decreased in 1998 in comparison with 1997 by 6. Areas for action and policy changes • Comprehensive policies to promote the health of women need to be developed involving all stages of a woman’s life; • Advocacy for legal reforms on abortion and sterilisation; • Information, Education and Communication activities needed; • Assistance to adolescent health projects needed, particularly health promotion and youth counselling and education services; • Acute respira to ry infections control programme and acute disease control programme should be extended; • Antenatal and perinatal care services should be strengthened. It is estimated that the population needs for hospitals and polyclinics are fairly well covered by the present number of institutions. There are as yet no private hospitals in Slovenia, however, one or two polyclinics are in progress to function on a private basis. The provision of reproductive health services is covered mainly by gynaecologists working at community health centres or at private clinics. At times gynaecologists working in ob-gyn departments are asked by the patient to provide reproductive health service. The first group of drugs are free of charge and covered by the compulsory health insurance and are defined as essential drugs. The second group are drugs free of charge for those who pay the additional health insurance. The third group consists of drugs free on the commercial market, to which the full price has to be paid. Family planning the national family planning programme in Slovenia dates back to the 60’s, when routine family planning and contraceptive counselling were implemented at primary and secondary health level. According to a new health law from 1992, National Guidelines for Implementation of Preventive Reproductive Health Care were adopted by the government in March 1998. There is no advisory group orienting the programme of family planning in Slovenia. Family planning counselling services are offered free of charge by her personal gynaecologist, who in most cases have a contract with the national health insurance. Adolescents do not need an authorization to receive family planning services in Slovenia. It is estimated that there is a reliable continuity of oral contraceptives available in the country. Most contraceptives are free of charge with the exception of condoms and diaphragms. The cost of these compared to an average salary are respectively 1% per 20 condoms and 2. Emergency contraceptives are available in Slovenia at family planning clinics in community health centres, gynaecological consultancies and ob-gyn hospitals. Abortion Clinical abortions are mainly performed at ob-gyn hospitals and in some consultancies. The vacuum aspiration and prostaglandin are the main techniques used for the performance of clinical abortions.