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Like many people, lasix type of medication Stephanie Holm made holiday cookies with her family last can you buy lasix year. Her daughter found a recipe on the internet, and the two of them set to making them in the kitchen of their apartment.Together, they mixed the dough, rolled it out, put the cookies on a pan and popped it in the oven — “literally covered in sprinkles on the outside…cute, and very delicious,” says Holm, a pediatric environmental medicine specialist at UC San Francisco.But as the cookies baked, Holm noticed that the cute sugary coating burned a little in the oven, though not enough to ruin the cookies. Then Holm heard her daughter exclaim, “Mama, it’s can you buy lasix purple!. € and she saw that the air quality sensor she keeps in their apartment had indeed turned from green (good air quality) to purple (very unhealthy). Could a single batch of slightly singed cookies have been to blame?.

What happened with can you buy lasix Holm’s cookies wasn’t a fluke. All cooking releases a complex mixture of chemicals, some of which would be classified as unhealthy pollutants. As for whether cooking is hazardous to your health — the short answer is, it depends. But generally, if you have good ventilation, you should be can you buy lasix fine.“We all cook, and the average life expectancy is 78 or 79 years old. So we shouldn’t get too worried,” says Delphine Farmer, an atmospheric chemist at Colorado State University.

€œBut it is an opportunity to think about how to reduce your exposure to pollutants.”Out of the Frying PanFarmer’s research found that cooking releases a mixture of hundreds of different chemical compounds into the air. Every ingredient gives can you buy lasix off its own unique blend of particles and gases. Proteins in meat can break down and give off ammonia. Roasting can produce isocyanates. Oils from frying and sautéing can aerosolize can you buy lasix (that’s how your counters end up with a fine layer of grease on them).

The airborne molecules can continue to react and change as they drift around your kitchen and bump into each other.“You can see some of these really interesting compounds,” Farmer says. €œBut are they at levels that are toxic?. We don't know.” Part of the uncertainty when it comes to health effects comes from the fact that most can you buy lasix air quality studies and standards are based on outdoor air — despite our world where people today spend an estimated 90 percent of their time indoors. While Canada and the World Health Organization have indoor air quality guidelines, the U.S. Does not.In general, indoor air chemistry fluctuates a lot more than outdoor air.

The average air quality can be good, but as Holm and her daughter experienced, some activities can you buy lasix — like cooking and cleaning — can cause dramatic changes. Pollutant levels will spike in the kitchen while cooking is actively happening and then drift back down as the airborne molecules disperse.“The pattern of exposure is different. And we really don't have great scientific data on what the difference of that pattern of exposures means for people's health.” Holm says.Acquiring that scientific data is no easy task. Variables that can affect cooking fumes and their contents include how often a can you buy lasix person cooks, what they cook, how they cook it, what kind of appliance they use, what kind of ventilation they have and maybe even the type of pots and pans they use, says Iain Walker, an engineer at Lawrence Berkeley National Lab who studies home air quality and ventilation. The best researchers can do is try to gauge the relative impact of each factor.

Gas stove or electric?. Boiling can you buy lasix or frying?. Meat or vegetables?. Nonstick pan or stainless steel?. Into the FireThe main pollutant of concern linked to can you buy lasix cooking is particulate matter.

This catchall term refers to a complex mix of microscopic solid bits and uafine liquid droplets that could be made up of hundreds of different chemical compounds. The chemistry doesn’t matter nearly as much as the size. Particles smaller than 10 microns (less than 1/5 the width of a human hair) can can you buy lasix make their way into the lungs and lodge there. Even smaller particles can make their way into the bloodstream.Particulate matter is the reason you don’t want to breathe in smoke or car exhaust. Chronic exposure to high levels of particulate matter exacerbates asthma, but also makes it more likely that a child will develop asthma, says Holm.

It’s also linked to changes in childhood growth, can you buy lasix metabolism and brain development, and it’s classified as a carcinogen by the WHO.All cooking produces some particulate matter in the form of aerosols and tiny bits of char generated from food and dust being heated up. If you can smell burning, you’re likely breathing in quite a bit of particulate matter. €œAnything with a red-hot element is going to generate particles,” says Walker. That includes most stovetops, ovens and even small appliances like toasters can you buy lasix. Frying and roasting cook methods both produce a lot more particulate matter than boiling or steaming.

And fatty foods give off more than veggies.Gas stoves are particularly bad for indoor air quality. Not only do they produce more can you buy lasix particulate matter by virtue of creating an open flame, but the actual fossil fuel combustion also generates other gases, such as carbon dioxide and nitrogen dioxide. From a health perspective, the thing that raises the biggest concern in this scenario is nitrogen dioxide.Nitrogen dioxide, like particulate matter, contributes to breathing problems like asthma and is regulated in outdoor air. The gas has also been linked to heart problems, lower birth weight in newborns and shorter lifespans for people who are chronically exposed.A 2016 study from Lawrence Berkeley National Lab found that simply boiling water on a gas stove produces nearly twice the amount of nitrogen dioxide as the EPA’s outdoor standard. Considering that about a third of American homes use natural gas for cooking, that’s a lot of potential exposure.“Somehow, we've just become used to an unvented fossil fuel device in our homes,” says Brady Seals, who manages the carbon-free buildings program at the Rocky Mountain Institute, a clean energy think tank can you buy lasix.

She wants to raise awareness of nitrogen dioxide’s health risks as a way to discourage natural gas use in homes. And she’s not alone in this mission. The Massachusetts Medical Society passed a resolution in 2019 to recognize can you buy lasix the link between gas stoves and pediatric asthma. Several cities in California, including San Francisco, have passed bans on natural gas in new construction, citing both climate and health hazards.If you have a gas cooktop, Seals and Walker recommend swapping it out for an electric one if you have the means and ability to do so. €œNot only are you reducing carbon impact [on the environment], but you can have a healthier home if you get rid of combustion appliances,” Walker says.The best option from both an energy-efficiency and air-quality perspective, he says, is an induction stove, which uses magnets to transfer heat directly to your pots and pans.

No red-hot elements can you buy lasix means less particulate matter. If you can’t replace your gas stove, Seals recommends a plug-in induction cooktop.Vented AirRealistically, few people are going to swear off stir frying or using their oven for the sake of producing less particulate matter. €œEverybody’s going to cook what they’re going to cook,” says Farmer, noting that people use whatever kitchen appliances they have. That’s why all these experts stress the importance of good ventilation.Holm was part of a 2018 study looking at particulate matter can you buy lasix in the homes of children with asthma. One of the most surprising findings.

In homes that never used a range hood or range fan, people were exposed to unhealthy levels of particulate matter for roughly 10 percent more time than in homes that used range ventilation.Walker, the ventilation expert, recommends that people should use a high setting on their kitchen range hood whenever possible, since the quieter low settings capture only about half of pollutants. Since most range hoods don’t extend over the front burners, you might want to consider using the back can you buy lasix burners, especially if you have a gas stove. Walker also advises that people keep the ventilation on for about 15 minutes after they’re done cooking. That’s about how long it takes for all of the air in the room to be replaced. But that only applies if your vent is sending can you buy lasix fumes outside, which is not often the case.Unless you have a new, higher-end kitchen and stove, your built-in range ventilation might essentially be a fan.

It’s just pushing the fumes around the room, which helps disperse the concentration of pollutants more quickly but doesn’t actually remove them from your house. Many homes and apartments, including Holm’s, don’t even have that option. In that can you buy lasix case, Holm recommends opening some windows if the outside air quality is good, or using a portable air purifier with a HEPA filter.In the end, there are still a lot of unknowns about how cooking fumes affect us. To some extent, we simply have to accept them as a byproduct of enjoying our favorite foods, much like we accept pet hair as a part of having a furry friend. €œYou start realizing how pollutants are a part of our life,” Seals says.

€œLet’s reduce pollution wherever we can can you buy lasix. But I’m not going to give up my dog and I’m not going to stop cooking.”[Correction. A previous version of this story erroneously stated the findings of Holm's 2018 air quality study and the type of portable air purifier that Holm recommends using in homes. We apologize for the errors, which have been corrected in this current version.]A happy accident with a chocolate bar led can you buy lasix to one of the most reliable kitchen appliances around today. Engineer Percy Spencer was standing in front of a device emitting high-frequency radio waves when the chocolate in his shirt pocket began to melt.

The change led him and his colleagues to investigate what electromagnetic radiation could do to food, and the microwave was born in 1947.Since its earliest days, the technology has gotten smaller and lighter, and the kind of radiation used has shifted. Spencer’s discovery happened with radio waves, and the devices now rely can you buy lasix on microwave radiation to cook our meals. Despite the changes — and how permanent a fixture microwaves have become in households — some people are still uneasy around the devices and worry about potential health effects. €œAs a professor working in this area, safety is important to me,” says Vijaya Raghavan, a bioresource engineer at McGill University, who studies how industrial microwave settings can pasteurize and sterilize foods. Luckily, a lot of the safety concerns are handled by regulations, and there are simple ways for people to minimize the very small risks can you buy lasix they face.Microwaves Bring the HeatMicrowaves are a kind of radiation, just like infrared, visible light, and x-rays.

They are also relatively large. In terms of size and speed, microwaves are more like radio waves than they are the kind of light we see. Put to work inside kitchen appliances, the radiation is useful for can you buy lasix cooking food fast. Microwaves emit from one side of the appliance while it’s running and bounce around, reflecting off the metal interior and going into your meal. There, microwaves force all the water molecules in your food to move.

The spinning water molecules generate heat and voila — your leftovers, vegetables or frozen dinner gets cooked.When it can you buy lasix comes to making water molecules spin and create heat, microwaves don’t discriminate. They’ll do the same to your arm or leg, which is why microwave exposure can be dangerous. Exposure can burn skin. Eyes and testicles are particularly vulnerable, according to the Food and can you buy lasix Drug Administration, because there’s relatively little blood flow in the area to carry away the building heat. Highly-Controlled and Low RiskHowever, microwave burns only happen after someone has had a lot of exposure to the radiation — which is not something that will happen from your microwave oven.

For one, microwaves can only operate if the door is closed, per FDA requirements. As soon can you buy lasix as it opens, the radiation production stops. Any microwaves that were still within the device dissipate into the air right away, Raghavan says. Theoretically, a tiny bit of the microwaves could leak out of any cracks, like where the door shuts. But the FDA regulates seeping radiation, can you buy lasix too.

The amount of microwave radiation the agency lets the kitchen appliances emit is significantly less than how much cell phones are allowed to release — and the levels our smartphones can generate are also considered safe. And because any radiation coming out of an operating microwave starts to fall apart very quickly, someone would have to be standing practically up against the microwave for a long time for the rays to cause any damage. Sure, the can you buy lasix farther away from the microwave you are, the safer it is, Raghavan says. €œBut if you’re certain that a microwave unit is being used, why do you want to stand next to it anyways?. €In his own lab, Raghavan uses all kinds of microwave ovens to see how they can help with industrial food preparation.

He often can you buy lasix buys standard microwaves most people put in their homes and reworked them to create the wavelength frequency he needs. Raghavan also keeps track of how much power is generated in the first place as well as how much of the microwaves are absorbed by the food or reflected. Even in this laboratory setting, he and his colleagues don’t wear protective gear. Instead, they put can you buy lasix leakage meters near the devices. People at home probably don’t need to stand right next to the microwave, as Raghavan points out.

Also, don’t run it without anything inside. The microwaves will bounce back can you buy lasix and damage the internal mechanisms that help transmit the microwaves, Raghavan says. And if you find your microwave keeps running once you open the door, remove it and get a new model — you don’t want to be Percy Spencer and find that radiation is melting your pocket chocolate.Part one of this article began with a light-hearted anecdote about Count Volta sticking electrodes in his ears. Part two takes a more serious tone. Here, we address the reasons why can you buy lasix cochlear implants aren’t available to everyone, and why they are nearly inaccessible to those who need them most in the developing world.

The most pressing barriers that prevent adults and children in developing countries from accessing the benefits of cochlear implants are plain enough. (1) the high cost of cochlear implant components. (2) the complexity and skill level required to perform can you buy lasix the surgery. And (3) the lack of local post-operative rehab services and expertise. Fortunately, there’s a light at the end of the tunnel.

In part two of this article, we look at can you buy lasix the tremendous efforts of nonprofit groups to overcome these barriers to cochlear implants in developing countries. We also look at an experimental (yet controversial) approach to cochlear implants that could dramatically reduce the cost and complexity of implant components and surgeries. Why Access to Cochlear Implants Is So Important for Children Cochlear implants can offer life-transforming help to adults with hearing loss, but they are even more important for children. That’s because children with hearing loss have a limited period of time in which to develop speech can you buy lasix and listening skills. If a hearing problem isn’t addressed with hearing aids or cochlear implants by the age of 3 (and preferably earlier), children with serious hearing conditions may not be able to develop auditory and speech skills naturally.

Without listening and spoken language skills, it is more difficult for children with deafness and profound hearing loss to attend mainstream school or fully participate in their hearing communities. Tragically, many can you buy lasix of these children in developing nations are miscategorized as intellectually disabled – when in fact, there is a shining, beautiful mind hidden behind their inability to communicate. Photo Courtesy of the Global Foundation For Children With Hearing Loss According to Paige Stringer, Executive Director of the Global Foundation For Children With Hearing Loss (GFCHL). €œIt is essential that hearing loss be identified as early as possible in newborns and young children so they can get the hearing technology and early intervention support they need to learn to listen and speak. For a child to develop on par with typically hearing can you buy lasix peers in the areas of speech, language, and audition, they must have access to the sounds of speech.

Early access to hearing aids or cochlear implants is key for successful outcomes.” A landmark 2010 study echoes Stringer’s perspective by confirming what most in the hearing and speech-language professions already knew. The study found that children who receive cochlear implants before the age of 18 months achieved a speaking ability closer to that of hearing children. In contrast, those who received cochlear implants after the age of 3 continued to exhibit can you buy lasix certain gaps in speaking ability compared to children without hearing loss. In developing countries, where access to cochlear implants and hearing aids is scarce, some deaf children may be able to attend schools where they can learn sign language and benefit from a specialized curriculum. But children in rural, undeveloped areas don’t tend to have this option.

Without cochlear implants, access to affordable hearing aids, or proper schooling, these children may not be able can you buy lasix to develop their language and communication skills in a mainstreamed environment. To say that these children face severe discrimination, social isolation, and extreme socio-economic challenges as a result of their hearing difficulties would be an understatement. Image source. BBC When children are born with hearing impairment and deafness in developed countries like the United States or the United Kingdom, technologies, therapies, and educational opportunities are more readily available and help to remove the barriers to living a can you buy lasix normal life. These children have the potential to grow up without impediments as developing children typically do.

Why Are Cochlear Implants Difficult to Access in Developing Countries?. There are three main reasons why cochlear implants are difficult to can you buy lasix access in developing countries. (1) the cost of the components and surgeries. (2) the complexity and surgical skill required to perform the procedures. And, (3) the need for can you buy lasix post-operative rehabilitation services.

(1) The High Cost of Cochlear Implant Components The cost of cochlear implant components and surgeries depends on a number of factors, but one thing is certain. The prices far exceed what the average person in a developing country can afford. In the United States, the components alone – without factoring in surgical costs – can you buy lasix can exceed $25,000 per ear, and total costs with surgery can exceed $80,000 per ear. In developed nations, private or national insurance usually covers these costs, so access isn’t an issue. In many Asian, African, and Latin American countries, the cost of cochlear implant components is less, but the prices are still prohibitively high.

In the article, “The Challenges of Starting can you buy lasix a Cochlear Implant Programme in a Developing Country,” Dr. Kumaresh Krishnamoorthy writes that Cochlear Implant components cost from $12,000 to $25,000 in India. With surgery, total costs come to $17,000 to $29,500. If you consider that the average Indian salary is $2,120 per year – and that these individuals are living paycheck to paycheck – it’s easy to see why cochlear implants are absolutely unaffordable for most Indians without any available government or insurance financial can you buy lasix support. According to Stringer.

€œThere are also the ongoing costs associated with cochlear implants after surgery – which includes a lifelong commitment to paying for post-op rehabilitation, replacement parts, servicing, and upgrades. Many families focus on the cost of the initial device and can you buy lasix surgery, but they don’t have the means to pay for these ongoing costs.” As Krishnamoorthy points out. €œCochlear implants are a proven auditory rehabilitative option for individuals with severe to profound sensorineural hearing loss, who otherwise do not benefit from hearing aids. Nevertheless, only a small percentage of these individuals receive cochlear implants, and cost remains a leading prohibitive factor, particularly in developing countries […] the technology is virtually unavailable to the masses.” Unfortunately, even though many developing countries have government-sponsored cochlear implant programs, most do not have enough surgeons or facilities – or rehabilitation support post-surgery – to service all of the people who need them. (2) The Complexity and Skill Level Required to Perform Cochlear Implant Surgeries Once fully trained, a neurotologist can you buy lasix can safely perform a cochlear implant procedure, but the surgical training is long, involved, and expensive – and it’s only available in developed countries.

As a result, there are not enough surgeons in developing countries who can safely perform cochlear implant procedures. Image Source. Blausen.com staff can you buy lasix (2014). €œMedical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2).

DOI:10.15347/wjm/2014.010. ISSN 2002-4436. When you see the steps involved, it’s easy to understand the complexity of the procedure. Administer general anesthesia. General anesthesia is required during the two- to four-hour procedure.

Make an incision behind the ear. The surgeon makes an incision behind the ear to expose the mastoid bone. Identify the facial nerves. The surgeon finds the facial nerves and drills an opening between them through the mastoid bone to expose the cochlea. Place the electrode array.

The surgeon opens the cochlea and threads the electrode array into the cochlea. Place the receiver. The surgeon makes a shallow indentation into the skull behind the ear and fixes the round, flat receiver into the bone just beneath the ear. Close the incisions. The surgeon closes the incisions and the procedure is complete.

Considering these steps, the cochlear implant procedure is neither “simple” nor “easy” to perform. It requires general anesthesia, drilling through the mastoid bone, and the removal of a portion of the skull. There is also the risk of facial nerve damage. While the use of surgical robots for cochlear implant procedures could reduce the skill requirement, this technology is still largely inaccessible in developing countries. As we will discuss in further detail below, there is the possibility that an experimental cochlear implant design could one day reduce the cost and surgical complexity associated with this technology.

(3) The Need for Post-Operative Rehabilitation and Training Beyond the cost and complexity of cochlear implant surgeries, implant recipients need several months – or years in the case of infants and young children – of training as they learn to recognize sounds and understand speech. For children, speech-language therapy is particularly important. This training requirement often prevents those living in rural areas from getting cochlear implants – simply because they cannot access an in-person therapist for post-op rehab and speech-language training. Stringer from GFCHL offered the following perspectives on this. €œCochlear implant technology is not a stand-alone solution.

It is an intensive medical device that needs a lot of support. CIs are not like glasses where you put them on and instantly see better. A CI is just a tool to enable access to the sounds of speech. There is a great deal of rehabilitation involved after the CI surgery, particularly in young children, to fully benefit from it.” Getting cochlear implants to those who need them isn’t just a question of funding and sourcing surgeons. To make this technology available to more people in developing countries, national governments also need to conquer the serious logistical challenge of building a medical infrastructure that (1) has enough skilled surgeons and surgical facilities to serve everyone.

And (2) has enough local training facilities where cochlear implant recipients can receive post-operative rehab and speech-language therapy. (4) The Lack of Awareness Surrounding the Benefits of Cochlear Implants There is also a lack of awareness surrounding (1) the need to screen babies and young children for signs of deafness, and (2) the benefits of cochlear implants and hearing aids when treating deafness and other hearing conditions. Without a general understanding of these issues, children born with hearing loss may never be identified – and even if they are identified, parents may not be aware that treatments and therapies are available. As for adults with hearing loss, they also might not realize that they are suffering from hearing loss – and if they do realize it, they might not know that a pair of hearing aids or cochlear implants can dramatically improve their lives. Incidentally, this lack of awareness is also a problem in the developed world, but adults – no matter where they are – can quickly assess their level of hearing loss by taking a free online hearing test.

If you’re curious to check your hearing, here’s a free, 5-minute hearing test from MDHearingAid. Overcoming the Challenges of Cochlear Implant Access The most common approach to overcoming the lack of access to cochlear implants is to increase nonprofit support and international aid for government cochlear implant programs. This involves helping developing nations overcome the logistical challenges of sourcing surgeons, establishing surgical and post-operative facilities, and educating the public on hearing loss treatment options. A second approach to increasing access involves a radical rethinking of the technology and its surgical techniques. By redesigning cochlear implants to be more affordable – and making surgeries simpler and less invasive – overcoming the cost and logistical challenges of cochlear implants becomes a great deal easier.

(1) Nonprofit Efforts to Boost Cochlear Implant Access in Developing Countries There aren’t many organizations expressly dedicated to increasing access to cochlear implants to children in developing countries. However, the Global Foundation for Children with Hearing Loss (GFCHL) is one such organization that’s passionately engaged with achieving this goal. Led by its Founder and Executive Director Page Stringer – a public health specialist and cochlear implant recipient herself – GFCHL has a mission to bring direct and lasting change for babies and young children who are deaf or hard of hearing and living in developing countries. Watch this video from Stringer to get a sense for the organization. According to Stringer.

€œA sustainable cochlear implant program in a country requires LOCALLY based expertise and services in cochlear implant surgery, audiology, cochlear implant mapping, auditory-verbal therapy, and early intervention. Not only do parents and family members need access to professional expertise and support, but they also need ongoing servicing and equipment. In many developing countries, these elements are lacking. There is also the high cost of all the elements, which makes it challenging for many families to afford if there is no insurance or government subsidy to support it.” Photo Courtesy of the Global Foundation For Children With Hearing Loss Stringer says that bringing hearing technology to children in developing countries is a two-fold effort. Raising awareness.

Helping governments, local health administrations, caregivers, and the community at large understand that children with hearing loss can learn to listen and speak when they receive the proper support at an early enough stage. This is a process of educating and involving family members and caregivers while raising awareness among the general public. Organization and Logistics. Offering training programs that help developing countries establish local services and professional expertise. This is a process of showing countries how to develop screening programs that support early identification, encouraging timely fitting of hearing aids and cochlear implants, and ensuring access to locally-based professionals – such as audiologists, cochlear implant specialists, and speech therapists.

With programs in Vietnam, Bhutan, and Mongolia, and previously in Ecuador, the efforts of GFCHL have made possible. The training of hundreds of teachers, therapists, and medical professionals Educational support about hearing loss in children for hundreds of families The fitting of over 400 children with digital hearing aids with ongoing support from professionals trained by GFCHL The GFCHL has also partnered with the global hearing care organization Hear the World Foundation (the charitable arm of Sonova that manufactures Advanced Bionics cochlear implants) to provide 10 Vietnamese children in need with cochlear implants along with 15 years of complimentary audiology support and technical upgrades. The children also receive complementary auditory-verbal therapy support by Vietnamese professionals trained by GFCHL for several years. Other organizations are also involved in providing hearing aid assistance to those in need. For example, key leadership from the affordable hearing aid manufacturer MDHearingAid (CEO Doug Breaker and VP of Product Sourcing Paul Bryant) recently helped sponsor the AllHear Foundation’s 2020 mission to Belize.

The AllHear Foundation completed 100 free hearing tests and provided 91 free hearing aids to those in need. Image source. AllHear Foundation, Photos of Hearing Loss Patients in Belize, Photo Dr. Chip Goldsmith (Center Left) with Patient (Right) The Belize mission with AllHear Foundation was MDHearingAid’s first participation in an overseas project. Locally, MDHearingAid also partnered with H.O.M.E.

To give away $100,000 worth of hearing aids to Chicago seniors in need. MDHearingAid says it will participate in more overseas and local missions to provide further hearing assistance in the future. Doug Breaker, MDHearing CEO commented, “Giving back is very important to us. Our mission is to provide affordable, high-quality hearing aids to as many people as possible. As part of that, we give to those in need whenever we can, and hope to expand those efforts in the future.” According to Stringer, overcoming the financial, organizational, and logistical challenges of providing hearing assistance to children in developing countries takes time.

Nevertheless, the profound results of GFCHL’s efforts – and those of other organizations – can already be seen. (2) An Experimental Technology that Could Make Cochlear Implants More Accessible So far, we’ve discussed how nonprofit groups are working to bring cochlear implants to more people around the world. However, there could be another way to boost access to cochlear implants even more. This involves a fundamental redesign of cochlear implant technology to make the devices more affordable to buy and the surgical techniques easier and safer to perform. We reached out to Dr.

Chip Goldsmith, a neurotologist and cochlear implant surgeon who founded the nonprofit AllHear Foundation, to learn more about the latest in low-cost cochlear implant design. Goldsmith is working on an experimental – yet safer and more cost-effective – approach to cochlear implants. According to Goldsmith, the larger medical community views his approach with skepticism, but he believes that once fully developed and tested in patient trials, his design could dramatically improve access to cochlear implants for those living in low- to medium-income countries. Goldsmith’s ideas center around the question of whether the long, multi-channel electrode arrays in modern cochlear implants are necessary. Neurotologists usually agree that a multi-channel cochlear implant is required to stimulate key areas of the cochlea.

Without this specific stimulation, they believe that perceiving speech and other complex sounds isn’t possible (see part one of this article to understand how conventional cochlear implants work). Unfortunately, the multi-channel requirement makes cochlear implants expensive to manufacture, and the surgery is invasive and difficult to perform. Moreover, inserting the long, multi-channel electrode array into the cochlea usually destroys any natural hearing ability the patient still has. According to Goldsmith, his late mentor, Dr. William F.

House (who is credited as one of the inventors of cochlear implants), believed in a different approach to cochlear implant design. Dr. House maintained that a short, single-channel cochlear implant could serve as an affordable, less invasive solution to treat hearing loss. Goldsmith adds that “Dr. House was known as the Father of Neurotology, and he was not too often wrong with his theories.” Image Source.

Edited Image from Advanced Bionics As a continuation of Dr. House’s ideas, Goldsmith argues that we can achieve similar treatment results using a tiny cochlear implant with a short, single-channel electrode array, instead of a long, multi-channel array. Goldsmith alleges that – even with a short, single-channel implant – the brain has the ability to interpret sounds with sufficient clarity to understand speech and experience a rich complexity of sounds. Putting he and Dr. House’s theories into practice, Goldsmith has designed an affordable, single-channel cochlear implant that – after human trials and development – could retail for about $1,800, representing a considerable savings over the cost of conventional implants.

The device is so tiny that the surgery for installing it is far less invasive and less complicated than traditional cochlear implant surgeries. Unlike conventional cochlear implants, installing the device would not pose a risk to the patient’s remaining hearing capabilities. Note the tiny size of Goldsmith’s single-channel implant compared to a multi-channel device. Image source. AllHear Foundation According to Goldsmith.

€œOur smaller and far less expensive cochlear implant system can be inserted through a simpler trans-canal surgical approach that goes through the ear canal and eardrum. This ‘transtympanic’ procedure is safer than conventional cochlear implant surgeries because it does not require drilling through the mastoid bone or skull. We have also demonstrated that this procedure can be performed under local anesthesia.” Goldsmith also wanted to add the following. €œI worked with Dr. House on his AllHear short electrode system for many years, and my AllHear Foundation is named after this implant.

My transtympanic configuration is merely an offshoot of Dr. House’s fundamental theories.” At this time, Goldsmith’s team has built a new sound processor for single-channel implant recipients. Researchers are currently retrofitting patients who received one of Dr. House’s single-channel implants with this sound processor. If they can improve the hearing of these patients, they will adapt the new sound processor to fit Dr.

Goldsmith’s transtympanic configuration. Goldsmith’s single-channel cochlear implant still requires extensive trials and testing – and the technology needs to gain acceptance and approval from the larger medical community. However, we spoke with Brandy Klann, MA, a cochlear implant audiologist at the Michigan Ear Institute who offered the following. "Dr. Goldsmith's ideas are intriguing.

I look forward to seeing the clinical trial data on his single-channel cochlear implant." It is encouraging to see that certain medical innovators are working to make cochlear implants more affordable and accessible to everyone – especially when efforts like these are often hindered by a lack of funding and support from governments and the industry at large. Final Thoughts To think that the road to overcoming deafness and hearing loss began with scientists like Allessandro Volta, Giuseppe Veratti, and Benjamin Wilson sticking electrodes in their ears over 200 years ago – and to see where we’re at today – is absolutely inspiring. Considering what we've already achieved, the barriers to cochlear implant access in developing countries are not insurmountable. We have all the technology and organizational tools at our disposal to make this miraculous technology available to everyone – regardless of their economic status. All we need is the continued determination of organizations like the Global Foundation for Children with Hearing Loss, Hear the World Foundation, and AllHear Foundation, and innovative physicians like Dr.

Chip Goldsmith, who are willing to think outside the box. Like a ripple effect, their efforts will bring transformative assistance to more children and adults with hearing loss, until eventually, no one is left behind. This article was sponsored in full by MDHearingAid, a hearing aid manufacturer that offers high-quality, affordable, FDA-registered hearing aids for a fraction of the cost of traditional aids. By selling its medical-grade hearing aids directly to consumers for just $399.98 to $999.99 a pair, MDHearingAid cuts out the middleman – transferring thousands of dollars in cost savings to its customers. This has opened the door to effective hearing loss treatment for millions of people who couldn’t previously afford to purchase hearing aids.

If you’d like to support MDHearingAid in its mission to break the cost barriers associated with hearing loss treatment, tell your friends and family who need hearing aids about MDHearingAid and its affordable product line. Also, if you want to check your hearing to see if you could benefit from a pair of aids, click this link to take a free 5-minute hearing test from MDHearingAid now. Biography Fascinated by emerging science, Jeremy Hillpot’s background in consumer litigation and technology offers a unique perspective on the latest developments in medical science, agrotechnology, blockchain, data engineering, app development, and the law. Contact Jeremy at jhillpot@legalwritingFINRA.com or follow him on Quora..

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Abstract Background lasix 500mg. The burden of mental illness among the scheduled tribe (ST) population in India is not known clearly.Aim. The aim was to identify and appraise mental health research studies on ST population in India and collate such data to inform future research.Materials and Methods lasix 500mg. Studies published between January 1980 and December 2018 on STs by following exclusion and inclusion criteria were selected for analysis. PubMed, PsychINFO, Embase, Sociofile, Cinhal, and Google Scholar were systematically lasix 500mg searched to identify relevant studies.

Quality of the included studies was assessed using an appraisal tool to assess the quality of cross-sectional studies and Critical Appraisal Checklist developed by Critical Appraisal Skills Programme. Studies were summarized and reported descriptively.Results. Thirty-two relevant studies were found and lasix 500mg included in the review. Studies were categorized into the following three thematic areas. Alcohol and substance use disorders, lasix 500mg common mental disorders and sociocultural aspects, and access to mental health-care services.

Sociocultural factors play a major role in understanding and determining mental disorders.Conclusion. This study is the first of its kind to lasix 500mg review research on mental health among the STs. Mental health research conducted among STs in India is limited and is mostly of low-to-moderate quality. Determinants of poor mental health and interventions for addressing them need to be studied on an urgent basis.Keywords. India, mental health, scheduled tribesHow to cite this article:Devarapalli S V, Kallakuri lasix 500mg S, Salam A, Maulik PK.

Mental health research on scheduled tribes in India. Indian J Psychiatry lasix 500mg 2020;62:617-30 Introduction Mental health is a highly neglected area particularly in low and middle-income countries (LMIC). Data from community-based studies showed that about 10% of people suffer from common mental disorders (CMDs) such as depression, anxiety, and somatic complaints.[1] A systematic review of epidemiological studies between 1960 and 2009 in India reported that about 20% of the adult population in the community are affected by psychiatric disorders in the community, ranging from 9.5 to 103/1000 population, with differences in case definitions, and methods of data collection, accounting for most of the variation in estimates.[2]The scheduled tribes (ST) population is a marginalized community and live in relative social isolation with poorer health indices compared to similar nontribal populations.[3] There are an estimated 90 million STs or Adivasis in India.[4] They constitute 8.6% of the total Indian population. The distribution varies across the states and union territories of India, with the highest percentage in Lakshadweep (94.8%) followed by Mizoram (94.4%). In northeastern lasix 500mg states, they constitute 65% or more of the total population.[5] The ST communities are identified as culturally or ethnographically unique by the Indian Constitution.

They are populations with poorer health indicators and fewer health-care facilities compared to non-ST rural populations, even when within the same state, and often live in demarcated geographical areas known as ST areas.[4]As per the National Family Health Survey, 2015–2016, the health indicators such as infant mortality rate (IMR) is 44.4, under five mortality rate (U5MR) is 57.2, and anemia in women is 59.8 for STs – one of the most disadvantaged socioeconomic groups in India, which are worse compared to other populations where IMR is 40.7, U5MR is 49.7, and anemia in women among others is 53.0 in the same areas.[6] Little research is available on the health of ST population. Tribal mental health lasix 500mg is an ignored and neglected area in the field of health-care services. Further, little data are available about the burden of mental disorders among the tribal communities. Health research on tribal populations is poor, globally.[7] Irrespective of the data available, it lasix 500mg is clear that they have worse health indicators and less access to health facilities.[8] Even less is known about the burden of mental disorders in ST population. It is also found that the traditional livelihood system of the STs came into conflict with the forces of modernization, resulting not only in the loss of customary rights over the livelihood resources but also in subordination and further, developing low self-esteem, causing great psychological stress.[4] This community has poor health infrastructure and even less mental health resources, and the situation is worse when compared to other communities living in similar areas.[9],[10]Only 15%–25% of those affected with mental disorders in LMICs receive any treatment for their mental illness,[11] resulting in a large “treatment gap.”[12] Treatment gaps are more in rural populations,[13] especially in ST communities in India, which have particularly poor infrastructure and resources for health-care delivery in general, and almost no capacity for providing mental health care.[14]The aim of this systematic review was to explore the extent and nature of mental health research on ST population in India and to identify gaps and inform future research.

Materials and Methods Search strategyWe searched major databases (PubMed, PsychINFO, Embase, Sociofile, Cinhal, and Google Scholar) and made hand searches from January 1980 to December 2018 to identify relevant literature. Hand search refers to searching through medical journals which are not lasix 500mg indexed in the major electronic databases such as Embase, for instance, searching for Indian journals in IndMed database as most of these journals are not available in major databases. Physical search refers to searching the journals that were not available online or were not available online during the study years. We used relevant Medical lasix 500mg Subject Heading and key terms in our search strategy, as follows. €œMental health,” “Mental disorders,” “Mental illness,” “Psychiatry,” “Scheduled Tribe” OR “Tribe” OR “Tribal Population” OR “Indigenous population,” “India,” “Psych*” (Psychiatric, psychological, psychosis).Inclusion criteriaStudies published between January 1980 and December 2018 were included.

Studies on mental disorders were included only when they focused on ST lasix 500mg population. Both qualitative and quantitative studies on mental disorders of ST population only were included in the analysis.Exclusion criteriaStudies without any primary data and which are merely overviews and commentaries and those not focused on ST population were excluded from the analysis.Data management and analysisTwo researchers (SD and SK) initially screened the title and abstract of each record to identify relevant papers and subsequently screened full text of those relevant papers. Any disagreements between the researchers were resolved by discussion or by consulting with an adjudicator (PKM). From each study, data were extracted on objectives, study design, study population, study duration, lasix 500mg interventions (if applicable), outcomes, and results. Quality of the included studies was assessed, independently by three researchers (SD, SK, and AS), using Critical Appraisal Checklist developed by Critical Appraisal Skills Programme (CASP).[15] After a thorough qualitative assessment, all quantitative data were generated and tabulated.

A narrative description of the lasix 500mg studies is provided in [Table 1] using some broad categories. Results Search resultsOur search retrieved 2306 records (which included hand-searched articles), of which after removing duplicates, title and abstracts of 2278 records were screened. Of these, 178 studies were deemed as potentially relevant and were reviewed in detail. Finally, we excluded 146 irrelevant studies and 32 studies were included in the review [Figure 1].Quality of the included studiesSummary of quality assessment of the included studies is reported lasix 500mg in [Table 2]. Overall, nine studies were of poor quality, twenty were of moderate quality, and three studies were of high quality.

The CASP shows that out of the 32 studies, the sample size of 21 studies was not representative, sample size of 7 studies was not justified, risk factors were not identified in 28 studies, methods lasix 500mg used were not sufficiently described to repeat them in 24 studies, and nonresponse reasons were not addressed in 24 studies. The most common reasons for studies to be of poor-quality included sample size not justified. Sample is lasix 500mg not representative. Nonresponse not addressed. Risk factors not measured correctly.

And methods used were not sufficiently described to repeat lasix 500mg them. Studies under the moderate quality did not have a representative sample. Non-responders categories was not addressed lasix 500mg. Risk factors were not measured correctly. And methods used were not sufficiently described to allow the study to be replicated by other researchers.The included studies covered three broad lasix 500mg categories.

Alcohol and substance use disorders, CMD (depression, anxiety, stress, and suicide risk), socio-cultural aspects, and access to mental health services.Alcohol and substance use disordersFive studies reviewed the consumption of alcohol and opioid. In an ethnographic study conducted in three western districts in Rajasthan, 200 opium users were interviewed. Opium consumption was common among lasix 500mg both younger and older males during nonharvest seasons. The common causes for using opium were relief of anxiety related to crop failure due to drought, stress, to get a high, be part of peers, and for increased sexual performance.[16]In a study conducted in Arunachal Pradesh involving a population of more than 5000 individuals, alcohol use was present in 30% and opium use in about 5% adults.[17] Contrary to that study, in Rajasthan, the prevalence of opium use was more in women and socioeconomic factors such as occupation, education, and marital status were associated with opium use.[16] The prevalence of opium use increased with age in both sexes, decreased with increasing education level, and increased with employment. It was observed that wages were used lasix 500mg to buy opium.

In the entire region of Chamlang district of Arunachal Pradesh, female substance users were almost half of the males among ST population.[17] Types of substance used were tobacco, alcohol, and opium. Among tobacco users, oral tobacco use was higher than smoking. The prevalence of tobacco use was higher among males, but the prevalence of alcohol use was higher in lasix 500mg females, probably due to increased access to homemade rice brew generally prepared by women. This study is unique in terms of finding a strong association with religion and culture with substance use.[18]Alcohol consumption among Paniyas of Wayanad district in Kerala is perceived as a male activity, with many younger people consuming it than earlier. A study concluded that alcohol consumption among them was less of a “choice” than a result of their lasix 500mg conditions operating through different mechanisms.

In the past, drinking was traditionally common among elderly males, however the consumption pattern has changed as a significant number of younger men are now drinking. Drinking was clustered within lasix 500mg families as fathers and sons drank together. Alcohol is easily accessible as government itself provides opportunities. Some employers would provide alcohol as an incentive to attract Paniya men to work for them.[19]In a study from Jharkhand, several ST community members cited reasons associated with social enhancement and coping with distressing emotions rather than individual enhancement, as a reason for consuming alcohol. Societal acceptance of drinking alcohol and peer pressure, as well as high emotional problems, appeared to be the major etiology leading to higher prevalence of substance dependence in tribal communities.[20] Another study found high life time alcohol use prevalence, and the reasons mentioned were increased poverty, illiteracy, increased stress, and peer pressure.[21] A household survey from Chamlang district of Arunachal Pradesh revealed that there was a strong association between opium use and age, occupation, marital status, religion, and ethnicity among both the sexes of STs, particularly among Singhpho and Khamti.[15] The average age of onset of tobacco use was found to be 16.4 years for smoked and 17.5 years for smokeless forms in one study.[22]Common mental disorders and socio-cultural aspectsSuicide was more common among Idu Mishmi in Roing and Anini districts of Arunachal Pradesh state (14.2%) compared to the urban population lasix 500mg in general (0.4%–4.2%).

Suicides were associated with depression, anxiety, alcoholism, and eating disorders. Of all the factors, depression was significantly high in people who lasix 500mg attempted suicide.[24] About 5% out of 5007 people from thirty villages comprising ST suffered from CMDs in a study from West Godavari district in rural Andhra Pradesh. CMDs were defined as moderate/severe depression and/or anxiety, stress, and increased suicidal risk. Women had a higher prevalence of depression, but this may be due to the cultural norms, as men are less likely to express symptoms of lasix 500mg depression or anxiety, which leads to underreporting. Marital status, education, and age were prominently associated with CMD.[14] In another study, gender, illiteracy, infant mortality in the household, having <3 adults living in the household, large family size with >four children, morbidity, and having two or more life events in the last year were associated with increased prevalence of CMD.[24] Urban and rural ST from the same community of Bhutias of Sikkim were examined, and it was found that the urban population experienced higher perceived stress compared to their rural counterparts.[25] Age, current use of alcohol, poor educational status, marital status, social groups, and comorbidities were the main determinants of tobacco use and nicotine dependence in a study from the Andaman and Nicobar Islands.[22] A study conducted among adolescents in the schools of rural areas of Ranchi district in Jharkhand revealed that about 5% children from the ST communities had emotional symptoms, 9.6% children had conduct problems, 4.2% had hyperactivity, and 1.4% had significant peer problems.[27] A study conducted among the female school teachers in Jharkhand examined the effects of stress, marital status, and ethnicity upon the mental health of school teachers.

The study found that among the three factors namely stress, marital status, and ethnicity, ethnicity was found to affect mental health of the school teachers most. It found a positive relationship between mental health and socioeconomic status, with an inverse relationship showing that as income increased, the prevalence lasix 500mg of depression decreased.[28] A study among Ao-Nagas in Nagaland found that 74.6% of the population attributed mental health problems to psycho-social factors and a considerable proportion chose a psychiatrist or psychologist to overcome the problem. However, 15.4% attributed mental disorders to evil spirits. About 47% preferred to seek treatment with lasix 500mg a psychiatrist and 25% preferred prayers. Nearly 10.6% wanted to seek the help of both the psychiatrist and prayer group and 4.4% preferred traditional healers.[28],[29] The prevalence of Down syndrome among the ST in Chikhalia in Barwani district of Madhya Pradesh was higher than that reported in overall India.

Three-fourth of the children were the first-born child. None of the parents of lasix 500mg children with Down syndrome had consanguineous marriage or a history of Down syndrome, intellectual disability, or any other neurological disorder such as cerebral palsy and epilepsy in preceding generations. It is known that tribal population is highly impoverished and disadvantaged in several ways and suffer proportionately higher burden of nutritional and genetic disorders, which are potential factors for Down syndrome.[30]Access to mental health-care servicesIn a study in Ranchi district of Jharkhand, it was found that most people consulted faith healers rather than qualified medical practitioners. There are few mental health services in the regions.[31] Among ST population, there was less reliance and belief in modern medicine, and it was also not easily accessible, thus the health-care systems must be more holistic and take care of cultural and local health practices.[32]The Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health project was implemented in thirty lasix 500mg ST villages in West Godavari District of Andhra Pradesh. The key objectives were to use task sharing, training of primary health workers, implementing evidence-based clinical decision support tools on a mobile platform, and providing mental health services to rural population.

The study included 238 lasix 500mg adults suffering from CMD. During the intervention period, 12.6% visited the primary health-care doctors compared to only 0.8% who had sought any care for their mental disorders prior to the intervention. The study also found a significant reduction in the depression and anxiety scores at the end of intervention and improvements in stigma perceptions related to mental health.[14] A study in Gudalur and Pandalur Taluks of Nilgiri district from Tamil Nadu used low cost task shifting by providing community education and identifying and referring individuals with psychiatric problems as effective strategies for treating mental disorders in ST communities. Through the program, the health workers established a network within the village, which in turn helped the patients to interact with them lasix 500mg freely. Consenting patients volunteered at the educational sessions to discuss their experience about the effectiveness of their treatment.

Community awareness programs altered knowledge and attitudes toward mental lasix 500mg illness in the community.[33] A study in Nilgiri district, Tamil Nadu, found that the community had been taking responsibility of the patients with the system by providing treatment closer to home without people having to travel long distances to access care. Expenses were reduced by subsidizing the costs of medicine and ensuring free hospital admissions and referrals to the people.[34] A study on the impact of gender, socioeconomic status, and age on mental health of female factory workers in Jharkhand found that the ST women were more likely to face stress and hardship in life due to diverse economic and household responsibilities, which, in turn, severely affected their mental health.[35] Prevalence of mental health morbidity in a study from the Sunderbans delta found a positive relation with psycho-social stressors and poor quality of life. The health system in that lasix 500mg remote area was largely managed by “quack doctors” and faith healers. Poverty, illiteracy, and detachment from the larger community helped reinforce superstitious beliefs and made them seek both mental and physical health care from faith healers.[36] In a study among students, it was found that children had difficulties in adjusting to both ethnic and mainstream culture.[27] Low family income, inadequate housing, poor sanitation, and unhealthy and unhygienic living conditions were some environmental factors contributing to poor physical and mental growth of children. It was observed that children who did not have such risk factors maintained more intimate relations with the family members.

Children belonging to the disadvantaged environment expressed their verbal, emotional lasix 500mg need, blame, and harm avoidances more freely than their counterparts belonging to less disadvantaged backgrounds. Although disadvantaged children had poor interfamilial interaction, they had better relations with the members outside family, such as peers, friends, and neighbors.[37] Another study in Jharkhand found that epilepsy was higher among ST patients compared to non-ST patients.[31] Most patients among the ST are irregular and dropout rates are higher among them than the non-ST patients. Urbanization per se exerted lasix 500mg no adverse influence on the mental health of a tribal community, provided it allowed preservation of ethnic and cultural practices. Women in the ST communities were less vulnerable to mental illness than men. This might be a reflection of their increased responsibilities and enhanced gender roles that are characteristic of women in many ST communities.[38] Data obtained using culturally relevant scales revealed that relocated Sahariya suffer a lot of mental health problems, which are partially explained by livelihood and poverty-related factors.

The loss of homes and displacement compromise mental health, especially the positive emotional well-being related to happiness, life lasix 500mg satisfaction, optimism for future, and spiritual contentment. These are often not overcome even with good relocation programs focused on material compensation and livelihood re-establishment.[39] Discussion This systematic review is to our knowledge the first on mental health of ST population in India. Few studies lasix 500mg on the mental health of ST were available. All attempts including hand searching were made to recover both published peer-reviewed papers and reports available on the website. Though we searched gray literature, it may be possible that it lasix 500mg does not capture all articles.

Given the heterogeneity of the papers, it was not possible to do a meta-analysis, so a narrative review was done.The quality of the studies was assessed by CASP. The assessment shows that the research conducted on mental health of STs needs to be carried out more effectively. The above mentioned gaps need to lasix 500mg be filled in future research by considering the resources effectively while conducting the studies. Mental and substance use disorders contribute majorly to the health disparities. To address this, one needs to deliver evidence-based treatments, but it is important to understand how far these interventions for the indigenous populations can incorporate cultural practices, which are essential for the development of mental health services.[30] Evidence has shown a disproportionate burden of suicide among indigenous lasix 500mg populations in national and regional studies, and a global and systematic investigation of this topic has not been undertaken to date.

Previous reviews of suicide epidemiology among indigenous populations have tended to be less comprehensive or not systematic, and have often focused on subpopulations such as youth, high-income countries, or regions such as Oceania or the Arctic.[46] The only studies in our review which provided data on suicide were in Idu Mishmi, an isolated tribal population of North-East India, and tribal communities from Sunderban delta.[24],[37] Some reasons for suicide in these populations could be the poor identification of existing mental disorders, increased alcohol use, extreme poverty leading to increased debt and hopelessness, and lack of stable employment opportunities.[24],[37] The traditional consumption pattern of alcohol has changed due to the reasons associated with social enhancement and coping with distressing emotions rather than individual enhancement.[19],[20]Faith healers play a dominant role in treating mental disorders. There is less awareness about mental health and available mental health services and even if such knowledge is available, access is limited due to remoteness of many of these villages, and often it involves high out-of-pocket expenditure.[35] Practitioners of modern medicine can play a vital role in not only increasing awareness about mental health in the community, but lasix 500mg also engaging with faith healers and traditional medicine practitioners to help increase their capacity to identify and manage CMDs that do not need medications and can be managed through simple “talk therapy.” Knowledge on symptoms of severe mental disorders can also help such faith healers and traditional medicine practitioners to refer cases to primary care doctors or mental health professionals.Remote settlements make it difficult for ST communities to seek mental health care. Access needs to be increased by using solutions that use training of primary health workers and nonphysician health workers, task sharing, and technology-enabled clinical decision support tools.[3] The SMART Mental Health project was delivered in the tribal areas of Andhra Pradesh using those principles and was found to be beneficial by all stakeholders.[14]Given the lack of knowledge about mental health problems among these communities, the government and nongovernmental organizations should collect and disseminate data on mental disorders among the ST communities. More research funding needs to be provided and key stakeholders should be involved in creating awareness both in the community and among policy makers to develop more projects for ST communities around mental health. Two recent meetings on tribal mental health – Round Table Meeting on Mental Health of ST Populations organized by the George Institute for Global Health, India, in 2017,[51] and the First National Conference on Tribal Mental Health organized by the Indian Psychiatric Society in Bhubaneswar in 2018 – have identified some key areas of research priority for lasix 500mg mental health in ST communities.

A national-level policy on mental health of tribal communities or population is advocated which should be developed in consultation with key stakeholders. The Indian Psychiatric Society can play a role in coordinating research lasix 500mg activities with support of the government which can ensure regular monitoring and dissemination of the research impact to the tribal communities. There is a need to understand how mental health symptoms are perceived in different ST communities and investigate the healing practices associated with distress/disaster/death/loss/disease. This could be done in the form of cross-sectional or cohort studies to generate proper evidence which could also include the information on prevalence, mental health morbidity, and any specific patterns associated with a specific disorder. Future research should estimate the prevalence of mental lasix 500mg disorders in different age groups and gender, risk factors, and the influence of modernization.

Studies should develop a theoretical model to understand mental disorders and promote positive mental health within ST communities. Studies should also look at different ST communities as cultural differences exist across them, and there are also differences in socioeconomic status which impact on ability to access lasix 500mg care.Research has shown that the impact and the benefits are amplified when research is driven by priorities that are identified by indigenous communities and involve their active participation. Their knowledge and perspectives are incorporated in processes and findings. Reporting of findings is meaningful to the lasix 500mg communities. And indigenous groups and other key stakeholders are engaged from the outset.[47] Future research in India on ST communities should also adhere to these broad principles to ensure relevant and beneficial research, which have direct impact on the mental health of the ST communities.There is also a need to update literature related to mental health of ST population continuously.

Develop culturally appropriate validated instruments to measure mental morbidity relevant to ST population. And use qualitative research to investigate the perceptions and barriers for help-seeking behavior.[48] Conclusion The current review helps not only to collate the existing literature on the mental health of ST communities but also lasix 500mg identify gaps in knowledge and provide some indications about the type of research that should be funded in future.Financial support and sponsorshipNil.Conflicts of interestThere are no conflicts of interest. References 1.Gururaj G, Girish N, Isaac MK. Mental. Neurological and Substance abuse disorders.

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Psychiatric morbidity in an urbanized tribal (Santal) community - A field survey. Indian J Psychiatry 1986;28:243-8. [PUBMED] [Full text] 48.Leske S, Harris MG, Charlson FJ, Ferrari AJ, Baxter AJ, Logan JM, et al. Systematic review of interventions for Indigenous adults with mental and substance use disorders in Australia, Canada, New Zealand and the United States. Aust N Z J Psychiatry 2016;50:1040-54.

49.Pollock NJ, Naicker K, Loro A, Mulay S, Colman I. Global incidence of suicide among Indigenous peoples. A systematic review. BMC Med 2018;16:145. 50.Silburn K, et al.

Evaluation of the Cooperative Research Centre for Aboriginal Health (Australian institute for primary care, trans.). Melbourne. LaTrobe University. 2010. 51.

Correspondence Address:S V. Siddhardh Kumar DevarapalliGeorge Institute for Global Health, Plot No. 57, Second Floor, Corporation Bank Building, Nagarjuna Circle, Punjagutta, Hyderabad - 500 082, Telangana IndiaSource of Support. None, Conflict of Interest. NoneDOI.

10.4103/psychiatry.IndianJPsychiatry_136_19 Figures [Figure 1] Tables [Table 1], [Table 2].

Abstract Background can you buy lasix http://racheljenae.com/journal/life/courage/. The burden of mental illness among the scheduled tribe (ST) population in India is not known clearly.Aim. The aim was to identify and appraise mental health research studies on ST population can you buy lasix in India and collate such data to inform future research.Materials and Methods. Studies published between January 1980 and December 2018 on STs by following exclusion and inclusion criteria were selected for analysis.

PubMed, PsychINFO, Embase, Sociofile, can you buy lasix Cinhal, and Google Scholar were systematically searched to identify relevant studies. Quality of the included studies was assessed using an appraisal tool to assess the quality of cross-sectional studies and Critical Appraisal Checklist developed by Critical Appraisal Skills Programme. Studies were summarized and reported descriptively.Results. Thirty-two relevant studies were found and can you buy lasix included in the review.

Studies were categorized into the following three thematic areas. Alcohol and can you buy lasix substance use disorders, common mental disorders and sociocultural aspects, and access to mental health-care services. Sociocultural factors play a major role in understanding and determining mental disorders.Conclusion. This study is the first of its kind to can you buy lasix review research on mental health among the STs.

Mental health research conducted among STs in India is limited and is mostly of low-to-moderate quality. Determinants of poor mental health and interventions for addressing them need to be studied on an urgent basis.Keywords. India, mental health, scheduled tribesHow to cite this article:Devarapalli S V, can you buy lasix Kallakuri S, Salam A, Maulik PK. Mental health research on scheduled tribes in India.

Indian J Psychiatry 2020;62:617-30 Introduction Mental health is a highly neglected can you buy lasix area particularly in low and middle-income countries (LMIC). Data from community-based studies showed that about 10% of people suffer from common mental disorders (CMDs) such as depression, anxiety, and somatic complaints.[1] A systematic review of epidemiological studies between 1960 and 2009 in India reported that about 20% of the adult population in the community are affected by psychiatric disorders in the community, ranging from 9.5 to 103/1000 population, with differences in case definitions, and methods of data collection, accounting for most of the variation in estimates.[2]The scheduled tribes (ST) population is a marginalized community and live in relative social isolation with poorer health indices compared to similar nontribal populations.[3] There are an estimated 90 million STs or Adivasis in India.[4] They constitute 8.6% of the total Indian population. The distribution varies across the states and union territories of India, with the highest percentage in Lakshadweep (94.8%) followed by Mizoram (94.4%). In northeastern states, they constitute 65% or more can you buy lasix of the total population.[5] The ST communities are identified as culturally or ethnographically unique by the Indian Constitution.

They are populations with poorer health indicators and fewer health-care facilities compared to non-ST rural populations, even when within the same state, and often live in demarcated geographical areas known as ST areas.[4]As per the National Family Health Survey, 2015–2016, the health indicators such as infant mortality rate (IMR) is 44.4, under five mortality rate (U5MR) is 57.2, and anemia in women is 59.8 for STs – one of the most disadvantaged socioeconomic groups in India, which are worse compared to other populations where IMR is 40.7, U5MR is 49.7, and anemia in women among others is 53.0 in the same areas.[6] Little research is available on the health of ST population. Tribal mental health is can you buy lasix an ignored and neglected area in the field of health-care services. Further, little data are available about the burden of mental disorders among the tribal communities. Health research on tribal populations is poor, globally.[7] Irrespective of the data available, it is clear that they have worse health indicators and less access to health facilities.[8] Even less is can you buy lasix known about the burden of mental disorders in ST population.

It is also found that the traditional livelihood system of the STs came into conflict with the forces of modernization, resulting not only in the loss of customary rights over the livelihood resources but also in subordination and further, developing low self-esteem, causing great psychological stress.[4] This community has poor health infrastructure and even less mental health resources, and the situation is worse when compared to other communities living in similar areas.[9],[10]Only 15%–25% of those affected with mental disorders in LMICs receive any treatment for their mental illness,[11] resulting in a large “treatment gap.”[12] Treatment gaps are more in rural populations,[13] especially in ST communities in India, which have particularly poor infrastructure and resources for health-care delivery in general, and almost no capacity for providing mental health care.[14]The aim of this systematic review was to explore the extent and nature of mental health research on ST population in India and to identify gaps and inform future research. Materials and Methods Search strategyWe searched major databases (PubMed, PsychINFO, Embase, Sociofile, Cinhal, and Google Scholar) and made hand searches from January 1980 to December 2018 to identify relevant literature. Hand search can you buy lasix refers to searching through medical journals which are not indexed in the major electronic databases such as Embase, for instance, searching for Indian journals in IndMed database as most of these journals are not available in major databases. Physical search refers to searching the journals that were not available online or were not available online during the study years.

We used relevant Medical Subject Heading and key terms in our can you buy lasix search strategy, as follows. €œMental health,” “Mental disorders,” “Mental illness,” “Psychiatry,” “Scheduled Tribe” OR “Tribe” OR “Tribal Population” OR “Indigenous population,” “India,” “Psych*” (Psychiatric, psychological, psychosis).Inclusion criteriaStudies published between January 1980 and December 2018 were included. Studies on mental disorders were included only when they focused on ST can you buy lasix population. Both qualitative and quantitative studies on mental disorders of ST population only were included in the analysis.Exclusion criteriaStudies without any primary data and which are merely overviews and commentaries and those not focused on ST population were excluded from the analysis.Data management and analysisTwo researchers (SD and SK) initially screened the title and abstract of each record to identify relevant papers and subsequently screened full text of those relevant papers.

Any disagreements between the researchers were resolved by discussion or by consulting with an adjudicator (PKM). From each study, data were extracted on objectives, study design, study population, study duration, interventions (if applicable), can you buy lasix outcomes, and results. Quality of the included studies was assessed, independently by three researchers (SD, SK, and AS), using Critical Appraisal Checklist developed by Critical Appraisal Skills Programme (CASP).[15] After a thorough qualitative assessment, all quantitative data were generated and tabulated. A narrative description of the studies is provided in [Table 1] can you buy lasix using some broad categories.

Results Search resultsOur search retrieved 2306 records (which included hand-searched articles), of which after removing duplicates, title and abstracts of 2278 records were screened. Of these, 178 studies were deemed as potentially relevant and were reviewed in detail. Finally, we excluded 146 irrelevant studies and 32 studies were included in can you buy lasix the review [Figure 1].Quality of the included studiesSummary of quality assessment of the included studies is reported in [Table 2]. Overall, nine studies were of poor quality, twenty were of moderate quality, and three studies were of high quality.

The CASP shows that out of the 32 can you buy lasix studies, the sample size of 21 studies was not representative, sample size of 7 studies was not justified, risk factors were not identified in 28 studies, methods used were not sufficiently described to repeat them in 24 studies, and nonresponse reasons were not addressed in 24 studies. The most common reasons for studies to be of poor-quality included sample size not justified. Sample is not can you buy lasix representative. Nonresponse not addressed.

Risk factors not measured correctly. And methods used can you buy lasix were not sufficiently described to repeat them. Studies under the moderate quality did not have a representative sample. Non-responders categories was not addressed can you buy lasix.

Risk factors were not measured correctly. And methods used were not sufficiently described to allow the study to be replicated can you buy lasix by other researchers.The included studies covered three broad categories. Alcohol and substance use disorders, CMD (depression, anxiety, stress, and suicide risk), socio-cultural aspects, and access to mental health services.Alcohol and substance use disordersFive studies reviewed the consumption of alcohol and opioid. In an ethnographic study conducted in three western districts in Rajasthan, 200 opium users were interviewed.

Opium consumption was common among both can you buy lasix younger and older males during nonharvest seasons. The common causes for using opium were relief of anxiety related to crop failure due to drought, stress, to get a high, be part of peers, and for increased sexual performance.[16]In a study conducted in Arunachal Pradesh involving a population of more than 5000 individuals, alcohol use was present in 30% and opium use in about 5% adults.[17] Contrary to that study, in Rajasthan, the prevalence of opium use was more in women and socioeconomic factors such as occupation, education, and marital status were associated with opium use.[16] The prevalence of opium use increased with age in both sexes, decreased with increasing education level, and increased with employment. It was can you buy lasix observed that wages were used to buy opium. In the entire region of Chamlang district of Arunachal Pradesh, female substance users were almost half of the males among ST population.[17] Types of substance used were tobacco, alcohol, and opium.

Among tobacco users, oral tobacco use was higher than smoking. The prevalence of tobacco use was higher among can you buy lasix males, but the prevalence of alcohol use was higher in females, probably due to increased access to homemade rice brew generally prepared by women. This study is unique in terms of finding a strong association with religion and culture with substance use.[18]Alcohol consumption among Paniyas of Wayanad district in Kerala is perceived as a male activity, with many younger people consuming it than earlier. A study concluded that alcohol consumption among them was less of a can you buy lasix “choice” than a result of their conditions operating through different mechanisms.

In the past, drinking was traditionally common among elderly males, however the consumption pattern has changed as a significant number of younger men are now drinking. Drinking was can you buy lasix clustered within families as fathers and sons drank together. Alcohol is easily accessible as government itself provides opportunities. Some employers would provide alcohol as an incentive to attract Paniya men to work for them.[19]In a study from Jharkhand, several ST community members cited reasons associated with social enhancement and coping with distressing emotions rather than individual enhancement, as a reason for consuming alcohol.

Societal acceptance of drinking alcohol and peer pressure, as well as high emotional problems, appeared to be the major etiology leading to higher prevalence of substance dependence in tribal communities.[20] Another study found high life time alcohol use prevalence, and the reasons mentioned were increased poverty, illiteracy, increased stress, and peer pressure.[21] A household survey from Chamlang district of Arunachal Pradesh revealed that there was a strong association between opium use and age, occupation, marital status, religion, and ethnicity among both the sexes of STs, particularly among Singhpho and Khamti.[15] The average age of onset of tobacco use was found to be 16.4 years for smoked and 17.5 years for smokeless forms in one study.[22]Common mental disorders and socio-cultural aspectsSuicide was more common among Idu Mishmi in Roing and Anini districts of Arunachal Pradesh state (14.2%) compared to the can you buy lasix urban population in general (0.4%–4.2%). Suicides were associated with depression, anxiety, alcoholism, and eating disorders. Of all the factors, depression was can you buy lasix significantly high in people who attempted suicide.[24] About 5% out of 5007 people from thirty villages comprising ST suffered from CMDs in a study from West Godavari district in rural Andhra Pradesh. CMDs were defined as moderate/severe depression and/or anxiety, stress, and increased suicidal risk.

Women had a higher prevalence of depression, but this may be due to the cultural norms, as can you buy lasix men are less likely to express symptoms of depression or anxiety, which leads to underreporting. Marital status, education, and age were prominently associated with CMD.[14] In another study, gender, illiteracy, infant mortality in the household, having <3 adults living in the household, large family size with >four children, morbidity, and having two or more life events in the last year were associated with increased prevalence of CMD.[24] Urban and rural ST from the same community of Bhutias of Sikkim were examined, and it was found that the urban population experienced higher perceived stress compared to their rural counterparts.[25] Age, current use of alcohol, poor educational status, marital status, social groups, and comorbidities were the main determinants of tobacco use and nicotine dependence in a study from the Andaman and Nicobar Islands.[22] A study conducted among adolescents in the schools of rural areas of Ranchi district in Jharkhand revealed that about 5% children from the ST communities had emotional symptoms, 9.6% children had conduct problems, 4.2% had hyperactivity, and 1.4% had significant peer problems.[27] A study conducted among the female school teachers in Jharkhand examined the effects of stress, marital status, and ethnicity upon the mental health of school teachers. The study found that among the three factors namely stress, marital status, and ethnicity, ethnicity was found to affect mental health of the school teachers most. It found a positive relationship between mental health and socioeconomic status, with an inverse relationship showing that as income increased, the prevalence of depression decreased.[28] A study among Ao-Nagas in Nagaland found can you buy lasix that 74.6% of the population attributed mental health problems to psycho-social factors and a considerable proportion chose a psychiatrist or psychologist to overcome the problem.

However, 15.4% attributed mental disorders to evil spirits. About 47% preferred to seek treatment with a psychiatrist and can you buy lasix 25% preferred prayers. Nearly 10.6% wanted to seek the help of both the psychiatrist and prayer group and 4.4% preferred traditional healers.[28],[29] The prevalence of Down syndrome among the ST in Chikhalia in Barwani district of Madhya Pradesh was higher than that reported in overall India. Three-fourth of the children were the first-born child.

None of can you buy lasix the parents of children with Down syndrome had consanguineous marriage or a history of Down syndrome, intellectual disability, or any other neurological disorder such as cerebral palsy and epilepsy in preceding generations. It is known that tribal population is highly impoverished and disadvantaged in several ways and suffer proportionately higher burden of nutritional and genetic disorders, which are potential factors for Down syndrome.[30]Access to mental health-care servicesIn a study in Ranchi district of Jharkhand, it was found that most people consulted faith healers rather than qualified medical practitioners. There are few mental health services in the regions.[31] Among ST population, there was less reliance and belief in modern medicine, and it was also not easily accessible, thus the health-care systems must be more holistic and take care of cultural and local health practices.[32]The Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health project was implemented in thirty ST can you buy lasix villages in West Godavari District of Andhra Pradesh. The key objectives were to use task sharing, training of primary health workers, implementing evidence-based clinical decision support tools on a mobile platform, and providing mental health services to rural population.

The study can you buy lasix included 238 adults suffering from CMD. During the intervention period, 12.6% visited the primary health-care doctors compared to only 0.8% who had sought any care for their mental disorders prior to the intervention. The study also found a significant reduction in the depression and anxiety scores at the end of intervention and improvements in stigma perceptions related to mental health.[14] A study in Gudalur and Pandalur Taluks of Nilgiri district from Tamil Nadu used low cost task shifting by providing community education and identifying and referring individuals with psychiatric problems as effective strategies for treating mental disorders in ST communities. Through the program, the health workers established a network within the village, which in turn helped can you buy lasix the patients to interact with them freely.

Consenting patients volunteered at the educational sessions to discuss their experience about the effectiveness of their treatment. Community awareness programs altered knowledge and attitudes toward mental illness in the community.[33] A study in Nilgiri district, Tamil Nadu, found that the community had can you buy lasix been taking responsibility of the patients with the system by providing treatment closer to home without people having to travel long distances to access care. Expenses were reduced by subsidizing the costs of medicine and ensuring free hospital admissions and referrals to the people.[34] A study on the impact of gender, socioeconomic status, and age on mental health of female factory workers in Jharkhand found that the ST women were more likely to face stress and hardship in life due to diverse economic and household responsibilities, which, in turn, severely affected their mental health.[35] Prevalence of mental health morbidity in a study from the Sunderbans delta found a positive relation with psycho-social stressors and poor quality of life. The health system in that remote area can you buy lasix was largely managed by “quack doctors” and faith healers.

Poverty, illiteracy, and detachment from the larger community helped reinforce superstitious beliefs and made them seek both mental and physical health care from faith healers.[36] In a study among students, it was found that children had difficulties in adjusting to both ethnic and mainstream culture.[27] Low family income, inadequate housing, poor sanitation, and unhealthy and unhygienic living conditions were some environmental factors contributing to poor physical and mental growth of children. It was observed that children who did not have such risk factors maintained more intimate relations with the family members. Children belonging to the disadvantaged environment can you buy lasix expressed their verbal, emotional need, blame, and harm avoidances more freely than their counterparts belonging to less disadvantaged backgrounds. Although disadvantaged children had poor interfamilial interaction, they had better relations with the members outside family, such as peers, friends, and neighbors.[37] Another study in Jharkhand found that epilepsy was higher among ST patients compared to non-ST patients.[31] Most patients among the ST are irregular and dropout rates are higher among them than the non-ST patients.

Urbanization per se exerted no adverse influence on the mental health of a tribal community, provided it allowed preservation of ethnic and cultural practices can you buy lasix. Women in the ST communities were less vulnerable to mental illness than men. This might be a reflection of their increased responsibilities and enhanced gender roles that are characteristic of women in many ST communities.[38] Data obtained using culturally relevant scales revealed that relocated Sahariya suffer a lot of mental health problems, which are partially explained by livelihood and poverty-related factors. The loss of homes and displacement compromise mental health, especially the positive can you buy lasix emotional well-being related to happiness, life satisfaction, optimism for future, and spiritual contentment.

These are often not overcome even with good relocation programs focused on material compensation and livelihood re-establishment.[39] Discussion This systematic review is to our knowledge the first on mental health of ST population in India. Few studies on the mental health of ST can you buy lasix were available. All attempts including hand searching were made to recover both published peer-reviewed papers and reports available on the website. Though we can you buy lasix searched gray literature, it may be possible that it does not capture all articles.

Given the heterogeneity of the papers, it was not possible to do a meta-analysis, so a narrative review was done.The quality of the studies was assessed by CASP. The assessment shows that the research conducted on mental health of STs needs to be carried out more effectively. The above mentioned gaps need to be filled in future research by considering the can you buy lasix resources effectively while conducting the studies. Mental and substance use disorders contribute majorly to the health disparities.

To address this, can you buy lasix one needs to deliver evidence-based treatments, but it is important to understand how far these interventions for the indigenous populations can incorporate cultural practices, which are essential for the development of mental health services.[30] Evidence has shown a disproportionate burden of suicide among indigenous populations in national and regional studies, and a global and systematic investigation of this topic has not been undertaken to date. Previous reviews of suicide epidemiology among indigenous populations have tended to be less comprehensive or not systematic, and have often focused on subpopulations such as youth, high-income countries, or regions such as Oceania or the Arctic.[46] The only studies in our review which provided data on suicide were in Idu Mishmi, an isolated tribal population of North-East India, and tribal communities from Sunderban delta.[24],[37] Some reasons for suicide in these populations could be the poor identification of existing mental disorders, increased alcohol use, extreme poverty leading to increased debt and hopelessness, and lack of stable employment opportunities.[24],[37] The traditional consumption pattern of alcohol has changed due to the reasons associated with social enhancement and coping with distressing emotions rather than individual enhancement.[19],[20]Faith healers play a dominant role in treating mental disorders. There is less awareness about mental health and available mental health services and even if such knowledge is available, access is limited due to remoteness of many of these villages, and often it involves high out-of-pocket expenditure.[35] Practitioners of modern medicine can play a vital role in not only increasing awareness about mental health in the community, but also engaging with faith healers and traditional medicine practitioners to help increase their capacity to identify and manage CMDs that do not need medications and can be managed through simple “talk therapy.” Knowledge on symptoms of severe mental disorders can also help such faith healers and traditional medicine practitioners to refer cases to primary care doctors or mental health professionals.Remote settlements make it difficult for ST communities to seek mental health can you buy lasix care. Access needs to be increased by using solutions that use training of primary health workers and nonphysician health workers, task sharing, and technology-enabled clinical decision support tools.[3] The SMART Mental Health project was delivered in the tribal areas of Andhra Pradesh using those principles and was found to be beneficial by all stakeholders.[14]Given the lack of knowledge about mental health problems among these communities, the government and nongovernmental organizations should collect and disseminate data on mental disorders among the ST communities.

More research funding needs to be provided and key stakeholders should be involved in creating awareness both in the community and among policy makers to develop more projects for ST communities around mental health. Two recent meetings on tribal mental health – Round Table Meeting on Mental can you buy lasix Health of ST Populations organized by the George Institute for Global Health, India, in 2017,[51] and the First National Conference on Tribal Mental Health organized by the Indian Psychiatric Society in Bhubaneswar in 2018 – have identified some key areas of research priority for mental health in ST communities. A national-level policy on mental health of tribal communities or population is advocated which should be developed in consultation with key stakeholders. The Indian Psychiatric Society can play can you buy lasix a role in coordinating research activities with support of the government which can ensure regular monitoring and dissemination of the research impact to the tribal communities.

There is a need to understand how mental health symptoms are perceived in different ST communities and investigate the healing practices associated with distress/disaster/death/loss/disease. This could be done in the form of cross-sectional or cohort studies to generate proper evidence which could also include the information on prevalence, mental health morbidity, and any specific patterns associated with a specific disorder. Future research should estimate the prevalence of mental disorders in can you buy lasix different age groups and gender, risk factors, and the influence of modernization. Studies should develop a theoretical model to understand mental disorders and promote positive mental health within ST communities.

Studies should also look at different ST communities as can you buy lasix cultural differences exist across them, and there are also differences in socioeconomic status which impact on ability to access care.Research has shown that the impact and the benefits are amplified when research is driven by priorities that are identified by indigenous communities and involve their active participation. Their knowledge and perspectives are incorporated in processes and findings. Reporting of can you buy lasix findings is meaningful to the communities. And indigenous groups and other key stakeholders are engaged from the outset.[47] Future research in India on ST communities should also adhere to these broad principles to ensure relevant and beneficial research, which have direct impact on the mental health of the ST communities.There is also a need to update literature related to mental health of ST population continuously.

Develop culturally appropriate validated instruments to measure mental morbidity relevant to ST population. And use qualitative research to investigate the perceptions and barriers for help-seeking behavior.[48] Conclusion The current review helps not only to collate the existing literature on the mental health of ST communities but also identify can you buy lasix gaps in knowledge and provide some indications about the type of research that should be funded in future.Financial support and sponsorshipNil.Conflicts of interestThere are no conflicts of interest. References 1.Gururaj G, Girish N, Isaac MK. Mental.

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Environ Health Insights 2008;2:61-76. 38.Jeffery GS, Chakrapani U. Eco-psychiatry and Environmental Conservation. Study from Sundarban Delta, India.

Working Paper- Research Gate.net. September, 2016. 39.Ozer S, Acculturation, adaptation, and mental health among Ladakhi College Students a mixed methods study of an indigenous population. J Cross Cultl Psychol 2015;46:435-53.

40.Giri DK, Chaudhary S, Govinda M, Banerjee A, Mahto AK, Chakravorty PK. Utilization of psychiatric services by tribal population of Jharkhand through community outreach programme of RINPAS. Eastern J Psychiatry 2007;10:25-9. 41.Nandi DN, Banerjee G, Chowdhury AN, Banerjee T, Boral GC, Sen B.

Urbanization and mental morbidity in certain tribal communities in West Bengal. Indian J Psychiatry 1992;34:334-9. [PUBMED] [Full text] 42.Hackett RJ, Sagdeo D, Creed FH. The physical and social associations of common mental disorder in a tribal population in South India.

Soc Psychiatry Psychiatr Epidemiol 2007;42:712-5. 43.Raina SK, Raina S, Chander V, Grover A, Singh S, Bhardwaj A. Development of a cognitive screening instrument for tribal elderly population of Himalayan region in northern India. J Neurosci Rural Pract 2013;4:147-53.

[PUBMED] [Full text] 44.Raina SK, Raina S, Chander V, Grover A, Singh S, Bhardwaj A. Identifying risk for dementia across populations. A study on the prevalence of dementia in tribal elderly population of Himalayan region in Northern India. Ann Indian Acad Neurol 2013;16:640-4.

[PUBMED] [Full text] 45.Raina SK, Chander V, Raina S, Kumar D. Feasibility of using everyday abilities scale of India as alternative to mental state examination as a screen in two-phase survey estimating the prevalence of dementia in largely illiterate Indian population. Indian J Psychiatry 2016;58:459-61. [PUBMED] [Full text] 46.Diwan R.

Mental health of tribal male-female factory workers in Jharkhand. IJAIR 2012;2278:234-42. 47.Banerjee T, Mukherjee SP, Nandi DN, Banerjee G, Mukherjee A, Sen B, et al. Psychiatric morbidity in an urbanized tribal (Santal) community - A field survey.

Indian J Psychiatry 1986;28:243-8. [PUBMED] [Full text] 48.Leske S, Harris MG, Charlson FJ, Ferrari AJ, Baxter AJ, Logan JM, et al. Systematic review of interventions for Indigenous adults with mental and substance use disorders in Australia, Canada, New Zealand and the United States. Aust N Z J Psychiatry 2016;50:1040-54.

49.Pollock NJ, Naicker K, Loro A, Mulay S, Colman I. Global incidence of suicide among Indigenous peoples. A systematic review. BMC Med 2018;16:145.

50.Silburn K, et al. Evaluation of the Cooperative Research Centre for Aboriginal Health (Australian institute for primary care, trans.). Melbourne. LaTrobe University.

2010. 51. Correspondence Address:S V. Siddhardh Kumar DevarapalliGeorge Institute for Global Health, Plot No.

57, Second Floor, Corporation Bank Building, Nagarjuna Circle, Punjagutta, Hyderabad - 500 082, Telangana IndiaSource of Support. None, Conflict of Interest. NoneDOI. 10.4103/psychiatry.IndianJPsychiatry_136_19 Figures [Figure 1] Tables [Table 1], [Table 2].

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Credit http://www.skywrite-translations.com/how-much-does-levitra-20mg-cost/ iv lasix push time. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the most common form of permanent alopecia in this iv lasix push time population.

The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb. Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal iv lasix push time organs), some types of lupus and clogged arteries. During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over.

The prevalence of those with fibroids was compared in iv lasix push time patients with and without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition. In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids.

The findings translate to a fivefold increased risk of uterine fibroids iv lasix push time in women with CCCA, compared to age, sex and race matched controls. Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause of the link between the two conditions remains unclear,” she says iv lasix push time.

However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should be screened not only for fibroids, but also for other disorders iv lasix push time associated with excess fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition.

The other authors on this paper were iv lasix push time Ginette A. Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit.

The New England Journal of Medicine Share Fast Facts This study clears up how big an effect the mutational burden iv lasix push time has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors. - Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study iv lasix push time led by Johns Hopkins Kimmel Cancer Center researchers shows.

The finding, published in the Dec. 21 New England Journal of Medicine, could be used to guide iv lasix push time future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells.

As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an . These medicines have had remarkable success in treating some types iv lasix push time of cancers that historically have had poor prognoses, such as advanced melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma.

The mutational iv lasix push time burden of certain tumor types has previously been proposed as an explanation for why certain cancers respond better than others to immune checkpoint inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow. Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across iv lasix push time many different cancer types was unclear.

To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data iv lasix push time on the mutational burden of thousands of tumor samples from patients with different tumor types. Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation.

The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that iv lasix push time cancer. €œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive.

It’s one of those things that doesn’t iv lasix push time sound right when you hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel iv lasix push time cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint inhibitors.

However, he explains, this cancer type is often caused by a lasix, which seems to encourage a strong immune response despite the cancer’s lower mutational burden. In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes iv lasix push time that these findings could help guide clinical trials to test checkpoint inhibitors on cancer types for which these drugs haven’t yet been tried.

Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether iv lasix push time cancers in individual patients might respond well to this class of immunotherapy drugs. €œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says.

Yarchoan receives funding from iv lasix push time the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..

Credit. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the most common form of permanent alopecia in this population. The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb.

Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and clogged arteries. During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over. The prevalence of those with fibroids was compared in patients with and without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition.

In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids. The findings translate to a fivefold increased risk of uterine fibroids in women with CCCA, compared to age, sex and race matched controls. Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause of the link between the two conditions remains unclear,” she says.

However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should be screened not only for fibroids, but also for other disorders associated with excess fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition. The other authors on this paper were Ginette A.

Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit. The New England Journal of Medicine Share Fast Facts This study clears up how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors.

- Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows. The finding, published in the Dec. 21 New England Journal of Medicine, could be used to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells.

As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an . These medicines have had remarkable success in treating some types of cancers that historically have had poor prognoses, such as advanced melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma. The mutational burden of certain tumor types has previously been proposed as an explanation for why certain cancers respond better than others to immune checkpoint inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow.

Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types was unclear. To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on the mutational burden of thousands of tumor samples from patients with different tumor types.

Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation. The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that cancer. €œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive.

It’s one of those things that doesn’t sound right when you hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint inhibitors. However, he explains, this cancer type is often caused by a lasix, which seems to encourage a strong immune response despite the cancer’s lower mutational burden.

In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials to test checkpoint inhibitors on cancer types for which these drugs haven’t yet been tried. Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs.

€œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says. Yarchoan receives funding from the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..

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November 25, can you buy lasix site here 2020U.S. Department of Labor Announces OSHA's ReturnTo Normal Enforcement Operations After Hurricane Zeta ATLANTA, GA – The U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) announced today the resumption of normal enforcement operations in Mississippi's Hancock and Harrison counties can you buy lasix following Hurricane Zeta.

In response to the storm, OSHA suspended programmed-planned enforcement inspections temporarily and deployed safety and health professionals to provide compliance assistance and help identify and eliminate serious hazards in recovery operations. OSHA worked with federal partners in these efforts and the agency's on-site interventions removed can you buy lasix 107 workers from serious hazards. As these areas continue to recover from the hurricane, OSHA encourages employers and workers to be vigilant in identifying and eliminating hazards associated with this work.

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For more information, can you buy lasix visit http://www.osha.gov. The mission of the Department of Labor is to foster, promote and develop the welfare of the wage earners, job seekers and retirees of the United States. Improve working conditions can you buy lasix.

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Click here to listen. About This Podcast Health care — and how much it costs — can you buy lasix is scary. But you’re not alone with this stuff, and knowledge is power.

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Before that date, people enrolled in http://www.darmsanierung-hund.de/ a Medicaid managed care plan obtained all of their health care through the plan, but used their regular Medicaid card to access any drug available on the state formulary on a "fee for service" basis without needing to utilize what is the cost of lasix a restricted pharmacy network or comply with managed care plan rules. COMING IN April 2021 - In the NYS Budget enacted in April 2020, the pharmacy benefit was "carved out" of "mainstream" Medicaid managed care plans. That means that members of managed care plans will access their drugs outside their plan, unlike the rest of their medical care, which is accessed from in-network providers.

How Prescription Drugs are Obtained through Managed Care plans No - Until April 2020 HOW DO MANAGED CARE PLANS DEFINE THE PHARMACY BENEFIT FOR CONSUMERS? what is the cost of lasix. The Medicaid pharmacy benefit includes all FDA approved prescription drugs, as well as some over-the-counter drugs and medical supplies. Under Medicaid managed care.

Plan formularies will be comparable to but what is the cost of lasix not the same as the Medicaid formulary. Managed care plans are required to have drug formularies that are “comparable” to the Medicaid fee for service formulary. Plan formularies do not have to include all drugs covered listed on the fee for service formulary, but they must include generic or therapeutic equivalents of all Medicaid covered drugs.

The Pharmacy Benefit what is the cost of lasix will vary by plan. Each plan will have its own formulary and drug coverage policies like prior authorization and step therapy. Pharmacy networks can also differ from plan to plan.

Prescriber Prevails what is the cost of lasix applies in certain drug classes. Prescriber prevails applys to medically necessary precription drugs in the following classes. atypical antipsychotics, anti-depressants, anti-retrovirals, anti-rejection, seizure, epilepsy, endocrine, hemotologic and immunologic therapeutics.

Prescribers will need to what is the cost of lasix demonstrate reasonable profession judgment and supply plans witht requested information and/or clinical documentation. Pharmacy Benefit Information Website -- http://mmcdruginformation.nysdoh.suny.edu/-- This website provides very helpful information on a plan by plan basis regarding pharmacy networks and drug formularies. The Department of Health plans to build capacity for interactive searches allowing for comparison of coverage across plans in the near future.

Standardized Prior Autorization (PA) Form -- The Department of Health worked with managed care plans, provider organizations and other state agencies to develop a standard prior authorization form for what is the cost of lasix the pharmacy benefit in Medicaid managed care. The form will be posted on the Pharmacy Information Website in July of 2013. Mail Order Drugs -- Medicaid managed care members can obtain mail order/specialty drugs at any retail network pharmacy, as long as that retail network pharmacy agrees to a price that is comparable to the mail order/specialty pharmacy price.

CAN CONSUMERS SWITCH PLANS IN ORDER TO what is the cost of lasix GAIN ACCESS TO DRUGS?. Changing plans is often an effective strategy for consumers eligible for both Medicaid and Medicare (dual eligibles) who receive their pharmacy service through Medicare Part D, because dual eligibles are allowed to switch plans at any time. Medicaid consumers will have this option only in the limited circumstances during the first year of enrollment in managed care.

Medicaid managed care enrollees can only leave and join another plan within the first 90 what is the cost of lasix days of joining a health plan. After the 90 days has expired, enrollees are “locked in” to the plan for the rest of the year. Consumers can switch plans during the “lock in” period only for good cause.

The pharmacy benefit changes are what is the cost of lasix not considered good cause. After the first 12 months of enrollment, Medicaid managed care enrollees can switch plans at any time. STEPS CONSUMERS CAN TAKE WHEN A MANAGED CARE PLAM DENIES ACCESS TO A NECESSARY DRUG As a first step, consumers should try to work with their providers to satisfy plan requirements for prior authorization or step therapy or any other utilization control requirements.

If the plan still denies what is the cost of lasix access, consumers can pursue review processes specific to managed care while at the same time pursuing a fair hearing. All plans are required to maintain an internal and external review process for complaints and appeals http://eclectic-oddities.com/?wpsc-product=chili-pepper-kids-small of service denials. Some plans may develop special procedures for drug denials.

Information on these procedures should be provided in what is the cost of lasix member handbooks. Beginning April 1, 2018, Medicaid managed care enrollees whose plan denies prior approval of a prescription drug, or discontinues a drug that had been approved, will receive an Initial Adverse Determination notice from the plan - See Model Denial IAD Notice and IAD Notice to Reduce, Suspend or Stop Services The enrollee must first request an internal Plan Appeal and wait for the Plan's decision. An adverse decision is called a 'FInal Adverse Determination" or FAD.

See model Denial FAD Notice and what is the cost of lasix FAD Notice to Reduce, Suspend or Stop Services. The enroll has the right to request a fair hearing to appeal an FAD. The enrollee may only request a fair hearing BEFORE receiving the FAD if the plan fails to send the FAD in the required time limit, which is 30 calendar days in standard appeals, and 72 hours in expedited appeals.

The plan may extend the time to decide both standard and what is the cost of lasix expedited appeals by up to 14 days if more information is needed and it is in the enrollee's interest. AID CONTINUING -- If an enrollee requests a Plan Appeal and then a fair hearing because access to a drug has been reduced or terminated, the enrollee has the right to aid continuing (continued access to the drug in question) while waiting for the Plan Appeal and then the fair hearing. The enrollee must request the Plan Appeal and then the Fair Hearing before the effective date of the IAD and FAD notices, which is a very short time - only 10 days including mailing time.

See more about the changes in what is the cost of lasix Managed Care appeals here. Even though that article is focused on Managed Long Term Care, the new appeals requirements also apply to Mainstream Medicaid managed care. Enrollees who are in the first 90 days of enrollment, or past the first 12 months of enrollment also have the option of switching plans to improve access to their medications.

Consumers who experience problems with access to prescription drugs should always file a complaint with the State Department of Health’s Managed Care Hotline, number what is the cost of lasix listed below. ACCESSING MEDICAID'S PHARMACY BENEFIT IN FEE FOR SERVICE MEDICAID For those Medicaid recipients who are not yet in a Medicaid Managed Care program, and who do not have Medicare Part D, the Medicaid Pharmacy program covers most of their prescription drugs and select non-prescription drugs and medical supplies for Family Health Plus enrollees. Certain drugs/drug categories require the prescribers to obtain prior authorization.

These include brand name drugs that have a generic alternative under New York's mandatory generic drug program or prescribed drugs that are not on New York's preferred drug list what is the cost of lasix. The full Medicaid formulary can be searched on the eMedNY website. Even in fee for service Medicaid, prescribers must obtain prior authorization before prescribing non-preferred drugs unless otherwise indicated.

Prior authorization is required for original prescriptions, not refills what is the cost of lasix. A prior authorization is effective for the original dispensing and up to five refills of that prescription within the next six months. Click here for more information on NY's prior authorization process.

The New York State Board of Pharmacy publishes an annual list what is the cost of lasix of the 150 most frequently prescribed drugs, in the most common quantities. The State Department of Health collects retail price information on these drugs from pharmacies that participate in the Medicaid program. Click here to search for a specific drug from the most frequently prescribed drug list and this site can also provide you with the locations of pharmacies that provide this drug as well as their costs.

Click here what is the cost of lasix to view New York State Medicaid’s Pharmacy Provider Manual. WHO YOU CAN CALL FOR HELP Community Health Advocates Hotline. 1-888-614-5400 NY State Department of Health's Managed Care Hotline.

1-800-206-8125 (Mon. - Fri. 8:30 am - 4:30 pm) NY State Department of Insurance.

Since October 2011, most people who do not have Medicare obtained their drugs throug their can you buy lasix Medicaid managed care plan Full Article. At that time, this drug benefit was "carved into" the Medicaid managed care benefit package. Before that date, people enrolled in a Medicaid managed care plan obtained all of their health care through the plan, but used their regular Medicaid card to access any drug available on the state formulary on a "fee for service" basis without needing to utilize a restricted pharmacy network or comply with managed care plan rules. COMING IN April 2021 can you buy lasix - In the NYS Budget enacted in April 2020, the pharmacy benefit was "carved out" of "mainstream" Medicaid managed care plans. That means that members of managed care plans will access their drugs outside their plan, unlike the rest of their medical care, which is accessed from in-network providers.

How Prescription Drugs are Obtained through Managed Care plans No - Until April 2020 HOW DO MANAGED CARE PLANS DEFINE THE PHARMACY BENEFIT FOR CONSUMERS?. The Medicaid pharmacy benefit includes all FDA approved prescription can you buy lasix drugs, as well as some over-the-counter drugs and medical supplies. Under Medicaid managed care. Plan formularies will be comparable to but not the same as the Medicaid formulary. Managed care plans are required can you buy lasix to have drug formularies that are “comparable” to the Medicaid fee for service formulary.

Plan formularies do not have to include all drugs covered listed on the fee for service formulary, but they must include generic or therapeutic equivalents of all Medicaid covered drugs. The Pharmacy Benefit will vary by plan. Each plan will have its own formulary can you buy lasix and drug coverage policies like prior authorization and step therapy. Pharmacy networks can also differ from plan to plan. Prescriber Prevails applies in certain drug classes.

Prescriber prevails applys to medically necessary precription drugs in the can you buy lasix following classes. atypical antipsychotics, anti-depressants, anti-retrovirals, anti-rejection, seizure, epilepsy, endocrine, hemotologic and immunologic therapeutics. Prescribers will need to demonstrate reasonable profession judgment and supply plans witht requested information and/or clinical documentation. Pharmacy Benefit Information Website -- http://mmcdruginformation.nysdoh.suny.edu/-- This website provides very helpful information on a plan by can you buy lasix plan basis regarding pharmacy networks and drug formularies. The Department of Health plans to build capacity for interactive searches allowing for comparison of coverage across plans in the near future.

Standardized Prior Autorization (PA) Form -- The Department of Health worked with managed care plans, provider organizations and other state agencies to develop a standard prior authorization form for the pharmacy benefit in Medicaid managed care. The form will be posted on the Pharmacy Information Website in can you buy lasix July of 2013. Mail Order Drugs -- Medicaid managed care members can obtain mail order/specialty drugs at any retail network pharmacy, as long as that retail network pharmacy agrees to a price that is comparable to the mail order/specialty pharmacy price. CAN CONSUMERS SWITCH PLANS IN ORDER TO GAIN ACCESS TO DRUGS?. Changing plans is often an effective strategy for can you buy lasix consumers eligible for both Medicaid and Medicare (dual eligibles) who receive their pharmacy service through Medicare Part D, because dual eligibles are allowed to switch plans at any time.

Medicaid consumers will have this option only in the limited circumstances during the first year of enrollment in managed care. Medicaid managed care enrollees can only leave and join another plan within the first 90 days of joining a health plan. After the 90 can you buy lasix days has expired, enrollees are “locked in” to the plan for the rest of the year. Consumers can switch plans during the “lock in” period only for good cause. The pharmacy benefit changes are not considered good cause.

After the first can you buy lasix 12 months of enrollment, Medicaid managed care enrollees can switch plans at any time. STEPS CONSUMERS CAN TAKE WHEN A MANAGED CARE PLAM DENIES ACCESS TO Bonuses A NECESSARY DRUG As a first step, consumers should try to work with their providers to satisfy plan requirements for prior authorization or step therapy or any other utilization control requirements. If the plan still denies access, consumers can pursue review processes specific to managed care while at the same time pursuing a fair hearing. All plans are required to maintain can you buy lasix an internal and external review process for complaints and appeals of service denials. Some plans may develop special procedures for drug denials.

Information on these procedures should be provided in member handbooks. Beginning April 1, 2018, Medicaid managed care enrollees whose plan denies prior approval of a prescription drug, or discontinues a drug that had been approved, will receive an Initial Adverse Determination notice from the plan - See Model Denial IAD Notice and IAD Notice to Reduce, Suspend or Stop Services The enrollee must first can you buy lasix request an internal Plan Appeal and wait for the Plan's decision. An adverse decision is called a 'FInal Adverse Determination" or FAD. See model Denial FAD Notice and FAD Notice to Reduce, Suspend or Stop Services. The enroll has the right to request a fair hearing to can you buy lasix appeal an FAD.

The enrollee may only request a fair hearing BEFORE receiving the FAD if the plan fails to send the FAD in the required time limit, which is 30 calendar days in standard appeals, and 72 hours in expedited appeals. The plan may extend the time to decide both standard and expedited appeals by up to 14 days if more information is needed and it is in the enrollee's interest. AID CONTINUING -- If an enrollee requests a Plan Appeal can you buy lasix and then a fair hearing because access to a drug has been reduced or terminated, the enrollee has the right to aid continuing (continued access to the drug in question) while waiting for the Plan Appeal and then the fair hearing. The enrollee must request the Plan Appeal and then the Fair Hearing before the effective date of the IAD and FAD notices, which is a very short time - only 10 days including mailing time. See more about the changes in Managed Care appeals here.

Even though that article is focused on Managed Long Term Care, can you buy lasix the new appeals requirements also apply to Mainstream Medicaid managed care. Enrollees who are in the first 90 days of enrollment, or past the first 12 months of enrollment also have the option of switching plans to improve access to their medications. Consumers who experience problems with access to prescription drugs should always file a complaint with the State Department of Health’s Managed Care Hotline, number listed below. ACCESSING MEDICAID'S PHARMACY BENEFIT IN FEE FOR SERVICE MEDICAID For those Medicaid recipients who are not yet in a Medicaid Managed Care program, and who do not have Medicare Part can you buy lasix D, the Medicaid Pharmacy program covers most of their prescription drugs and select non-prescription drugs and medical supplies for Family Health Plus enrollees. Certain drugs/drug categories require the prescribers to obtain prior authorization.

These include brand name drugs that have a generic alternative under New York's mandatory generic drug program or prescribed drugs that are not on New York's preferred drug list. The can you buy lasix full Medicaid formulary can be searched on the eMedNY website. Even in fee for service Medicaid, prescribers must obtain prior authorization before prescribing non-preferred drugs unless otherwise indicated. Prior authorization is required for original prescriptions, not refills. A prior authorization is effective for the original dispensing and up to five refills of that prescription within can you buy lasix the next six months.

Click here for more information on NY's prior authorization process. The New York State Board of Pharmacy publishes an annual list of the 150 most frequently prescribed drugs, in the most common quantities. The State Department of Health collects retail price information on these drugs from pharmacies that participate in the Medicaid program. Click here to search for a specific drug from the most frequently prescribed drug list and this site can also provide you with the locations of pharmacies that provide this drug as well as their costs. Click here to view New York State Medicaid’s Pharmacy Provider Manual.

WHO YOU CAN CALL FOR HELP Community Health Advocates Hotline. 1-888-614-5400 NY State Department of Health's Managed Care Hotline. 1-800-206-8125 (Mon.

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