Epidemiologists help with study design, collection and statistical analysis of data, and interpretation and dissemination of results (including peer review and occasional systematic review). Epidemiology has helped develop methodology used in clinical research, public health studies and, to a lesser extent, basic research in the biological sciences

Minggu, 29 September 2013

How do you prevent HIV?

How do you prevent HIV?

There is no cure for HIV, but there are ways to prevent getting the virus.
HIV is generally passed from person-to-person through sexual (anal, vaginal, or oral) contact or by sharing needles and other drug works. HIV can be prevented through abstinence, mutual monogamy, condoms, by not sharing needles and drug works (commonly referred to as paraphernalia), and by limiting the use of substances (i.e. alcohol and other non-injecting drugs) that impair judgment.
There is currently no vaccine for HIV. Researchers have been trying to find an HIV vaccine since the virus was first identified in 1984. HIV is a very complex virus, so researchers have not been successful in creating a vaccine, but they continue to try.

Abstaining from sex means not having any type of sex at all—oral, anal, or vaginal. Abstinence is 100% effective in preventing HIV and other STDs.
The decision to practice abstinence does not mean that you should not know about condoms and safe sex practices.  Most people stop being abstinent at some point in their lives.  Learning how to protect yourself from HIV allows you to be prepared in case you decide to have sex.

Mutual monogamy means that you agree to be sexually active with only one person, and that person has agreed to be sexually active only with you. Reducing your number of sexual partners can decrease your risk for HIV. It is still important that you and your partner get tested for HIV and share your test results with one another. Many people choose to continue using condoms in a mutually monogamous relationship for further protection from HIV and other STDs.

When used consistently and correctly, condoms are highly effective in preventing HIV infection. If you are sexually active, latex condoms provide the best protection against HIV infection. Polyurethane or plastic condoms may also be used and are good options for people with latex allergies. Natural membrane (such as lambskin) condoms are porous, meaning that fluids can seep through them, and therefore do not offer the same level of protection against HIV and other STDs.
Male latex condoms, placed over the penis, offer greater protection from HIV than female condoms. However, using a female condom is better than not using any form of protection at all. Condoms should be used consistently—EVERY time you have sex. Be sure not to tear the condom when opening the wrapper. Open the wrapper carefully with your hands—never use your teeth. And always use a NEW condom with every act of vaginal, anal, or oral sex.
To use a male condom correctly
  • Before the penis comes into contact with the genitals, mouth, or anus, put the condom
    on the tip of the erect penis with the rolled side out.
  • If the condom does not have a reservoir tip, pinch the tip, leaving a half-inch space for semen to collect.
  • Holding the tip, unroll the condom all the way down to the base of the erect penis.
  • After ejaculation and before the penis gets soft, hold the rim of the condom (at the base of the penis) and carefully withdraw.
  • Gently pull the condom off the penis, making sure that semen doesn't spill out.
  • Wrap the condom in a tissue and throw it in the trash where others won't handle it.
  • If you feel the condom break at any point during sexual activity, stop immediately,  withdraw, remove the broken condom, and put on a new condom.
  • Ensure that adequate lubrication is used during vaginal and anal sex.
  • Use water-based lubricants.
  • Oil-based lubricants, such as petroleum jelly, shortening, mineral oil, massage oils, body                lotions, and cooking oil, should NOT be used because they can weaken latex, causing the           condom to break or tear.
  • Use a new condom for every act of anal, vaginal, and oral sex—from start to finish.

To use a female condom correctly
  • Put lubricant on the outside of the closed end.
  • Squeeze together the sides of the inner ring of the condom and insert it into the vagina             like a tampon.
  • With your finger, push the inner ring into the vagina as far as it will go.
  • The inner ring will stay in place, kind of like a diaphragm.
  • Pull out your finger, allowing the outer ring to stay outside the vagina.
  • Guide the penis into the condom.
  • Pull out gently.
  • Remove the condom before standing up.

How effective are latex condoms in the fight against HIV?

Latex condoms, when used consistently and correctly, are highly effective in preventing sexual transmission of HIV, the virus that causes AIDS. Research on the effectiveness of latex condoms in preventing heterosexual transmission is both comprehensive and conclusive. The ability of latex condoms to prevent transmission has been scientifically established.  It should be noted that condom use cannot provide absolute protection against HIV. The surest way to avoid transmission of HIV is to abstain from sexual intercourse or to be in a long-term mutually monogamous relationship with a partner who has been tested and you know is not infected.

Are health care workers at risk of getting HIV on the job?

The risk of health care workers being exposed to HIV on the job is very low, especially if they carefully follow universal precautions (i.e., using protective practices and personal protective equipment to prevent HIV and other blood-borne infections). It is important to remember that casual, everyday contact with an HIV-infected person does not expose health care workers or anyone else to HIV. For health care workers on the job, the main risk of HIV transmission is through accidental injuries from needles and other sharp instruments that may be contaminated with the virus; however, even this risk is small.

Drug and Alcohol Use

There are a couple of ways that drug and alcohol use can increase a person’s risk of HIV infection. One way is that using drugs and alcohol can reduce inhibitions and possibly increase the chance of one engaging in risky behaviors that can increase the risk of HIV exposure, such as unprotected sex.
Another way is that of using intravenous drugs (i.e., “shooting up”) and sharing needles or works (cooker, syringes, etc) with an infected person increases a person’s risk of HIV infection. If you use intravenous drugs, do NOT share needles or other drug works with another person. Many communities have needle exchange programs where people who are addicted to injection drugs can exchange used needles for new needles, and many pharmacies and medical specialty shops sell disposable needles and syringes.  You should never share needles and other drug works with anyone else. But, the unfortunate reality is that access to clean, new, sterile syringes is sometimes limited. 
If you inject illicit drugs, or if you are addicted to drugs and/or alcohol and are interested in treatment programs and other options that can help you, talk with your doctor or health care provider, counselor, loved one, or someone else you trust about getting into a treatment program.

Are there medications I can take that will keep me from getting HIV if I am exposed?

There may be. Promising research has shown that PrEP—Pre-Exposure Prophylaxis—may provide some protection against HIV infection.  PrEP trials involve the use of HIV treatment medications in an attempt to protect high-risk uninfected individuals from HIV infection. However, the research to date has only been shown to reduce HIV infection among gay and bisexual men, and transgendered women who have sex with men, and there are no data regarding its benefit among heterosexuals or injection drug users. There are many other important aspects to PrEP and its limitations in preventing HIV.

If I think I have been exposed to HIV, what are my options?

There is a treatment regimen called Post-Exposure Prophylaxis, or PEP that may be useful in preventing HIV infection. However, there are some things to keep in mind about PEP.
  • PEP is NOT a “morning after” pill. It is a round of several drugs that have to be taken for at least 30 days and are very expensive (anywhere from $600 to $1,000).
  • The medications have serious side effects.
  • There is no research to show that PEP works for non-work exposure.
  • The use of PEP for non-work-related exposure is controversial because of fear it will encourage risky behaviors. It’s important to keep in mind that even among health care workers, PEP is not 100% effective in preventing HIV.

Manfaat Jeruk Nipis Untuk Kecantikan, Kesehatan Serta Obat Tradisional

Manfaat Jeruk Nipis Untuk Kecantikan, Kesehatan Serta Obat Tradisional

  Jeruk nipis ternyata menyimpan berbagai jenis nutrisi yang sangat bermanfaat bagi tubuh. Selain terkenal karena kandungan vitamin C nya yang melimpah, jeruk nipis juga mengandung beberapa nutrisi lain seperti kadinen, minyak atsiri, vitamin C asam amino, glikosida, asam sitrun, dan juga lemak

manfaat jeruk nipis

Jeruk nipis yang dikenal oleh wanita sebagai bahan bumbu dapur, dan sebagai bumbu tambahan masakan ternyata banyak sekali manfaat nya:
Apakah anda para wanita tau jeruk nipis mengandung banyak manfaat untuk kulit wajah?

Seperti anda ketahui kandungan vitamin pada jeruk sangatlah tinggi, yang akan membuat jeruk bermanfaat bagi kesehatan.
Beberapa manfaat jeruk nipis yaitu untuk menghilangkan jerawat,menghilangkan noda hitam pada wajah, serta bisa mengencangkan kulit wajah yang akan membuat wajah menjadi awet muda, tidak cuman itu jeruk nipis juga bisa membuat kulit nampak putih dan halus , selain bermanfaat untuk wajah jeruk nipis juga bermanfaat untuk rambut dan juga bisa menyembuhkan penyakit,
yaitu sebagai berikut:

  • Meredakan Batuk
jika anda terserang batuk, segera cari jeruk nipis karena jeruk nipis ini salah satu obat batuk yang paling mujarab gini caranya,siapkan air hangat secukupnya lalu peras satu buah jeruk nipis dicampur dengan satu sendok makan kecapatau madu kemudian beri sedikit garam,aduk hingga merata dan saring. jangan lupa minum 2-3 kali sehari untuk meredakan batuk anda tersebut.

  • Menghilangkan Bau Badan
memang bau badan ini sangat mengganggu sekali membuat seseorang yang dekat sama kita akan menjauh merasa gak betah karena dengan bau badan yang gak enak dicium itu,tetapi jangan dulu khawatir karena jeruk ini bisa mengatasinya,dengan cara sebagai berikut: Potong satu jeruk nipis yang besar menjadi 2 belah bagian,olesi bagian dalam jeruk nipis dengan kapur sirih,kemudian oleskan di ketiak anda setelah habis mandi dan diamkan selama 5 menit lalu bilas dengan air.

  • Amandel
anda pasti belum tau ya.. penyakit amandel bisa disembuhkan dengan jeruk nipis, gini caranya cuci 3 jeruk nipis dengan air bersih,potong-potong menjadi bagian kecil kemudian rebus dengan 2 gelas air yang mendidih hingga tersisa 3/4 dan saring, dalam keadaan yang hangat gunakan air tersebut untuk berkumur,lakukan 3-4 kali sehari.

Manfaat Jeruk Nipis Untuk Kesehatan Rambut
Jika rambut anda kotor,berketombe, jangan khawatir dulu kami punya solusinya yang tepat dan benar. segera mencucinya dengan campuran ekstrak jeruk nipis,cara menggunakan untuk perawatan rambut menjadi bersih kembali dan sehat yaitu sebagai berikut:

Siapkan air hangat dengan secukupnya, dan kemudian campurkan air perasan jeruk nipis ke dalam air hangat tersebut. dan anda juga bisa menggunakan sekitar 4 sampai 6 butir jeruk nipis untuk setiap kali merawat rambut anda tersebut. sesudah melakukan perawatan dengan menggunakan campuran perasan jeruk nipis tersebut maka rambut anda akan tersa sangat lembut,berkilau,dan wangi rambutnya juga akan terasa segar sekali. 

Minum segelas air hangat dengan perasan jeruk nipis di pagi hari bisa menjadi cara terbaik untuk kesehatan Anda.

Cara ini sederhana namun penting karena bisa membantu aktivitas anda.

Beriku 8 manfaat luar biasa dari minuman air jeruk nipis hangat.

1. Meningkatkan pencernaan Anda Air hangat dengan tambahan perasan jeruk nipis baik untuk proses pencernaan. Ini merangsang dan mengaktifkan seluruh proses, sehingga membantu Anda tetap sehat dan aktif.

2. Meningkatkan kekebalan tubuh Jeruk nipis kaya akan vitamn C yang menawarkan perlindungan terhadap penyakit akibat dingin dan penyakit umum lainnya. Dengan sistem kekebalan tubuh yang fit, tubuh Anda terlindungi dari infeksi dan penyakit.

3. Membantu dari sembelit Membiasakan diri minum air hangat dengan perasan jeruk nipis menyingkirkan sembelit dan masalah gastro lainnya. Air jeruk hangat akan merangsang dan mengatur gerakan usus Anda sehingga menyembuhkan dari semua rasa sakit dan trauma yang berhubungan dengan sembelit.

4. Agen pembersih alami Jeruk nipis hangat bisa membantu detoksifikasi dan membersihkan tubuh dengan membuang semua racun berbahaya yang terakumulasi di tubuh. Ini membersihkan sistem Anda, membuat Anda lebih sehat dan segar.

5. Bagus untuk kulit Efek menghilangkan racun dari tubuh juga bisa membuat kulit menjadi terlihat cerah. Vitamin C dari jeruk nipis membantu Anda terlihat lebih muda.

6. Melawan penuaan Jeruk nipis memberikan Vitamin C yang bertindak sebagai antioksidan alami. Ini menghilangkan radikal bebas yang berbahaya bagi tubuh yang menyebabkan banyak kerusakan pada kulit Anda. Dengan minum jeruk nipis hangat memastikan Anda melawan kerutan akibat penuaan dini.

7. Hidrat sistem Anda Air adalah obat mujarab yang yang memberikan keajaiban di tubuh. Minum air hangat dengan manfaat tambahan dari jeruk nipis memastikan sistem Anda tetap terhidrasi.

8. Membantu menurunkan berat badan Pengamat berat badan sering merekomendasikan agar memulai hari dengan segelas air jeruk nipis hangat. Selain memberikan perasaan kenyang, jeruk nipis juga menyediakan serat dan vitamin C yang membantu menurunkan berat badan.

Manfaat Garam

Manfaat Garam, Tak Hanya untuk Masak

8 Manfaat Garam, Tak Hanya untuk Masak

Manfaat penggunaan garam yang baik bagi kulit dan tubuh, seperti dilansir Organic Authority:

1. Mandi
Garam bisa digunakan untuk berendam, rasanya seperti ketika kita berenang di laut. Masukkan secangkir garam dapur ke air dalam bak mandi Anda. Harumkan dengan minyak esensial atau herbal kering kesukaan Anda. Merendamkan tubuh ke dalam air garam dapat mengurangi peradangan dalam tubuh dan meminimalisir rasa pegal pada otot dan sendi.

2. Scrub
Garam mengandung exfoliant alami yang dapat menghaluskan kulit Anda. Jika Anda memiliki kulit kering, cobalah untuk menggunakan scrub garam. Siapkan seperempat cangkir garam dan setengah atau tiga per empat cangkir minyak almond atau wijen. Campurkan keduanya dan tambahkan 20 tetes minyak esensial favorit Anda untuk memberikan aroma. Gunakan seperti ketika Anda menggunakan scrub pada umumnya.

3. Masker
Bagi Anda yang memiliki kulit berminyak atau berjerawat, tak ada salahnya untuk menggunakan masker garam. Jenis masker ini dapat mengurangi peradangan kulit, menyeimbangkan kadar minyak, dan mempercepat penyembuhan kulit dari jerawat. Larutkan satu cangkir kecil garam ke dalam air hangat. Lalu, masukkan tiga sendok makan madu murni. Campurkan semuanya. Setelah itu, oleskan ke wajah Anda dan diamkan selama 15 menit. Bilas dengan air hangat.

4. Deodoran
Garam dapat membunuh bakteri penyebab bau. Untuk itu, garam sangat berguna jika dibuat deodoran. Namun, jika Anda baru saja mencukur bulu pada ketiak Anda, jenis deodoran ini akan memberikan sengatan kecil pada pori-pori kulit Anda.

5. Pasta gigi
Pasta gigi yang terbuat dari garam ternyata lebih baik daripada jenis pasta gigi lainnya. Sebab, garam memiliki sifat antibakteri. Campurkan baking soda dan garam dapur dengan takaran 3 banding 1. Anda dapat membuatnya dalam bentuk bubuk atau pasta. Tambahkan beberapa tetes minyak esensial beraroma mint atau cengkeh. Ini hanya membutuhkan cara yang sederhana, mudah, murah, dan efektif.

6. Obat kumur
Berkumur dengan air garam dapat menghilangkan rasa sakit pada tenggorokan. Memang ada banyak jenis obat kumur di luar sana, namun jenis obat kumur ini lebih sehat dan lebih baik bagi tubuh. Obat kumur garam tidak mengandung bahan kimia jahat. Selain itu, obat kumur garam cukup efektif untuk membunuh bakteri pada mulut Anda. Jangan lupa untuk menambahkan satu atau dua tetes minyak esensial peppermint atau spearmint jika Anda ingin mendapatkan rasa segar seperti mint.

7. Pembersih hidung
Anda harus rutin membersihkan hidung untuk meningkatkan pernapasan dan mengurangi risiko alergi atau infeksi sinus. Masukkan air ke dalam neti pot dan tambahkan sedikit garam laut. Tuangkan ke dalam lubang hidung sambil memiringkan kepala agar air dapat memasukki rongga hidung. Tundukkan kepala Anda ke bawah dan miringkan kepala ke sisi yang lain.

8. Perawatan luka
Sifat antimikroba dalam garam menjadikannya sebagai salah satu pengobatan yang efektif untuk luka kulit. Apabila luka Anda mengalami pendarahan, tunggu hingga darah tidak keluar sama sekali. Setelah itu, gosokkan garam ke luka. Ini dapat membersihkan luka dari kuman bakteri dan mempercepat proses penyembuhan.

9. Menghilangkan jerawat
Cara menghilangkan jerawat dengan air Garam:

  • Langkah pertama yang harus dilakukan Ambil kira-kira segelas air yang masih hangat dan campurkan garam kedalam air hangat tersebut hingga air hangatnya berubah menjadi sangat asin.
  • Lalu ambil kapas secukupnya kamudian Rendam kapas kedalam air sekitar satu menit atau lebih dikit.
  • Langkah selanjutnya kemudian tekan-tekan secara lembut bagian wajah yang terdapat jerawat dengan mengunakan kapas yang sudah direndam tadi selama beberapa menit.
  • Anda juga Jangan kaget apabila Anda menemukan beberapa jerawat yang sudah sedikit-demi sedikit tidak lagi meradang.
  • Kemudian anda bisa mencelupkan sekitar dua buah kapas langsung ke dalam air garam yang sudah dipersiapkan dan ulangi pengekanan kembali pada jerawat secara berbarengan pada berbagai sisi jerawat yang ada pada muka anda.
Manfaat rendaman Air Garam untuk menghilangkan jerawat di wajah sebagai campuran:

Yaitu anda dapat menggunakan buah-buahan sebagai alat nya seperti buah-buahan berikut: belimbing,  tomat yang sudah diiris tipis, mentimun yang bisa diginakan sebagai masker muka.

Buah-buahan ini dapat dilakukan dengan menempelkan pada seluruh bagian wajah yang terkena jerawat dan dilakukan kurang lebih selama 15 menit. Dan dilakukan 1 hingga 2 kali dalam sehari.

Khusus untuk belimbing cara pemakaiannya dapat dilakukan dengan cara menumbuk belimbing sampai halus kemudian hasil tumbukan dicampur dengan air garam secukupnya, lalu dioleskan sebagai masker ke berbagai letak jerawat dan dikerjakan minimal 3 kali sehari.

Selain aneka buahan yang ada diatas, tips menghilangkan jerawat menggunakan metode alamiiah yaitu dengan memanfaatkan buah jeruk nipis sebagai penghilang jerawat, air jeruk nipis yang sudah diperas kemudian dicampur dengan madu sekitar satu sendok teh, kemudian dioleskan pada wajah yang terdapat jerawat selama kurang lebih 15-20 menit kemudian bilas muka dengan air hangat.

Garam adalah unsur penting yang bisa ditemukan di setiap dapur. Memasak tanpa garam rasanya tentu hambar. Selain itu, garam juga menjadi bagian dari unsur perawatan kecantikan alami. Pada dasarnya, terdapat dua jenis garam untuk kulit. Pertama, garam mandi yang dicampur dalam bak mandi. Jenis garam lain untuk kulit Anda adalah garam scrub, yang berfungsi untuk mengelupas kulit mati dan menyingkirkan jerawat. Berikut adalah beberapa manfaat garam untuk kulit, seperti dilansir, Boldsky.

1. Exfoliating atau pengelupasan

Garam yang biasa digunakan untuk scrub dapat mengangkat sel kulit mati dan meremajakan kulit. Selain itu, garam scrub juga benar-benar bersifat organik karena mengandung silika pasir.

2. Jerawat

Garam memiliki efek anti-bakteri pada kulit. Itulah sebabnya garam scrub dapat membantu menyingkirkan jerawat dari kulit.

3. Kulit Berminyak

Jika Anda memiliki kulit berminyak, garam dapat bermanfaat untuk kulit Anda. Sifat kering yang dimiliki garam dapat membantu menyerap minyak ekstra dari kulit. Hal ini akan menyingkirkan tekstur berminyak dari kulit Anda dan juga mencegah wabah jerawat.

4. Menghilangkan bau badan
Garam mandi biasanya beraroma. Ketika Anda mencampur mereka dengan air mandi Anda, mereka dapat membantu Anda untuk menyingkirkan bau badan dan membuat Anda merasa segar.
5. Mineral untuk kulit

Garam laut sangat baik untuk kulit karena mengandung banyak mineral. Mineral ini dapat meresap ke dalam kulit dan membuatnya sehat dari dalam.

6. Alergi

Garam dapat menyembuhkan alergi dan infeksi pada kulit. Anda bisa mencampur air mandi Anda dengan garam untuk menyingkirkan infeksi kulit ringan.

7. Penghilang rasa sakit

Ketika kaki Anda terasa sakit setelah melalui hari yang melelahkan, pedikur dengan air garam dapat menghilangkan rasa sakitnya. Rendam kaki dalam bak air hangat yang telah ditaburi garam untuk menyingkirkan rasa sakit.

Diphtheria Prevention


Before antibiotics were available, diphtheria was a common illness in young children. Today, the disease is not only treatable but is also preventable with a vaccine.
The diphtheria vaccine is usually combined with vaccines for tetanus and whooping cough (pertussis). The three-in-one vaccine is known as the diphtheria, tetanus and pertussis vaccine. The latest version of this vaccine is known as the DTaP vaccine for children and the Tdap vaccine for adolescents and adults.
The diphtheria, tetanus and pertussis vaccine is one of the childhood immunizations that doctors in the United States recommend during infancy. Vaccination consists of a series of five shots, typically administered in the arm or thigh, given to children at these ages:
  • 2 months
  • 4 months
  • 6 months
  • 12 to 18 months
  • 4 to 6 years

The diphtheria vaccine is effective at preventing diphtheria. But there may be some side effects. Some children may experience a mild fever, fussiness, drowsiness or tenderness at the injection site after a DTaP shot. Ask your doctor what you can do for your child to minimize or relieve these effects.
Rarely, the DTaP vaccine causes serious complications in a child, such as an allergic reaction (hives or a rash develops within minutes of the injection), seizures or shock — complications which are treatable.
Some children — such as those with progressive brain disorders — may not be candidates for the DTaP vaccine.
You can't get diphtheria from the vaccine.

Booster shots

After the initial series of immunizations in childhood, you need booster shots of the diphtheria vaccine to help you maintain immunity. That's because immunity to diphtheria fades with time.
Children need their first booster shot at around age 12. The next booster shot is recommended 10 years later, then repeated at 10-year intervals. Booster shots are particularly important if you travel to an area where diphtheria is common.
The diphtheria booster is combined with the tetanus booster in one vaccine — the tetanus-diphtheria (Td) vaccine. This combination vaccine is given by injection, usually into the arm or thigh.
Doctors recommend that anyone older than age 7 who has never been vaccinated against diphtheria receive three doses of the Td vaccine.
The Centers for Disease Control and Prevention also recommend a one-time combined tetanus toxoid, reduced diphtheria and acellular pertussis (Tdap) vaccine for adolescents around the age of 12 and for anyone older than that who hasn't received the vaccine in the past — or doesn't know if they've received the vaccine. It's also recommended for anyone who's pregnant, regardless of previous vaccination status.

Malaria Prevention

Malaria Prevention

Malaria is a preventable and curable disease. Awareness and precautions, especially before travelling to an area endemic for malaria, is important for prevention of malaria. Travellers are most susceptible to bringing back infections. For example in 2010, over 1,700 travellers were diagnosed with malaria after returning to the UK. Most of these cases were acquired in Africa.

Four step approach to prevention

There is a four step approach to prevention of malaria:
1. Awareness of the risk of malaria and the risk of complications associated with it is the first step in prevention. Travellers to areas with a high incidence of malaria need to be aware of their risk and take adequate precautions.
2. Prevention of mosquito bites. A single bite is enough to transmit malaria infection. Adequate protection against mosquito bites is important. Simple measures like wearing covered clothes, using a mosquito net and using an insect repellent helps in preventing bites. Complete avoidance of bites is not possible however the number of bites may be reduced as much as possible.
All travellers and residents of high malaria risk areas are advised to stay indoors especially after dusk and keep doors and windows screened or closed to mosquitoes. A mosquito net especially ones treated with insecticide help prevent bites during sleep.
An insect repellent should be used on the skin and around the sleeping area. Those applied over the skin need to be re-applied frequently. The most effective repellents contain diethyltoluamide (DEET) and are available in sprays, roll-ons, sticks and creams.
Covered clothes also help prevent bites. Light colored, loose fitting, trousers, rather than shorts, and shirts with long sleeves are preferable particularly during early evening and at night when mosquitoes prefer to feed.
3. Antimalaria tablets for prevention of infection. A complete course of prescribed medication before, during and after travel is important in prevention of acquiring infections. This is called chemoprophylaxis and is useful for travellers.
Antimalarials are not 100% effective so taking steps to avoid bites is also important. Commonly prescribed drugs include Chloroquine, doxycycline, mefloquine, primaquin and atovaquone plus proguanil (Malarone) etc. Choloroquine needs to be taken for four weeks after return from travel. Malarone may be taken for one week after return.
Drug Adult dose
Atovaquone (250mg) plus proguanil (100mg) 1 tablet daily
Choloroquine 300mg base tablets once weekly
Doxycycline 100mg orally daily
Hydroxycholoroquine sulfate 310mg base once weekly
Mefloquine 228mg base once weekly
Primaquine 30mg base orally daily
4. Immediate diagnosis after onset of symptoms helps prevent complications of malaria. Symptoms could appear after a year after travelling and this needs to be considered while diagnosing and treating malaria.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)


  1. http://www.nhs.uk/Conditions/Malaria/Pages/Prevention.aspx
  2. http://www.bbc.co.uk/health/physical_health/conditions/malaria1.shtml
  3. http://www.cdc.gov/malaria/travelers/index.html
  4. http://www.niaid.nih.gov/topics/malaria/documents/malaria.pdf
  5. http://www.vaccinations.com.au/PDF/deseases/malaria.pdf

New cancer treatment beats chemotherapy without the toxic side effects

New cancer treatment beats chemotherapy without the toxic side effects

Abnormal lymphocyte being attacked by macrophages (upper right), which lead to enhanced gr...
Abnormal lymphocyte being attacked by macrophages (upper right), which lead to enhanced growth and progression of many cancers (Photo: National Cancer Institute)

If a locked door must be opened, explosives can be used, but normally it is better to use a key. The conventional treatments for cancer, surgery, radiation, and chemotherapy, have a range of terrible side effects that resemble the use of explosives. Now a key has been found to treat various forms of leukemia and lymphoma with only very minor side effects. The drug ibrutinib has proven sufficiently safe and effective in early clinical tests by physicians at Ohio State University that it has been given breakthrough drug status by the FDA.
Both chemotherapy and radiation treatment protocols for cancer have one primary goal – design a treatment that is slightly more lethal to the cancer than to the patient. Chemotherapy began nearly 100 years ago, when mustard gas derivatives were studied following World War I. From this early start, serious research on chemotherapy agents for cancers began around 1950. While chemotherapy is still one of the key weapons to use in fighting cancer, a good deal of pharmaceutical and medical research is presently going toward more targeted agents to minimize the enormous stress of cancer therapy on the patient.
A pair of high power micrographs of blood cancers (left) chronic lymphocytic leukemia - da...
Leukemia and lymphoma are cancers of the blood. Leukemia is the proliferation of immature white cells in the blood, which leads to impairment of the immune system, blood clotting issues, and red cell anemia. Lymphoma is a similar proliferation of lymphocytes, which has similar symptoms, but can also involve solid tumors of the lymph nodes. In both cancers, complete cure is unlikely, but the disease can be managed in most cases by triggering partial or complete periods of remission through chemotherapy and/or radiation treatment. As these treatments are still painful and debilitating, and sometimes ineffective, new forms of treatment are an active area of research.
The chemical structure of ibrutinib (1-[(3R)-3-[4-amino-3-(4-phenoxyphenyl)pyrazolo[3, 4-d...
Ibrutinib is a member of a new class of drugs for use against B-cell blood cancers. B-cells are a type of white blood cell that is active in the body's immune system. They have B-cell receptor (BCR) proteins on the cell surfaces, which binds to specific bodily invaders, thereby allowing the immune system to attack the invaders. B-cells also act as part of the memory function of the immune system, keeping a chemical record of past targets of the immune reaction. Malfunctioning B-cells can cause autoimmune diseases as well as becoming cancerous themselves.
In B-cells, an enzyme called Bruton's tyrosine kinase (BTK) is an important stage in the B-cell maturation and activation of the BCR proteins. Among other functions, this BCR signaling is thought to drive the growth and well-being of many types of B-cell cancers. In short, B-cell cancers have a very difficult time surviving in the absence of BTK.
Ibrutinib is a strong covalent inhibitor of BTK, and in inhibiting BTK triggers B-cells to undergo apoptosis, or cell death, effectively blocking cancer growth and metastasis. Ibrutinib also shows activity in treatment of autoimmune disease, by throttling back the action of the immune system.
A new clinical trial carried out by medical researchers at Ohio State University Comprehensive Cancer Center in cooperation with MD Anderson Cancer Center, investigated the effect of ibrutinib in two groups of patients, one having confirmed recurring or resistant cases of chronic lymphocytic leukemia (CLL) and the other having confirmed recurring or resistant cases of mantle cell lymphoma (MCL). Neither study involved a control group or healthy patients, as the object was to determine the toxicity and efficacy of the ibrutinib treatments.
The CLL trial involved 85 ambulatory patients, 51 of whom received ibrutinib at 420 mg/day, and 34 who received 840 mg/day. Ibrutinib can be absorbed by mouth, so the doses were given orally. The lower dose group included a third group, originally excluded from the study because of high-risk genetic factors, who showed no response to chemoimmunotherapy. The early results of the clinical study proved sufficiently positive that exclusion of the third group was judged to be inappropriate.
Treatment with ibrutinib proved to be very safe, with most participants only encountering annoying side effects that did not require stopping the treatment. Only six patients were forced to halt treatment, primarily due to diarrhea and the associated dehydration, and upper respiratory tract infections.
The treatment was also very effective at stopping progression of CLL, and in most cases (71 percent) causing at least a partial remission. The results were independent of the doses used, which argues toward using smaller doses. The response was somewhat better (85 percent) in patients lacking high-risk genetic mutations. Overall, the 26-month survival rate was 83 percent, with little dependence of age or stage of the cancer at the start of participation in the study.
The MCL trial included 111 ambulatory patients, all of whom received 560 mg/day of ibrutinib. Nearly all of the patients had previously received multiple rounds of chemotherapy, and 86 percent had intermediate or high-risk lymphoma.
The ibrutinib treatment proved quite effective, with 21 percent of the patients experiencing a complete remission of MCL, and another 47 percent having a partial remission. The estimated total rate of survival at 18 months was 58 percent. Again, a remarkable feature of the trial is that ibrutinib helped nearly all patients to one extent or another.
“This is remarkable because the last agent approved by the Food and Drug Administration for MCL had a 30 percent response rate,” says senior author Kristie Blum, MD, associate professor of medicine, and head of the OSUCCC – James lymphoma program. “This trial suggests that ibrutinib could significantly improve the landscape of therapy options for MCL.”
The level of response found to ibrutinib could only be approached through conventional chemotherapy by intensive, multiagent regimes of treatment associated with very high toxicity. Ibrutinib is clearly on the fast track to approval for treating a range of B-cell cancers. Hopefully it becomes a standard therapy option before any reader needs such treatment.
Source: Ohio State University

Vaccine 'clears HIV-like virus' in monkeys

Vaccine 'clears HIV-like virus' in monkeys

The team looked at a form of SIV that is up to 100 times more deadly than HIV
A vaccine for the monkey equivalent of HIV appears to eradicate the virus, a study suggests.
Research published in the journal Nature has shown that vaccinated monkeys can clear Simian Immunodeficiency Virus (SIV) infection from their bodies.
It was effective in nine of the 16 monkeys that were inoculated.
The US scientists say they now want to use a similar approach to test a vaccine for HIV in humans.
Prof Louis Picker, from the Vaccine and Gene Therapy Institute at Oregon Health and Science University, said: "It's always tough to claim eradication - there could always be a cell which we didn't analyse that has the virus in it. But for the most part, with very stringent criteria... there was no virus left in the body of these monkeys."
Search and destroy The research team looked at an aggressive form of virus called SIVmac239, which is up to 100 times more deadly than HIV.
Infected monkeys usually die within two years, but in some inoculated primates the virus did not take hold.

Start Quote

It maintains an armed force, that patrols all the tissues of the body, all the time, indefinitely”
Prof Louis Picker Oregon Health and Science University
The vaccine is based on another virus called cytomegalovirus (CMV), which belongs to the herpes family.
It used the infectious power of CMV to sweep throughout the body. But instead of causing disease, it has been modified to spur the immune system into action to fight off the SIV molecules.
"It maintains an armed force, that patrols all the tissues of the body, all the time, indefinitely," explained Prof Picker.
The researchers gave rhesus macaque monkeys the vaccine, and then exposed them to SIV.
They found that at first the infection began to establish and spread. But then the monkeys' bodies started to respond, searching out and destroying all signs of the virus.
Of the monkeys that successfully responded to the vaccine, they were still clear of infection between one-and-a-half and three years later.
Prof Picker said his team was still trying to work out why the vaccination worked in only about half of the monkeys.
"It could be the fact that SIV is so pathogenic that this is the best you are ever going to get.
"There is a battle going on, and half the time the vaccine wins and half the time it doesn't," he said.
Human trials The researchers are now testing the vaccine to see if it can be used after SIV exposure to treat and potentially cure infected monkeys.
They also want to see if the technique could work in humans.
Prof Picker said: "In order to make a human version we have to make sure it is absolutely safe.
A rhesus macaque monkey  
The researchers now want to move from monkeys to test the vaccine in humans
"We have now engineered a CMV virus which generates the same immune response but has been attenuated [modified to lose its virulence] to the point where we think it is unequivocally safe."
This would first have to pass through the regulatory authorities, but if it does, he said he hoped to start the first clinical trials in humans in the next two years.
Commenting on the research, Dr Andrew Freedman, from Cardiff University School of Medicine, said: "This suggests that prophylactic vaccines - vaccines designed to prevent infection - using CMV vectors may be a promising approach for HIV.
"While they may not prevent the initial infection, they might lead to subsequent clearance, rather than the establishment of chronic infection."

Sabtu, 28 September 2013

Health Care Communication

Health Care Communication

Types of relationships in health care
Communication barrier in health care setting
Conflict resolutions
I. Types of relationships in health care:
What is communication?
The process of sharing information using a set of common rules
Type of relationships in health care setting:

Macam hubungan komunikasi di pelayanan kesehatan
1. Professional-patient relationships
Banyak mempengaruhi keberhasilan terapi
Ketidakpuasan pasien
Hasil penelitian:
Provider yang merasa lebih tahu à kurang memperhatikan yang diinginkan pasien à less effective helping
Hambatan hubungan profesional-pasien
Hambatan hubungan:
Role uncertainty:
Ketidakpastian peran
Pasien bingung harus berperan bagaimana agar cepat sembuh
Responsibility conflicts
Konflik tanggung jawab
Pasien merasa dokter yang paling bertanggung jawab untuk kesembuhan
Dokter menuntut pasien ikut bertanggung jawab
Power differences
Pasien kurang tahu tentang kesehatan vs dokter jauh lebih tahu
Unshared meanings à karena knowledge differences

Hambatan hubungan professional-patient: Role uncertainty
Kebingungan dan harapan peran antara professional dan pasien
Kebingungan peran pasien: lonely, unfamiliar with variety of health providers
Tak ingin membuat marah provider
Takut menyita waktu provider

Takut menyatakan perasaan
Dianggap tak punya inisiatif
Hambatan hubungan professional-patient: Responsibility conflict
Siapa yg bertanggung jawab untuk  manajemen kesakitan: pasien vs provider
Seberapa banyak partisipasi pasien?
Jika pasien / professional tak menyetujui kesepakatan tanggung jawab
The model of helping and coping:
How professional help
How patient cope

The model of helping and coping
Hambatan hubungan professional-patient: Power differences
Health provider vs patient= powerful vs powerless
 Can fix body à pasien sangat tergantung à berupaya menjadi good patient
Powerful à more authority
Keputusan berdasarkan nilai provider
Keputusan orientasi hidup-mati bukan harapan pasien

Hambatan hubungan professional-patient : Unshared meanings
Provider orientasi tugas vs pasien orientasi kesehatannya
Banyak jargon medis
Ex: decubitus, alopecia
Interpretasi berbeda
Ex: efek samping, komplikasi, kronis
Be aware:
Kata bermakna ganda
Orientasi orang à bgm perasaan pasien dengan kata itu
Berkomunikasi dengan berbagai cara

2. Professional-professional relationships
Permasalahan yang sering muncul:
Role stress, karena konflik peran atau role overload
Memahami profesi lain, pendidikan terisolasi tapi bekerja dalam team
Autonomy struggle. Pertikaian untuk kekuasaan menentukan keputusan
Professional-family relationships
Keluarga mendukung keberhasilan terapi
Hambatan hubungan:
Kontak keluarga dengan profesional terbatas: keluarga merasa bukan orang yang perlu diperhatikan, profesional terbatas waktunya
Akses informasi
Privileged communication
Patient do not know the information
Filtered communication
Family knowing the information from patient

Patient-family relationships
Keluarga adalah satu sistem yang memiliki fleksibilitas
Permasalahan hubungan pasien-keluarga:
Gangguan peran anggota keluarga
Perubahan peran, jika lama menimbulkan role ambiguity
Terutama untuk penyakit kronis
Menutup komunikasi untuk melindungi si sakit

II. Hambatan berkomunikasi di bidang kesehatan
Membuka diri

Ex: pemeriksaan PA konfirmasi Hodgkin’s disease:
“Akhirnya ketemu juga penyakitnya pak, anda harus bersyukur karena penyakit anda adalah Hodgkin’s disease, anda memiliki waktu cukup lama,10 tahun. Padahal banyak kemungkinan lain yang lebih buruk”
Empati= Usaha untuk ikut memahami perasaan pihak lain
Simpati= Mengekspresikan perasaan atas kejadian yang menimpa orang lain
Pasien dan profesional memiliki kebutuhan untuk dipahami

2. Kontrol
Pasien = kehilangan personal dan relational control
Personal control= Persepsi kemampuan seseorang menentukan jalan hidupnya
Internal vs eksternal
Internal control à lebih mampu mengontrol kesehatannya
Relational control= persepsi kemampuan seseorang menentukan hubungan dengan orang lain
Pasien à good patient or bad patient

3. Kepercayaan
Pasienà helpless, membutuhkan support
Kepercayaan= Harapan seseorang terhadap orang lain untuk memiliki karakteristik positif tertentu
Kepentingan trust:
Untuk mendapatkan rasa aman dan hubungan
Menciptakan suasana komunikasi yang nyaman
Komunikasi yang mendukung dan tidak mendukung  kepercayaan
Tidak mendukung vs mendukung:
Evaluasi vs deskripsi

Cara penangananmu kok nggak benar?
Pasien tampak lebih nyaman jika ...
Kontrol vs orientasi masalah
Kamu tahu jika makan manis akan buruk untuk kamu, sebaiknya hentikan kebiasaanmu itu
Saya tahu jika bapak/ibu suka makan manis, apakah bapak/ibu sudah menemukan cara untuk mengurangi kebiasaan itu?

Komunikasi yang mendukung dan tidak mendukung  kepercayaan
Strategi vs spontanitas
Kamu pandai dalam ...., tolong buatkan aku....
Saya merasa kesulitan dalam hal... Dapatkah kamu membantu bagaimana caranya membuat ....
Netralitas vs empati
Kasihan, ibu itu tak bisa membayar tagihan
Ibu punya Jamkesos? Kalau tidak punya…
Superioritas vs Kesetaraan
Berdasarkan pengalaman saya untuk kasus seperti ini biasanya ...
Pengalaman anda dan keluarga sangat penting dalam menangani masalah kesehatan ini....

4. Self disclosure
Self disclosure= Proses dimana seseorang mau mengkomunikasikan informasi, pikiran dan perasaan
Hambatan self disclosure pasien dan profesional:
Malu jika mengeluhkan sesuatu yg ternyata normal
Takut merusak hubungan
Tak punya waktu
Takut menjadi subyektif

5. Konfirmasi
Konfirmasi= Mengekspresikan empati, kesetaraan, kepercayaan, self disclosing
Respon mengkonfirmasi:
Merespon apa yang dikomunikasikan
Menyetujui isi pesan
Respon mendukung
Ekspresi perasaan positif sebagai dampak
Respon tak mengkonfirmasi:
Mengabaikan pendapat
Menginterupsi pembicaraan
Respon tak relevan
Pindah topik pembicaraan tanpa permisi
Inkoheren à jawaban panjang tak jelas isinya
Incongruous à verbal beda dengan non verbal

Konflik Resolution
Konflik= perseteruan antar unit terkait yang telah melibatkan unsur emosi karena perbedaan yang dirasakan antar unit
Antecedent conditions
Perceived conflict
Felt conflict
Manifest behavior
Conflict resolution or suppression
Resolution aftermath
Styles of approaching conflict

Northouse PG., Northouse LL.,1992 ,Health communication Strategies for health professionals 2nd ed., Prentice Hall Inc., USA
Chrissie Wright, 1995 , Communication Skills, Heinemann Asia Singapore
US Dept. of Health and Human Services, NIH, NCI, Making Health Communication Programs Work
Joseph A. Devito, 1995, The Interpersonal Communication Book , Harper Colins College Publishers, New York



1. Basic skills
Self Disclosure, Listening, Expressing
2. Advanced skills
3. Conflict skills
4. Social skills
5. Public skills

Self Disclosure
Rewards of Self Disclosure
Increased Self Knowledge
Closer intimate relationship
Improved communication
Lighter guilt feelings
More energy
Blocks to Self Disclosure
Fear of rejection
Fear of punishment
Fear of being talked about behind your back
Fear that someone will take advantage of you

Practice in Self Disclosure
Tell about your job, last vacation or some interesting experience
Tell about your opinion about ambitions at work, how you feel about it & what needs you have regarding it
Tell about how you are feeling attracted to the other person

Understand someone
Enjoy someone
Learn something
Give help

Keywords : wanting & intending
Blocks to listening
1. Comparing
2. Mind reading
3. Rehearsing
4. Filtering
5. Judging
6. Dreaming
7. Identifying
8. Advising
9. Sparring
10.Being right
11. Derailing
12. Placating

Four steps to effective listening
1. Active listening
2. Listening with empathy
3. Listening with openness
4. Listening with awareness

1. Active listening
An active process that requires your participation
Ask questions & give feedback
You get a fuller appreciation of what’s being said
You are a collaborator in the communication process
The ways to listen actively ; paraphrasing, clarifying & feedback
To state in your own words what you think someone just said
Absolutely necessary to good listening
Example ; what I hear you saying is, in other words, let me understand, so basically how you felt was, what happened was, etc

Five big dividends
1. People deeply appreciate feeling heard
2. Paraphrasing stops escalating anger & cools down crisis
3. Paraphrasing stops miscommunication, false assumption, errors & misinterpretations are corrected on the spot
4. Paraphrasing helps you remember what was said
5. When you paraphrase you’ll find it  much harder to compare, judge, rehearse, advice,etc

Often goes along with paraphrasing
Asking questions until you get more of the picture
Sharpen your listening focus so that you hear more than vague generalities
Let’s the other person know that you are  interested
I’m willing to work at knowing & understanding you
Active listening depends on feedback
Helps the other person understand the effect of the communication
It is another chance to correct errors & misconceptions
3 important rules for giving feedback : IMMEDIATE, HONEST & SUPPORTIVE
2. Listening with empathy
Only one requirement : simply know that everyone is trying to survive
You don’t have to like everyone or agree with them, but recognize that you do share the same struggle
Saying to yourself

3. Listening with  openness
Listen selectively
Filtering out everything that makes sense
Pouncing on whatever seems false or silly
A skill you can learn
The most important rules is to hear the whole statement, the entire communication, before judging

4. Listening with awareness
1.To compare what’s being said to your own knowledge of history, people & the way things are. You do this without judgement, simply making note of how a communication fits with known facts

2. To hear & observe congruence. Does person’s tone of voice, emphasis, facial expression & posture fit with the communication

Total Listening
1. Maintain good eye contact
2. Lean slightly forward
3. Reinforce the speaker by nodding or paraphrasing
4. Clarify by asking question
5. Actively move away from distractions
6. Be committed, even if you’re angry or upset, to understanding what was saidBASIC SKILLS

1. Observation
I broke the toaster this morning
2. Thought
Unselfishness is essential for a successful marriage
3. Feeling
I missed Mr..x & felt a real loss when he left for Europe
4. Need
Could you just hug me for a while?
Rules for effective expression
Messages should be direct
Messages should be immediate
Messages should be clear
Messages should be straight
Messages should be supportive
2. Advanced skills

Body Language
You can’t “not communicate” with others
Without saying a word, you reveal your feelings & attitudes
Albert Mehrabian ; the total impact of a message :
7%    verbal (words)
38%    vocal (volume, pitch, rhythm)
55%    body movements (mostly facial expressions)
Communicate nonverbally
1. Body movements
Facial expressions
Postures & breathing
2. Spatial relationships
How much distance you put between yourself & the other person

1. Body movements
Body movements serve several communication purposes
Indicating : attitude, conveying feelings, serve as illustrators & regulators
Illustrators are nonverbal movements that accompany & illustrate verbal communication
Regulators are nonverbal cues that monitor or control the speaking of another individual facial expression
The most expressive part of the body
Some emotions can be interpreted reliably by looking only at that eyes & mouth
When observing facial expression: eyebrows are raised or lowered, the forehead is wrinkled or smooth & the chin is set or flaccid

Arms & hands
People who talk with their hands
Unconsciously use regulating & illustrating gestures
Scratch the head in puzzlement, touch the nose in doubt, rub the neck in anger
Lock the hands behind the head as a statement of superiority
Cross arms in front the chest when feeling defensive or unwilling to communicate

Legs & feet
Sit with legs uncrossed & slightly apart, you communicate openness
Straddle a chair indicating dominance
Put one leg over the arm chair, suggesting indifference
Sitting with ankles crossed can be a sign of resistence
Sitting with one leg crossed over the other & swinging & forth is often a sign of bore dome, anger or frustration

Use another exercise to experiment with regulators
When a friend is talking, use different gestures to indicate nonverbally that you want your friend to :
Go on talking
Speed up
Slow down
Get to the point
Stop & let you talk
Stop & end the conversation

Posture & Breathing
Slumped posture can be a sign of feeling “low”, fatigue, a sense of inferiority
Erect posture is generally associated with higher spirits, greater confidence & more openness than slumped posture
Leaning forward tends to suggest openness & interest
Leaning away suggest lack of interest or defensiveness
A tense, rigid posture tends to be a sign of defensiveness, while a relaxed posture indicates openness
Breathing is another indicator of feelings & attitudes
Rapid breathing can be associated with excitement, fear, irritability, extreme joy or anxiety
A pattern of holding breath, alternating with short gasps for air is a sign of anxiety of built up tension
Shallow breathing in the upper chest often indicates thinking that is cut off from feelings
Deep breathing into the stomach is more likely to be associated with feelings & action

2. Spatial relationships
Polemics is the study of what you communicate by the way you use space
How far you stand from a person you’re talking to, how you arrange the furniture in your home & how you respond to others invading your territory are important nonverbal statements
Four distinct zones that people unconsciously use as they interact with others
( Edward T Hall- Anthropologist )
1. Intimate distance
2. Personal distance
3. Social distance
4. Public distance

Intimate distance
A close subphase of actually touching & a far sub phase of 6 to 18 inches from the body
Zone for lovers, close friends & children holding onto their parents or each other
Non intimates usually feel threatened if circumstances force them to share this space without nonverbal barriers to protect themselves
Personal distance
A close sub phase of 1,5 to 2,5 feet
A comfortable zone for talking at a party
Easily touch your partner, whereas in the far sub phase of 2,5 to 4 feet you can discuss something relatively privately without risking touch
In the far sub phase you are literally keeping your partner at arm’s length

Social distance
A close sub phase of 4 to 7 feet
You are most likely to transact such interpersonal business as talking to a client
This sub phase is often used manipulatively to indicate dominance
The far sub phase of 7 to 12 feet is most frequently used for formal business or social interactions
This distance also useful in an open office setting

Public Distance
A close sub phase of 12 to 20 feet which is usually used for relatively informal gathering such as a teacher working with a classroom of students or a boss talking with a group of employees
The far sub phase of 20 feet or more is reserved for politicians & celebrities

3. Conflict skills assertiveness
Teaches you to express your feelings, thoughts & wishes & to stand up for your legitimate rights without violating the rights of others
Is a skill you can acquire, not a personality trait that some people are born with & others are not
Like aggression & passivity, assertiveness is a social behavior that can be learned
Nobody is consistently assertive
You may be assertive with your children in one instance, aggressive with them in another & passive in still another
You might have no trouble being assertive with your family, yet find it almost impossible to be assertive with strangers
Learning to be assertive does not mean that you must always behave assertively
There are times when it is entirely appropriate to be aggressive, as it is when your life or property is being threatened
There are also times when it’s appropriate to be passive, such when a judge is lecturing you
Learning to be assertive means that you can choose when & where to assert yourself

Identifying The Three  Basic Styles Of Communication
Passive style
Aggressive style
Assertive style

Passive style
You don’t directly express your feelings, thoughts & wishes
You may try to communicate them indirectly by frowning, crying or whispering something under your breath
You tend to smile a lot & subordinate your needs to those of others
If you do speak up directly, you make disclaimer such as i’m no expert.. I’m really not sure etc
A passive style includes a soft, weak, even wavering voice
Pauses & hesitation are common
You are likely to be at a loss for words
You may ramble, be vague & use the phrases “ i mean” & “you know” often
Your posture is likely to be slouched & perhaps you will lean againts something for support
Your hands are apt to be cold, sweaty & fidgety
Eye contact is difficult for you, you tend to look down or away

Aggressive style
You are quite capable of stating how you feel, what you think & what you want but often at the expense of other’s rights & feelings
You tend to humiliate others by using sarcasm or humorous put-downs
You are likely to go on the attack when you don’t get your way & you stir up guilt & resentment in others by pointing a finger of blame
Your sentence often begin with “you…” followed by an attack or a negative label
You use absolute terms such as “always” & “never” & describe things in a way that implies that you’re always right & superior
When you are behaving aggressively, you tend to move with an air of superiority & strength
Your eyes are narrowed & expressionless
Your posture is that of a solid rock : feet planted apart, hands on hips, jaw clenched & jutting out, gestures rigid, abrupt & intimidating
Sometimes you point your finger or make a fist
You are so intent on being right that you don’t really hear what others are saying, even when you ask them a direct question

Assertive style
You make direct statements regarding your feelings, thoughts & wishes
You stand up for your rights & take into account the rights & feelings of others
You listen attentively & let other people know that you have heard them
You are open to negotiation & compromise, but not at the expense of your own rights & dignity
You can make direct requests & direct refusals
You can give & receive compliments
You can start & stop a conversation
You can deal effectively with criticism, without becoming hostile or defensive
When you are behaving assertively, you convey an air of assured strength & empathy
Your voice is relaxed, well modulated & firm
While you are comfortable with direct eye contact, you don’t stare
Your eyes communicate openness & honesty
Your posture is balanced & erect

Special Assertive Strategies
Broken record
Content to process shift
Momentary delay
Time out

Assertive Skills Practice
Broken record
Calmly & firmly repeat your statement as many times as necessary for the person to get your message & to realize that you won’t change your mind
Use body language to support your statement
Stand or sit erect, look the other person in the eye, keep your hands quietly at your sides
Content to process shift
When the focus of a conversation is drifting away from the topic you want to talk about
You simply shift from the actual subject being discussed (the content) to what is going on between you & the other person (the process)
Often involves some self disclosure about how you are feeling or thinking in the interaction at that very moment
Momentary delay
You may feel compelled to respond immediately to any situation
Make sure that you understand the other person, analyze what has been said, go inside & become aware of what you feel, think & want in this situation, consciously influence the situation so that you are more likely to get the outcome you want
Time out
When you know that what you are discussing is important, but the discussion is at an impasse, delay the conversation until another time
Time out is valuable when the interaction is too passive or too aggressive
Time out can also be used when you just want some room to think
Set up a specific time in the near future to continue your discussion

Assertive Skills Practice
Ideally you will practice these skills with a sympathetic friend before you apply them in your daily life
Many people find it helpful to rehearse their assertive lines in front of a mirror in order to make sure that their body language is consistent with what they’re saying
Tape recording an imagery assertive conversation can also be very useful

4. Social Skills Making Contact
The world is full of interesting strangers
Everyday potential friends & lovers pass you in the hall way
They eat next to you
It’s frightening to step out of your anonymous role & make contact
What would you do if you were rejected?
The fear of strangers
Outmoded 19th century social restriction
Strangers must be introduced before initiating conversation
Self depriciating
Habitual negative thoughts
They don’t want to talk to me
5 ways to cope with fear of stranger
1. Analyze what you say to yourself
2. Reframe your approach behavior
3. Reframe rejection
4. Deal with the emotional blow when rejected
5. Plan to get rejected

2 Basic rules for successfully making contact

1. To give what you would like to receive
Attention, interest, respect & liking that you want musat also be something you offer to others
2. To have an outward rather than an inward focus
Listen to other person instead of rehearsing your next remark or worrying about your hair or your awkwardness

Body Language For Making Contact
Move toward the other person
Lean forward
Uncross your arms & legs
Make eye contact
Let your responses show
Touch the other person
Ice breakers
start talking
Ask for information
Is there a gift shop in the lobby?
Give a compliment
Your purse has some of the most intricate tooled leather work i’ve ever seen
A little humor
You could get old waiting for a table in this restaurant
Use current events
This city’s full of muggers
The art of conversation
Active listening
Self disclosure

What is Public Health?

What is Public Health?

Public Health is the science of protecting and improving the health of communities through education, promotion of healthy lifestyles, and research for disease and injury prevention. Public health professionals analyze the effect on health of genetics, personal choice and the environment in order to develop programs that protect the health of your family and community.
Overall, public health is concerned with protecting the health of entire populations. These populations can be as small as a local neighborhood, or as big as an entire country.
Public health professionals try to prevent problems from happening or re-occurring through implementing educational programs, developing policies, administering services, regulating health systems and some health professions, and conducting research, in contrast to clinical professionals, such as doctors and nurses, who focus primarily on treating individuals after they become sick or injured. It is also a field that is concerned with limiting health disparities and a large part of public health is the fight for health care equity, quality, and accessibility.
The field of public health is highly varied and encompasses many academic disciplines. However, public health is mainly composed of the following core areas:

Behavioral Science / Health Education

Stopping the spread of sexually transmitted diseases, such as herpes and HIV/AIDS; 
helping youth recognize the dangers of binge drinking; and promoting seatbelt use.
Behavioral Science/Health Education focuses on ways that encourage people to make healthy choices.
This includes the development of community-wide education programs that range from
promoting healthy lifestyles in order to prevent disease and injury, to researching complex health issues.
Specialists encourage people to make healthy choices and develop educational programs that promote
 healthy lifestyles and prevent disease and injury. They also promote more efficient uses of health services,
adopt self-care practices, and participate actively in the design and implementation of health programs.
Some examples of concentrations include mental health, aging, health promotion and disease prevention,
public health practice, health education and behavior change, disability and health, and social research.


Estimating the number of deaths from gun violence or looking at trends in drunk driving injuries
by using math and science is the study of biostatistics. Using biostatistics, one can identify health trends
 that lead to life-saving measures through the application of statistical procedures, techniques, and
methodology. Forecasting scenarios, identifying health trends within the community, explaining biological
phenomena, as well as determining the causes of disease and injury, biostatistics are an integral part of
public health. Biostatistics are often utilized in tandem with epidemiology.

Emergency Medical Services (EMS)

Ensuring that communities have trained emergency medical responders always available to respond to
 emergencies.  Emergency Medical Services focuses on ensuring a functioning emergency care system.
This includes licensing paramedics and emergency medical technicians, approving the training curriculum
and licensing EMS instructors, ensuring ambulances are safe and well-equipped, and ensuring that every
 community has access to emergency care-from first responders through to a sophisticated trauma center. 
State or regional public health specialists may focus on training, licensing, quality control, access, research,
or disaster preparedness.  While the actual emergency care may be provided by a hospital, a fire
 department, a private company, or a non-profit organization, EMS Public Health professionals ensure
a coordinated EMS system that works seamlessly to provide rapid, competent, emergency care to all
Public Health at Work Today page
Emergency Medical Services: Making Children Safer
Florida's EMS for Children Program within the Bureau of EMS at the State Department of Health is
directly improving emergency care for children in a variety of ways, including providing supplemental
pediatric care training to paramedics and emergency medical technicians, purchasing specific pediatric
medical supplies for EMS organizations, providing over 18,000 special pediatric emergency care toolkits
for special needs shelters, and performing research on pediatric emergency care throughout the state.
This example, part of a nationwide program to improve pediatric emergency care is a great example of
how EMS Public Health professionals have a direct impact on their communities
Source: http://www.doh.state.fl.us/demo/ems/EMSC/EMSChome.html
Information for Prospective Students page/Getting Public Health Experience
  • Volunteer for your local emergency medical service organization, get trained, and get hands-on 
  • experience saving lives while you learn about the emergency care system firsthand.
Web Resources Page/General Public Health Websites

Environmental Health

The air we breathe; the water we drink; the complex interactions between human genetics and our 
surroundings. How do the built and natural environments influence our health and how can we reduce risk
 factors? These environmental risk factors can cause diseases such as asthma, cancer, and food poisoning.
Specialists from chemistry, toxicology, engineering, and other disciplines combine their expertise to answer
 these important questions. Environmental health studies the impact of our surroundings on our health.
Because environmental health is so broad in scope, it is often broken down in academic and professional
settings in areas of contact and medians. These areas are: 
  • air quality
  • food protection
  • radiation protection
  • solid waste management
  • hazardous waste management
  • water quality
  • noise control
  • environmental control of recreational areas
  • housing quality
  • vector control 


When food poisoning or an influenza outbreak attacks a community, the "disease detectives" or
 epidemiologists are asked to investigate the cause of disease and control its spread. Epidemiologists
do fieldwork to determine what causes disease or injury, what the risks are, who is at risk, and how to
 prevent further incidences. They spot and understand the demographic and social trends that influence
 disease and injury and evaluate new treatments. The initial discovery and containment of an outbreak,
such as West Nile virus, often comes from epidemiologists. Some of the most important health-related
discoveries in history are associated with epidemiology including the landmark 1964 Surgeon General's
 report on smoking tobacco stating its harmful effects. Biostatistics are often used in tandem with

Health Services Administration/Management

Managing the database at a school clinic; developing budgets for a health department; 
creating polices for health insurance companies; and directing hospital services all depend 
on health administrators. The field of health services administration combines politics, business,
and science in managing the human and fiscal resources needed to deliver effective public health services.
Specialization can be in planning, organization, policy formulation and analysis, finance, economics,
or marketing.

International / Global Health

Addressing health concerns from a global perspective and encompassing all areas of public health 
(e.g., biostatistics, epidemiology, nutrition, maternal and child health, etc.). International health
professionals address health concerns among different cultures in countries worldwide.
Globalization has linked our health more closely to one another than ever before. The rapid movement
of people and food across borders means that a disease can travel from a remote village to an urban hub
 at breakneck speed. Global public health meets the rising health challenges that transcend national
boundaries. This international field encompasses virtually all specializations in public health.
Every school offers slightly different tracks or areas of interest. Here are examples from various schools:
  • Health-Care Finance and Economics
  • Population Policy and Demography
  • Maternal and Child Health/Primary Health Care/Health Services
  • Communication and Behavioral Science
  • Coping with Complex Emergencies
  • Mental Health and Medical Anthropology
  • Program Evaluation/Information Systems
  • Public Nutrition and Food Security
  • International Health Policy and Management
  • Infectious Disease Epidemiology and Control
  • Research and Evaluation Methods
  • Health Promotion

Maternal and Child Health

Providing information and access to birth control; promoting the health of a pregnant woman
 and an unborn child; and dispensing vaccinations to children are part of maternal and child health.
 Professionals in maternal and child health improve the public health delivery systems specifically for women,
 children, and their families through advocacy, education, and research.


Promoting healthy eating and regular exercise; researching the effect of diet on the elderly;
 teaching the dangers of overeating and overdieting are the responsibility of public health
 nutritionists. In short supply in both public and private sectors, this field examines how food and nutrients
affect the wellness and lifestyle of population. Nutrition encompasses the combination of education and
science to promote health and disease prevention.

Public Health Laboratory Practice

Public health laboratory professionals such as bacteriologists, microbiologists, and biochemists test
biological and environmental samples in order to diagnose, prevent, treat, and control infectious diseases
in communities. In order to ensure the safety of our food and water, to screen for the presence of certain
diseases within communities, and to respond to public health emergencies, such as bioterrorism, public
health laboratory practice is essential.

Public Health Policy


Analyzing the impact of seat belt laws on traffic deaths; monitoring legislative activity on
 a bill that limits malpractice settlements; advocating for funding for a teen anti-smoking 
campaign. Professionals in public health policy work to improve the public's health through legislative
action at the local, state, and federal levels.

Public Health Practice

Public health is an interdisciplinary field and professionals in many disciplines such as nursing, medicine,
veterinary medicine, dentistry, and pharmacy routinely deal with public health issues. A degree in public
health practice enables clinicians to apply public health principles to improve their practice.