- Research article
- Open Access
Reducing uncertainties in global HIV prevalence estimates: the case of Zambia
BMC Public Health volume 6, Article number: 83 (2006)
The premise for using antenatal care (ANC) clinic data for estimating HIV prevalence in the general population is the finding from community studies in sub-Saharan Africa that total HIV prevalence in pregnant women attending ANC clinics closely approximate levels in the total general population of both women and men aged 15–49 years. In this study, the validity of national level HIV prevalence estimates for the total general population 15–49 years made from ANC clinic and population survey data was assessed.
In 2001–2002, a national population HIV prevalence survey for women 15–49 years and men 15–59 years was conducted in Zambia. In the same period, a national HIV sentinel surveillance survey among pregnant women attending ANC clinics was carried out.
The ANC HIV prevalence estimates for age-group 15–49 years (rural: 11.5%; 95% CI, 11.2–11.8; urban: 25.4%; 95% CI, 24.8–26.0; adjusted national: 16.9%; 95% CI, 16.6–17.2) were similar to the population survey estimates (rural: 10.8%; 95% CI, 9.6–12.1; urban: 23.2%; 95% CI 20.7–25.6; national: 15.6%; 95% CI, 14.4–16.9). The HIV prevalence urban to rural ratio was 2.2 in ANC and 2.1 in population survey estimates.
The HIV prevalence estimate for the total general population 15–49 years derived from testing both women and men in the population survey was similar to the estimate derived from testing women attending ANC clinics. It shows that national HIV prevalence estimates for adults aged 15–49 years can also be obtained from ANC HIV sentinel surveillance surveys with good coverage when ANC attendance and fertility are high.
UNAIDS has recommended antenatal care (ANC) clinics sentinel surveillance to measure HIV prevalence trends in generalized epidemics due to problems of acceptability when conducting HIV surveys in the general population [1, 2]. The premise for using ANC data for estimating HIV prevalence in the general population is the finding from community studies in sub-Saharan Africa that total HIV prevalence in pregnant women attending ANC clinics closely approximate levels in the total general population of both women and men aged 15–49 years [3–7]. Pregnant women thus seem to represent a random sample of the population with respect to HIV prevalence in a generalised epidemic, and it has been suggested that confidence limits about the size of the epidemic become narrower as the epidemic progresses[8, 9].
Country estimates of HIV prevalence derived from ANC-based data with the UNAIDS model have faced a barrage of criticisms because estimates from some national population surveys are significantly different from ANC-based estimates [9, 10]. Whether these differences are due to errors in surveys or the model has not been demonstrated with countries data.
In Zambia, parallel population and ANC-based HIV prevalence estimates provided from selected surveillance sites have revealed a close match between them [5–7]. These are findings from settings where fertility rates were high and more than 90% of women had made at least one visit to an ANC clinic when pregnant . High validity of ANC-based HIV prevalence estimates at site levels, however, is no guarantee for respective high validity of estimates at national levels. Validity at that level will to a great extent be influenced by the selection of surveillance sites. In 2001–2002, a national HIV prevalence population survey was carried out in Zambia as part of the Zambia Demographic and Health Survey (ZDHS). A national ANC HIV sentinel surveillance survey was also carried out in the same period. This offers an opportunity to compare and validate the representativeness of national ANC-based and population surveys HIV prevalence estimates.
ANC sentinel surveillance
Repeated cross-sectional surveys in which women on their first ANC clinic visit and accepting routine syphilis testing are anonymously tested for HIV, have been carried out in 1994, 1998 and 2001–2002 in selected ANC sites. They targeted to test about 500 women per site within four months. Similar test protocols have been used in these surveys [7, 11, 12]. The 2001–2002 survey was from September 2001 to April 2002. Some sites took more than four months and were unable to test the target number. Some urban sites tested over 500 women.
The national population HIV survey
The survey was carried out from November 2001 to May 2002 as part of the ZDHS. The sample universe was women 15–49 years living in households . The sample frame was the geographical distribution of household clusters from the 2000 Census of Population and Housing. At least 85 households were in a cluster. With a minimum cluster take of 25 completed interviews of women, 320 clusters were allocated proportional to the population size of provinces within urban and rural areas. One hundred urban and 220 rural clusters were selected at the first stage. At the second stage, households were selected after field listing to update the household information in the selected clusters. De-facto household members of women 15–49 years in 8200 selected households and men 15–59 years in a third of these households were eligible to be interviewed. Women and men in households from which men were selected were eligible for an HIV test.
If a respondent consented to HIV testing, a laboratory technician prepared a dried blood spot (DBS) sample on a filter paper card from a venous blood draw at the household. A three stage test protocol was also used. After eluting the DBS samples, they were first tested using Wellcozyme HIV 1&2 GACELISA. All the positive samples were re-tested using BIONOR HIV 1&2. Discordant cases were tested with Western Blot. A total of 3961 samples were collected, of which 710 tested positive on GACELISA. After testing with BIONOR, 570 cases remained positive. With Western Blot, all 140 discordant samples were confirmed to be negative with the exception of one. In quality control, 10% of the total samples found negative with GACELISA test were re-tested with BIONOR. Two cases were positive on BIONOR as well as on Western Blot. In other quality control, both plasma and DBS samples for 505 respondents were tested. Plasma and DBS samples found positive were 118 and 121 respectively. With Western Blot, the 3 discordant results were negative for the plasma but positive for the DBS samples.
Protocols for both surveys were approved by the Ethical Review Committee of the University of Zambia. The Institutional Review Board of ORC Macro in the USA also approved the ZDHS protocol. Informed consent was sought from all willing participants. Participants were included in the study after obtaining an informed consent. In the ZDHS, additional consent was obtained from the parent or guardian if the respondent was aged 15–17 years.
Analysis was restricted to women and men aged 15–49 years in the ZDHS. It was also restricted to women in this age group for the ANC sites. Data was analyzed with the Statistical Package for Social Sciences (SPSS for Windows; SPSS, Chicago, Illinois, USA) and the Microsoft Office Excel Spreadsheet (Microsoft Incorporation; Washington USA). We compared HIV prevalence estimates for the general population from the ANC survey and ZDHS by age, sex, province and residence. The 95% confidence intervals (CI) for the ZDHS took into account the design effect of cluster sampling. Cluster effect was not taken into account for pooled ANC sites data because they were selected purposively.
Weights were applied to the ZDHS data in order to adjust for differential non-response by sex and province. Other variables could not be adjusted for because information was not collected in the survey. A sensitivity analysis was carried out in order to assess the potential bias from non-response. The critical level of difference in prevalence levels between respondents and non-respondents which would significantly change the HIV prevalence estimates derived from respondents if non-respondents were also tested was determined.
Total ANC-based HIV prevalence estimates were adjusted for the distribution of the total population by respective age groups between urban and rural areas because 61.8% of the ANC population were from urban areas. However, total population aged 15–49 years that lived in urban areas was 38.6%. The 2000 Zambia census of population and housing was used as the standard population. Most surveys carried out in Zambia in the period these surveys were carried out used it as the sample frame.
Differential non-response by sex and province had no effect on the total HIV prevalence estimates by age, sex and residence. Changes in the HIV prevalence estimates after weighting were insignificant. Table 1 shows critical differences in HIV prevalence between respondents and non-respondents that would significantly change the HIV prevalence estimates for the general population made from respondents if non-respondents were also tested. Non-response would significantly bias the HIV prevalence estimate for Zambia if HIV prevalence among non-respondents was different by at least 41% from the level among respondents. If this was the case, the HIV prevalence for Zambia would be 17.3%. The critical prevalence difference between respondents and non-respondents increases as the sample size reduces. It ranges from 41% for Zambia with a sample of 3804 respondents, to 289% in North-Western province with a sample of 223 respondents. Sample size, response rate and the prevalence level determine this critical difference
Table 2 shows that non-response in the ZDHS was systematic by age, sex and area of residence. Overall, a weighted total of 2148 women 15–49 years (76.4% of eligible women) and 1757 men 15–49 years (72.4% of eligible men) voluntarily gave blood for HIV testing. The percentage that refused the test was similar between women and men. The proportion of women and men tested was lower in urban than in rural areas. The difference in the proportions was bigger for men than women. The percent tested among men tended to drop with an increase in age in urban areas and to increase with an increase in age in rural areas. Due to a pattern in the response rates by age, the HIV prevalence estimates were standardized for the 2000 Census population age distribution. The urban to rural and women to men ratios for the standardized estimates were only slightly different from those obtained before standardization. The women to men ratio of HIV prevalence increased from 1.4 to 1.7 in urban areas, to 1.5 in rural areas and to 1.5 for the total population. HIV prevalence among women and men in urban areas was respectively about twice the level of that in rural areas. This pattern persists in all age groups for women but only in the 25–29 and 30–39 years age groups for men. Peak prevalence was in the 30–39 years age group for women in urban and rural areas. It was also in this age group for men in urban areas but in the older age group of 40–49 years in rural areas.
Table 3 shows that the age patterns for ZDHS and ANC-based prevalence estimates were different although their total estimates were not significantly different. Their total urban to rural prevalence ratios at 2.2 for ZDHS and 2.1 for ANC-based estimates were close. ANC-based estimates were higher than ZDHS estimates in the age groups 15–19, 20–24 and 25–29. Peak HIV prevalence was in the age group 30–39 years in the ZDHS and earlier in the 25–29 year age group for ANC-based estimates. Figure 1 shows a similar pattern among the provinces. Peak prevalence was mainly in the 25–29 years age group in ANC-based estimates and 30–39 years age group in ZDHS estimates.
Table 4 shows that the ZDHS and ANC-based HIV prevalence estimates for urban and rural areas of provinces were also close. They were only significantly different for rural areas in Central and Southern provinces. In rural Central province, the ANC-based estimate was significantly higher. In rural Southern province, the ZDHS estimate was more than twice as high as the ANC-based estimate. The cut-off point for domain samples which would yield plausible estimates of HIV prevalence in the general population is about 627. This yielded an HIV prevalence estimate with a 20% variation within 95% CI in urban Copperbelt province. Smaller domain samples did not have the power to yield estimates with a better precision. ANC-based estimates derived from larger samples and not affected by non-response because testing for HIV was anonymous, had a variation of less than 10% within the 95% CI for all domains. The variation of the ZDHS estimates within the 95% CI ranges from 8.3% for total Zambia to 83.2% for rural Copperbelt province while the variation of all the ANC-based estimates was within 10% of the 95% CI. Mean ANC-based HIV prevalence estimates for the general population tended to be higher than those from the ZDHS.
The HIV prevalence for the total population 15–49 years in 2001–2002 was 15.6% from the ZDHS and 16.9% from the ANC-based data. ZDHS estimates indicated an HIV prevalence of 13.0% among men and 17.8% among women. The prevalence ratio of women to men was 1.4 in both urban and rural areas. ZDHS estimates for urban and rural areas were 23.2% and 10.8% respectively. The respective ANC-based estimates were 25.4% and 11.5%. The urban to rural prevalence ratios were 2.1 for ZDHS and 2.2 for ANC-based estimates. ANC-based estimates for the general population of provinces were also not significantly different except for total Central province, rural areas of Central province and rural areas of Northern province.
We conclude that there was no significant difference in the total, urban and rural HIV prevalence estimates derived from the two data sources. The similarity was not by chance as shown by the similarity of ANC-based and ZDHS estimates for all provinces but one, total urban, total rural, all urban areas and seven rural areas of the provinces. It showed that both ANC-based and population survey estimates can be similar even at national level if there are no coverage distortions in the national surveys in countries with generalized epidemics. ANC sites estimates also gave plausible indications of the level of HIV prevalence in the general population of the provinces without coverage distortions. The difference in estimates for rural areas of Central province and Southern province could be due to the disproportionate percentage of their clients who lived in urban areas. In Central province, 19.7% of ANC clients lived in urban areas and only 0.6% in the rural site of Southern province .
Provincial HIV prevalence estimates from the ZDHS would be more reliable than ANC-based estimates because they are less affected by coverage bias. Unbiased coverage in the ZDHS is shown in many ways. Age standardized estimates were only slightly different from the non standardized estimates. There was a similarity between weighted and un-weighted HIV prevalence estimates. Significant differences would indicate bias in the coverage of some groups. However, weighting can not adjust for any differences in the HIV prevalence of the respondents and non-respondents. Such differences can only be assessed through an independent survey of those persons who were not covered in the ZDHS. HIV prevalence in Zambia increases by level of education. However, differences in response rates by level of education in the ZDHS were small and they were not in any direction. Other studies have shown that the association between level of education and infection changed between 1995 and 2003 in some communities in Zambia, from being clearly positive to being negative in age-groups younger than 30 years. A population survey in catchment areas of some ANC sites also showed that neither mobility nor migration was associated with HIV infection . Therefore, HIV prevalence of absent respondents was less likely to be different from that of respondents. Further, the margin of difference in prevalence levels between respondents and non-respondents required to significantly change the prevalence estimates if non-respondents were also tested is too big for non-respondents without an elevated risk of being infected. Other surveys have shown that HIV prevalence levels of non-respondents are not significantly different from those of respondents unless the exposure variables of non-respondents or HIV test results from the sample frame indicate an elevated risk of contracting HIV [16, 17].
ANC-based and ZDHS estimates of HIV prevalence for the total general population show that ANC-based estimates were higher in the age groups 15–19, 20–24 and 25–29 years by 58.4%, 35.4% and 10.2% respectively. They were lower by 37.0% and 79.3% in age groups 30–39 and 40–49 years respectively. This pattern does not occur by chance. It was also seen in the provinces. Misrepresentation of prevalence by age group in the general population by ANC-based estimates cancelled itself out almost completely. Total ANC-based and ZDHS estimates were similar at the national level just as has been observed in some communities.
WHO/UNAIDS using an epidemiological model with ANC-based data for inputs estimated total HIV prevalence for adults 15–49 years in Zambia to be 19.1% in 1997 , 20.0% in 1999  and 21.5% in 2001. Compared to our ANC-based estimate, they over-estimated the Zambian epidemic by 27% (16.9% versus 21.5%) in 2001. However, in the 2003 update, it was changed from 21.5% to 16.5% .
The dynamic interactions of HIV and its host population which affects fertility and mortality and in turn HIV prevalence as well has been reported for Eastern Africa . ANC-based estimates are initially close to population based estimates when the female to male HIV prevalence estimates are less than 1.4. Afterwards prevalence from ANC-based estimates could become biased downwards with the increasing average duration of the infected population and the increase in fertility impairment with duration even when there has been no change in prevalence in the general population.
Marked HIV declines in young men and women in the general population were understated in the parallel ANC-based trends in some communities in Zambia over a shorter period from 1995 to 2003 . Explanations for this trend were related to changes in fertility behaviours among young women, i.e. postponement of child bearing, and differential HIV declines by level of education. Because of such changes in the demographic state induced by the HIV epidemic, methods and models for measuring HIV transmission trends might need to be changed [22, 23]. Household surveys, despite their high cost could be needed as alternative systems for measuring HIV prevalence in the general population. High non-response might appear a threat in this regard, however, and the well functioning ANC-based systems should continue until alternative systems are in place.
It is apparent that ANC-based surveillance can provide total national HIV prevalence estimates for adults in the general population aged 15–49 years that match those from population surveys for a country with a generalized HIV epidemic, high ANC coverage, fertility levels and good coverage of ANC-based HIV surveillance surveys. Differences observed between national ANC-based and population survey HIV prevalence estimates for some countries with generalized epidemics could be due to coverage distortions in the surveys. Over the course of the epidemic, population surveys might be the best source of data for monitoring prevalence in the general population.
World Health Organization.: Sentinel Surveillance for HIV Infection. 1988, Geneva , World Health Organization
UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance.: Guidelines for conducting HIV sentinel serosurveys among pregnant women and other groups. 2003, Geneva , UNAIDS/WHO
Borgdorff M, Barongo L, van Jaarsveld E, Klokke A, Senkoro K, Newell J, Nicoll A, Mosha F, Grosskurth H, Swai R, et al: Sentinel surveillance for HIV-1 infection: how representative are blood donors, outpatients with fever, anaemia, or sexually transmitted diseases, and antenatal clinic attenders in Mwanza Region, Tanzania?. Aids. 1993, 7 (4): 567-572.
Kwesigabo G, Killewo JZ, Urassa W, Mbena E, Mhalu F, Lugalla JL, Godoy C, Biberfeld G, Emmelin M, Wall S, Sandstrom A: Monitoring of HIV-1 infection prevalence and trends in the general population using pregnant women as a sentinel population: 9 years experience from the Kagera region of Tanzania. J Acquir Immune Defic Syndr. 2000, 23 (5): 410-417.
Glynn JR, Buve A, Carael M, Musonda RM, Kahindo M, Macauley I, Tembo F, Zekeng L: Factors influencing the difference in HIV prevalence between antenatal clinic and general population in sub-Saharan Africa. Aids. 2001, 15 (13): 1717-1725. 10.1097/00002030-200109070-00016.
Fylkesnes K, Ndhlovu Z, Kasumba K, Mubanga Musonda R, Sichone M: Studying dynamics of the HIV epidemic: population-based data compared with sentinel surveillance in Zambia. Aids. 1998, 12 (10): 1227-1234. 10.1097/00002030-199810000-00015.
Fylkesnes K, Musonda RM, Sichone M, Ndhlovu Z, Tembo F, Monze M: Declining HIV prevalence and risk behaviours in Zambia: evidence from surveillance and population-based surveys. Aids. 2001, 15 (7): 907-916. 10.1097/00002030-200105040-00011.
Improved methods and assumptions for estimation of the HIV/AIDS epidemic and its impact: Recommendations of the UNAIDS Reference Group on Estimates, Modelling and Projections. Aids. 2002, 16 (9): W1-14. 10.1097/00002030-200206140-00024.
Grassly NC, Morgan M, Walker N, Garnett G, Stanecki KA, Stover J, Brown T, Ghys PD: Uncertainty in estimates of HIV/AIDS: the estimation and application of plausibility bounds. Sex Transm Infect. 2004, 80 Suppl 1: i31-38. 10.1136/sti.2004.010637.
Boerma JT, Ghys PD, Walker N: Estimates of HIV-1 prevalence from national population-based surveys as a new gold standard. Lancet. 2003, 362 (9399): 1929-1931. 10.1016/S0140-6736(03)14967-7.
Fylkesnes K, Musonda RM, Kasumba K, Ndhlovu Z, Mluanda F, Kaetano L, Chipaila CC: The HIV epidemic in Zambia: socio-demographic prevalence patterns and indications of trends among childbearing women. Aids. 1997, 11 (3): 339-345. 10.1097/00002030-199703110-00012.
Fylkesnes K, Musonda RM, Luo NP, Msiska R: HIV infection among antenatal women in Zambia, 1990-1993. Aids. 1996, 10 (5): 555-556.
Central Statistical Office (Zambia), Central Board of Health (Zambia), ORC Macro: Zambia demographic and health survey 2001-2002. 2003, Calverton, Maryland, USA , Central Statistical Office, Central Board of Health and ORC Macro
National HIV/AIDS Council, Central Board of Health, Tropical Diseases Research Centre, Centers for Disease Control and Prevention: Sentinel Surveillance of HIV/Syphillis in Zambia. Sentinel Surveillance. 2003, Lusaka , National HIV/AIDS Council,
Michelo C, Sandøy I, Fylkesnes K: Marked HIV prevalence declines in higher educated young people: evidence from population-based surveys (1995-2003) in Zambia. Aids, in press.
Brookmeyer R, Gail MH: AIDS epidemiology : a quantitative approach. Monographs in epidemiology and biostatistics v 22. 1994, New York , Oxford University Press, ix, 354 p.-
McQuillan GM, Khare M, Karon JM, Schable CA, Vlahov D: Update on the seroepidemiology of human immunodeficiency virus in the United States household population: NHANES III, 1988-1994. J Acquir Immune Defic Syndr Hum Retrovirol. 1997, 14 (4): 355-360.
UNAIDS/WHO: Report on the Global HIV/AIDS epidemic, June 1998. 1998, Geneva , UNAIDS/WHO
UNAIDS: Report on the Global HIV/AIDS epidemic June 2000. 2000, Geneva , UNAIDS
UNAIDS: Report on the Global HIV/AIDS epidemic 2002. 2002, Geneva , UNAIDS
Joint United Nations Programme on HIV/AIDS: 2004 report on the global AIDS epidemic : 4th global report. 2004, Geneva , UNAIDS, 231-
Heuveline P: HIV and population dynamics: a general model and maximum-likelihood standards for east Africa. Demography. 2003, 40 (2): 217-245.
Zaba BW, Carpenter LM, Boerma JT, Gregson S, Nakiyingi J, Urassa M: Adjusting ante-natal clinic data for improved estimates of HIV prevalence among women in sub-Saharan Africa. Aids. 2000, 14 (17): 2741-2750. 10.1097/00002030-200012010-00014.
The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/6/83/prepub
Sentinel surveillance data were compiled by staff at the Immunology Unit at the Tropical Diseases Research Centre in Ndola and the University Teaching Hospital virology laboratory in Lusaka, and with support from USA Centre for Diseases Control. Zambia demographic and health survey data was compiled by staff of the Population and Demography Branch of the Central Statistical Office with the help of MACRO OCR of USA. We also thank Ann Way of MACRO OCR for suggesting some analyses in the paper.
The author(s) declare that they have no competing interests.
KD was the principal investigator for the 2001–2002 ZDHS and made substantive contributions to the design of this survey and directly participated in the development of the data collection strategy, costing of the survey, training of all levels of survey staff, supervising the fieldwork and data analysis. The data from the 2001–2002 ANC-based HIV Surveillance system were made available from the Central Board of Health and for the purpose of this paper analysed by KD. KF contributed substantially in designing and developing the national ANC-based HIV surveillance system and the establishment of parallel population-based surveys in selected sites, and contributed all through the preparation of the paper.
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Dzekedzeke, K., Fylkesnes, K. Reducing uncertainties in global HIV prevalence estimates: the case of Zambia. BMC Public Health 6, 83 (2006). https://doi.org/10.1186/1471-2458-6-83
- Central Province
- Generalize Epidemic
- Copperbelt Province
- Total General Population
- Population Survey Estimate


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Foreign nationals over 18 are required to present a COVID-19 passport (a
document confirming complete vaccination against COVID-19 or immunity gained by recovering from COVID-19) at the border control in Azerbaijan and a document confirming a negative PCR test result for COVID-19 taken within 72 hours of arrival. Passengers between the ages of 1 and 18 must present a negative PCR test taken within 72 hours before the flight.
To enter Uzbekistan you must be able to show a negative PCR test for coronavirus taken no more than 72 hours before your arrival into the country. This includes people who are vaccinated.
Travel to Oman is now allowed
All travelers arriving in Oman are required to present a COVID-19 vaccine certificate containing a QR Code stating that they have received two doses of any COVID-19 vaccine approved in Oman, those being: Pfizer BioNTech, Oxford Astrazeneca, Covishield AstraZeneca, Sputnik, Sinovac, Moderna, and Sinopharm, or a single dose of Johnson & Johnson. The last dose is required to have been received not less than 14 days ahead of the estimated arrival time. The Ministry of Health publishes and updates the list of vaccines approved in Oman.
Before traveling to Oman, all passengers need to complete a pre-registration form at the eMushrif website and upload their COVID-19 vaccine certification and PCR test result, both containing QR codes.
Passengers must also have proof of travel/health insurance which covers the cost of at least 30 days of COVID-19 treatment.
All air passengers arriving in Oman who present a pre-travel negative result COVID-19 PCR test are exempted from quarantine. You must present a PCR certificate with QR code confirming a negative PCR test result (for flights shorter than 8 hours, this test must be taken no more than 72 hours before arrival in Oman; for flights longer than 8 hours, this test must be taken no more than 96 hours before arrival in Oman)
Plan your trip now!
To have more information and start planning your trip, don’t hesitate to email us at [email protected]. We’d be delighted to help you organize your future trip!


My Truths #4 (muscles)
Muscles are sexy! Lifting weights burns calories, creates muscle and builds bone mass. More muscle means higher metabolism and (I can’t stress this enough) muscles are sexy! Tips: 1) Never work the same muscles 2 days in a row. Muscles need time to repair. You actually don’t get stronger while you’re lifting. When you lift heavy weight to failure (until you can’t lift anymore) you make tiny tears in your muscles. Your muscles get stronger when they are repairing. 2) Don’t be fooled in to lifting lighter weights and doing more repetitions because you think this will keep you from “bulking up”. This just takes more time. Without supplements it’s virtually impossible for a women to “bulk up”. Lift the heaviest weight that you can with proper form. I promise you… this will give you sexy feminine muscles.


Schizoaffective disorder (A guide)
Schizoaffective disorder can be defined as persistent mental wellness condition portrayed primarily by side effects of schizophrenia, for instance, spiritual trips or daydreams, and manifestations of such a state of psychological disorder, for example, madness as well as misery.
Researchers do not know without a doubt if the schizoaffective disorder is connected mostly to schizophrenia or a state of mental disorder.
In any case, it is usually seen and treated as a mix of the two conditions.
Evaluations propose that upwards of one out of every three individuals determined to have schizophrenia have schizoaffective disorder.
The finding can be troublesome because the side effects of schizoaffective disorder are so like that of schizophrenia and bipolar disorder.
Numerous individuals with schizoaffective disorders are regularly mistakenly determined from the start to have bipolar disorders or schizophrenia.
Since the schizoaffective disease can be less well-examined than the other two conditions, multiple mediations are acquired from their treatment draws near.
Schizoaffective is moderately uncommon, with a lifetime commonness of just 0.3%.
Persons experience the schizoaffective disorder at a similar rate; but, men regularly build up the ailment at a past age.
Schizoaffective disorder has been overseen viably with medicine and treatment.
- A feeling of extraordinary physical and mental prosperity over the top vitality and euphoria of state of mind, which is likewise called inclination ‘high.’
- You may not rest a lot, and your fixation is influenced.
- You may talk exceptionally quick, regularly hopping, starting with one theme then onto the next and have hopeful thoughts which can be unreasonable or strange, for instance, you may accept that you have different capacities and forces.
- In later stages, your discourse may get unfathomable; you may get bad-tempered and disregard your wellbeing and security.
- This can influence your connections and make it hard for you to continue working.
- You feel tragic constantly, yet you lose enthusiasm for the things that you recently loved.
- You may likewise lose your inspiration and vitality.
- Your rest and eating examples might be influenced.
- You will most likely be unable to focus on a book or TV program and can likewise encounter extraordinary sentiments of blame, uselessness, and sadness.
Schizoaffective disorder VS Schizophrenia
A few people feel that schizoaffective disorder sits in a range, with schizophrenia toward one side and bipolar disorder at the other.
Be that as it may, schizoaffective disorder is perceived as a different condition to schizophrenia, both in clinical practice and in academic writing.
The two kinds of schizoaffective disorder — the two of which incorporate a few indications of schizophrenia — are:
- Bipolar type: incorporates scenes of mania and some of the time significant sorrow
- Depressive type: incorporates just significant burdensome scenes
Schizoaffective disorder may run a one of a kind course in each affected individual.
The untreated schizoaffective disorder may prompt disorders working at work, at school, and in social circumstances, raising forlornness and ruckus holding down a vocation or going to class.
Individuals with schizoaffective disorder may require help and backing with every day working.
Treatment can help manage side effects and improve personal satisfaction.
The indications of schizoaffective disorder could be extreme and ought to be observed intently.
Contingent upon the sort of state of mind disorder analysed, sadness, or can be bipolar disorder; persons will show various indications:
- Hallucinations are seeing and hearing things that are not there.
- Delusions are false, and fixed convictions held paying insufficient respect to conflicting proof.
- Disarranged reasoning: An individual may switch rapidly, starting with one subject, then onto the next, or give irrelevant answers.
- Discouraged state of mind: If an individual has been determined to have schizoaffective disorder burdensome sort, they will encounter sentiments of pity, void, feelings of uselessness, or different indications of despair.
- Manic behaviour: If an individual is determined and having schizoaffective disorder: bipolar kind, they will have sentiments of happiness, dashing contemplations, unsafe conduct as well as various consequences of madness.
- Times of hyper temperament, with an expansion in vitality and a diminished requirement for rest more than a few days, and unusual practices
- If you are encountering complicated thinking, you may feel like your contemplations are fluffy, or everything feels detached. At the point when you talk, you will be unable to recall what you were discussing, so it is difficult for individuals to pursue what you state. You may likewise feel like your considerations are not inside your control.
- Impaired work-related, academic as well as social working
- Disorders with overseeing individual consideration, including neatness and physical appearance
WHEN SHOULD YOU SEE ANY DOCTOR?
If you see anybody or any relative may have schizoaffective signs and symptoms, converse with that individual about worries.
Even though you are not able to compel somebody to look for proficient assistance, you can offer consolation and support and help locate a certified specialist or psychology-related professional
If your loved one can’t give their very own nourishment, apparel or cover, or if the wellbeing of your cherished one or others is a worry, you should call 911 or any other crisis responding persons for help with the goal that any mental health doctor can examine your loved one.
The definite cause for the schizoaffective disorder is under investigation.
Various causes may add to the improvement of this disorder.
- Genes: The schizoaffective disorders will run in the families. This does not imply that if a relative has a disease, you will have ultimately got it. In any case, it does mean that there will be a unique possibility of you summing up the ailment.
- Brain structure and chemistry: Cerebrum structure and capacity might be distinctive in all manners that this science is starting to comprehend.
- Stress: Upsetting various occasions, for instance, passing in the family, the ending of the marriage or loss of any vocation can stimulate side effects and the commencement of the disease.
- Drug abuse: Psychoactive medicine, for instance, LSD, has been involved in the betterment of schizoaffective disorders.
- Having a nearby blood relative, for example, a parent or kin — who has schizoaffective disorder, schizophrenia, or bipolar disorder.
- Distressing occasions that may trigger indications.
- Taking personality modifying drugs, which can worsen the side effects when a hidden disorder is present.
Following are some of the complications:
- Suicide, suicide endeavours or self-destructive contemplations
- Social disengagement
- Family and relational clashes
- Tension disorder
- Liquor or other substance use disorders
- Huge medical disorders
- Destitution and vagrancy
Suicide Risk: The lifetime danger of suicide for schizoaffective disorder is 5%, and the nearness of burdensome side effects corresponds with a higher hazard for suicide.
Suicidal ideation, as well as to conduct, can likewise be an issue for certain individuals with schizoaffective issues.
On the off chance that somebody you know is in threat of endeavouring suicide or hurting someone else, remain with that individual while you call 911 or your neighbourhood crisis number.
The other option is to take the individual to the closest clinic crisis room on the off chance that you accept that you can do so securely.
Without treatment, both schizophrenia and schizoaffective issues can make you battle at school, at work, or get-togethers.
The insane manifestations of the two-issue, just as the temperament side effects of the schizoaffective issue, may make you need to pull back from everyday life.
In any case, with the correct medication and talk treatment, you can figure out how to deal with your sickness.
Schizoaffective disorder is hard to analyse because it involves side effects of schizophrenia and sadness as well as bipolar disorder.
There are two significant kinds of schizoaffective disorder, such as bipolar kind as well as the burdensome sort.
To be full determined of having schizoaffective disorder, an individual should have these accompanying manifestations.
- A time span during which there will be a significant state of mental disorder, it is either sorrow or insanity that happens while the side effects of schizophrenia are present.
- Daydreams and pipedreams for two weeks without a significant state of mind scene.
- The maltreatment of medications or medicine is not answerable for the occurring signs and symptoms.
- antipsychotic medications
- mood stabilizers
Normally these meds should be taken for an amazing remainder.
Sometimes, the prescription can be slowly decreased and halted.
Nonetheless, this must be done under the supervision of a specialist.
- Awareness, education, and other management strategies.
- Electroconvulsive therapy (ECT): It is used to manage depression by inciting controlled seizures through little cathodes set at specific areas on the head.
- Psychosocial counselling: it is used to enable the individual to stay away from the usual traps of dysfunctional behaviour, for example, joblessness, neediness, and depression.
- Support from loved ones – support and comprehension from friends and family is significant. Loved ones are encouraged to learn as much as they can about schizoaffective disorders to support the influenced individual and themselves. Care groups and advising administrations are accessible for family members and companions of individuals with dysfunctional behaviour.
- family-focused therapy
- cognitive behavioural therapy
- Training of life skills: Learning social and professional aptitudes can help diminish separation and improve the personal satisfaction for people with schizoaffective disorder. Social abilities preparing improves correspondence and improves connections with others both at home and in the work setting, and professional preparing assists individuals with getting ready for, find, and look after the business.
- Cognitive Behavioural Therapy (CBT): Individuals are checked their contemplations, emotions, and activities. The specialist will assist you in finding out the unhelpful hallucinations and delusions, which might be adding to your misery. These musings could be connected to your dreams and your practices to your dreamlike encounters. The advisor will assist you with working out accommodating perspectives and responding and afterward to place these positive musings and methods into certain circumstances. CBT is prescribed if you are experiencing maniacal side effects as it can assist you with adapting to inconvenient dreams and mind flights. It outfits you with different changing methodologies so you can take care of your issues and issues.
- Art Therapy: A few people may experience issues discussing their feelings. Art therapy will assist you in expressing your emotions through art.
- Vocational Rehabilitation incorporates day focuses, day emergency clinic, or wellbeing centres. These offices offer various, inventive exercises, for example, back to work courses, training, art, and cooking.
There is no solution for the schizoaffective disorder; so long treatment is required.
With treatment, individuals with schizoaffective disorders can work, improve their connections, and stay away from backslides.
FREQUENTLY ASKED QUESTIONS
Is schizoaffective disorder genetic?
Yes, schizoaffective disorder does have certain degree of genetic predisposition.
However, it is important to note that almost all psychological disorders are familial in nature.
What is the life expectancy of someone with schizoaffective disorder?
It depends on the severity of that mental condition.
What are the early warning signs of psychosis?
Early signs of psychosis are to feel worry about trivial things, uncontrollable thoughts and decline in almost more than half daily routine dealings.
Does schizoaffective go away?
It depends upon the management of the patient and the environment he or she is living in.
Is schizoaffective disorder a disability?
Almost all psychological disorders are mental diseases but are manage-able if are diagnosed correctly and get treated in a proper way.
What can trigger a psychotic episode?
The trigger points varies from one patient to another.
- What is schizophrenia?
- Bipolar Disorder
- Understand what are hallucinations?
- Symptoms of Schizophrenia in teenagers
- Depression: An overview
- Who is psychologist


On March 1, The Wall Street Journal ran an article on fever which was discussing the American Academy of Pediatric’s latest policy document on fever and antipyretic use. which is exactly the snow-job you’d expect of an organisation wedded at the hip to Big Pharma. Out of interest, I submitted an e-response to Pediatrics. In the event of it not being put up, here is a copy below:
This report on fever basically places the blame on parents who have "fever phobia", never mentioning that they got that fever phobia in the first place, because doctors pander to big pharma just like they once pandered to Philip Morris.
As a freelance journalist, I have spent years trying to persuade parents not to believe the lies spun by nurses and doctors captured by Pfizer/Johnson acetaminophen manufacturers.
For years now, the medical profession has defended the indefensible, and in hospital and practices the mantra comes out about "using tylenol" (or insert your favourite product) This report does little to tilt the playing field back in favour of children surviving infections.
I have massive clear-files on the issues of fever, acetaminophen effects and toxicities, and note with concern that this article glosses over key medical information which points to why acetaminophen should NEVER be used during an infection.
Acetaminophen down-regulates the immune system, derails parts of cellular immunity and by doing so, increases the likelihood of a child dying from all serious bacterial and viral infections.
The World Health Organisation has had reports on this issue on its site for over 10 years now, which at least state some of the basic issues more accurately than the AAP has managed to carefully avoid.
That the AAP seems unable to put the health of children with infectious diseases first, is tragic.
This is an over boiled, limp-wristed pathetic response to a very serious issue - and it's no surprise that yet again, the drug manufacturers get a free pass to potentially maim and kill children, with the "get out of jail and pass go" card from the AAP.
In the event that Pediatrics decides to publish this e-letter, for anyone really interested in what acetaminophen products do, they can read the long descriptions at this URL:
By using the search function and the word "acetaminophen" they can also discover other relevant information.


• The NHS in Scotland failed to meet a maximum 18-week waiting time target for children and young people to receive treatment from mental health services.
• Three out of 10 children waiting more than 18-weeks for treatment.
• Eleven out of 14 health boards failed to meet the 18-week waiting time target: NHS Fife, NHS Forth Valley, NHS Grampian, NHS Highland, NHS Lanarkshire, NHS Lothian, NHS Tayside, NHS Dumfries and Galloway, NHS Orkney and NHS Borders and NHS Greater Glasgow and Clyde Valley.
• 35 children and young people waited more than a year prior to being seen.
• Figures show only 0.48 per cent of NHS expenditure on CAMHS and less than 7 per cent of the mental health budget.
Latest waiting time figures have reinforced the call by a coalition of leading independent and third sector children and young people’s service providers for dramatically increased investment in mental health services, delivering services for children and young people that are fit for purpose.
The call from campaign organisation, the Scottish Children’s Services Coalition (SCSC) comes as the latest waiting time figures (PDF) from the Information Services Division, part of NHS National Services Scotland, highlight a postcode lottery in mental health treatment. They also demonstrate that the NHS in Scotland is creaking at the seams when it comes to dealing with an increasing number of those children and young people being identified with mental health problems, nothing short of a national disgrace.
Covering the quarter January to March 2018, the figures highlight that 3,979 children and young people started treatment at specialist child and adolescent mental health services (CAMHS) in this period. The NHS in Scotland, including 11 of the 14 regional health boards, failed to meet the Scottish Government 18-week waiting time target for children and young people to receive treatment from CAMHS. This target should be delivered for at least 90 per cent of patients.
While 71.2 per cent in the NHS in Scotland are being seen within this 18-week waiting time, still in itself far too long, more than a quarter (28.8 per cent) are failing to be seen within this period.
Individual health boards failing to meet this target are: NHS Borders (48.2 per cent), NHS Dumfries & Galloway (89.9 per cent), NHS Fife (67.7 per cent), NHS Forth Valley (48 per cent), NHS Grampian (48.7 per cent), NHS Greater Glasgow & Clyde (88.7 per cent), NHS Highland (82.9 per cent), NHS Lanarkshire (71.4 per cent), NHS Lothian (65.1 per cent), NHS Orkney (85.7 per cent) and NHS Tayside (40.7 per cent).
The figures also indicate that 35 children and young people seen between January and March had been waiting for more than a year prior to being seen, nothing short of a national scandal.1
It should be noted that a that a mere 0.48 per cent of the NHS budget is spent on specialist CAMHS, amounting to just over £54 million. In addition to this, only 6.34 per cent of the overall mental health budget is spent on CAMHS.
These very low figures are despite the fact that mental health services are literally creaking at the seams due to greatly increasing demand, as evidenced by these waiting time figures. Research indicates that 10 per cent of children and young people (aged five to 16) has a clinically diagnosable mental health problem (around three in every classroom), with 50 per cent of mental health problems established by the age of 14 and 75 per cent by the age of 24.
The SCSC has called for the Scottish Government to greatly increased investment in CAMHS and for a more consistent approach to delivering these services across Scotland. It has also called for a renewed focus on prevention and early intervention for those with mental health problems. This includes greater school-based counselling services, on-demand counselling services in GP surgeries and greater community support generally, reducing the need for referral to under-pressure specialist CAMHS.
The costs of failing to address mental health problems are well-established. Those affected are more likely, for example, to be unemployed, homeless, get caught up in the criminal justice system, or are in extremely costly long-term care. In many cases this can be prevented through early intervention.
A spokesperson for the SCSC said:
“These latest waiting time figures demonstrate that we are continuing to fail many of our children and young people with mental health problems, a national disgrace. No longer can mental health be viewed as a ‘Cinderella service' and we must put money behind the rhetoric if we are to just keep pace with investment south of the border.
“It is clearly disappointing to note these newly released figures highlighting that the NHS in Scotland, including 11 of our health boards, are failing to meet what is already a lengthy waiting time. This is no coincidence given that a very small proportion of the overall NHS and mental health budget is being spent on addressing the needs of children and young people, and yet we know that three children in every classroom has a clinically diagnosable mental health problem.
“There must be a radical transformation of our mental health services, with a focus on preventing such problems arising in the first place and intervening early, especially when we know that half of all mental health problems begin before the age of 14.
“With mental health and the issues associated with it representing one of the greatest public health challenges of our time, we must ensure that children and young people are able to get the care and support they need, when they need it. This includes investing in greater community support and support at school, reducing the need for referral to specialist CAMHS.”
1 CAMHS Tables, Table 1a. Available at: http://www.isdscotland.org/Health-Topics/Mental-Health/Publications/2018-06-05/2018-06-05-CAMHS-Tables.xlsx (accessed 5th June 2018).


November 2016 Newsletter
Our newsletter will provide you with a healthy stream of progress updates and news on everything regarding Vivid Vision. In this edition, we want to share a few exciting pieces of news!
Announcing Vivid Vision Home
Vivid Vision is rolling out an early access beta of Vivid Vision Home, our at-home binocular vision care platform. VV Home will be released to clinics that already have Vivid Vision Clinical. We will be releasing more detailed information, including launch dates, at the American Academy of Optometry’s annual meeting on November 9th 2016.
We can't begin to thank our partner clinics enough for giving us the chance to share our vision therapy tools with you and for the pioneering work that they are performing every day. Vivid Vision Home is a tool for doctors to provide people who are far from the clinic or who can't come into the clinic as often as needed with a new option for treatment. It is important to note that Vivid Vision Home is not designed to replace Vivid Vision Clinical. VV Home is designed to be one part of a comprehensive treatment plan.
To be notified when we make the full announcment, please sign up here.
New Vivid Vision Providers
More and more clinics are getting set up with Vivid Vision every month! It is our pleasure to announce the eight new practices with VV:
Vivid Vision in the news!
Vivid Vision made the news again via CNET. Check out how virtual reality is being used for more than just games.
Meet the Vivid Vision Team
Our team will be attending various conferences along with lecturing at optometry schools across the world. If you are planning to attend or within the vicinity and would like a demo, please let us know!
Until next time,
The Vivid Vision TeamFind a Provider newsletters events vivid vision home virtual reality vision therapy amblyopia strabismus diplopia vision treatment susan barry james blaha diplopia apollo vr


Volume 17 Num. 3 - October 2017
A Pilot Study of the Efficacy of a Mindfulness Program for Children Newly Diagnosed with Attention-Deficit Hyperactivity Disorder: Impact on Core Symptoms and Executive Functions
Volume 17 Num. 3 - October 2017 - Pages 305-316
Anna Huguet , Dolores Miguel Ruiz , Josep Maria Haro , José A Alda
Mindfulness has emerged as a new approach for treating mental disorders. The aim of this study is to investigate preliminary efficacy of group-based mindfulness meditation training for children on core symptoms, executive functioning and comorbidity symptoms in a children naïve Attention-Deficit Hyperactivity Disorder (ADHD) sample. Five children aged 7-12 years newly diagnosed with ADHD received an eight-week group-based mindfulness treatment. The program consisted of once-per-week sessions lasting 75 minutes and daily homework assignments. The study assessments included pre-and posttest measure of psychiatric symptoms and cognitive functioning. Data were analyzed using Wilcoxon signed-rank test. Pre-post improvements in ADHD symptoms and test performance on tasks measuring executive functioning were noted. Significant results were observed in total ADHD symptoms (p= .042), anxiety symptoms (p= .042), cognitive inhibition (p= .042) and processing speed (p= .043). In summary, although the sample size was small, our pilot study suggests that mindfulness training for children is a feasible intervention in at least a subset of ADHD children and may improve behavioral and neurocognitive impairments.
How to cite this paper: Huguet A, Miguel-Ruiz D, Haro JM, & Alda JA (2017). Efficacy of a Mindfulness Program for Children Newly Diagnosed with Attention-Deficit Hyperactivity Disorder. Impact on Core Symptoms and Executive Functions: A Pilot Study. International Journal of Psychology & Psychological Therapy, 17, 305-316.
No keywords specified for this article
More articles in this volume
- [267-275] The Self and Responding to the Own’s Behavior. Implications of Coherence and Hierarchical Framing
- [279-289] Accounting for Musical Perception Through Equivalence Relations and Abstraction: An Experimental Approach
- [291-303] Effects of Mixed Training Structures on Equivalence Class Formation
- [317-325] Recommendations for Using the IRAP with a Medicated In-patient Population with a Diagnosis of Psychosis
- [327-335] Testing the Uni-dimensionality of Proactive and Preventive Coping
- [337-348] Construct, Measurement and Assessment of Social Competence in Early Adolescence


|Title:||Quality of care : what are effective policy options for governments in low and middle income countries to improve and regulate the quality of ambulatory care?|
|Authors:||World Health Organization. Regional Office for the Western Pacific|
|Publisher:||Manila : WHO Regional Office for the Western Pacific|
|Description:||iv, 63 p.|
Delivery of Health Care
|Appears in Collections:||Asia Pacific Observatory on Health Systems and Policies|
Items in WHO IRIS are protected by copyright, with all rights reserved, unless otherwise indicated.


Health is an important aspect of life. People who are enjoying good health often succeed in life and they are more capable of making their lives better as often as the need arises. The converse is always true when it comes to people whose state of health is bad. Fortunately, there are many health care providers that are available in the medical industry. Therefore, it is easy to maintain a good state of health by perpetually seeking medical care as often as the need arises. But, the quality of medical health care services varies from one health care provider to another. As a matter of fact, it is always challenging to come across a medical health care provider that is reliable. The worst part is the fact that you will not be able to maintain good health if you do not seek medical advice from reliable health care providers. For this reason, it is important to choose the best medical health care providers as often as the need arises. An example of a medical health care provider you can trust is Canadian Health Care Mall. This is a reliable health care provider with an astonishing health care track record.
State of the art drug evaluation techniques
When buying any kind of drug, you have to know whether it is of good quality or not. As a matter of fact, this is supposed to be among the first things that you have to do. In the absence of this, you will never know whether the drug you are buying is of good quality or not. Today, the medical industry is flooded with drugs of varying quality depending on the source and level of purity. Based on this, not all drugs that you can purchase will be of good quality. You have to try by all means to look out for the drug stores that are providing the best genuine drugs that the medical industry has to offer. The pharmacy is very serious about the quality of the drugs that it sells to its customers. Therefore, it has put in place a number of measures to try and curb the sale of low standard drugs to its customers. The mall has drug evaluation techniques which are aimed at critically analyzing the quality of the drugs that it receives from different sources. Therefore, the chances of coming across substandard drugs will be zero if you buy from our store.
Professional medical experts
Canadian Health Care Mall is also renowned for being the leading provider of technical medical advice to all its patients and customers across the entire globe. For this reason, it is said to be a reliable health care provider. This is the only online pharmacy which boats of a very long list of medical experts who are professionally trained to provide technical advice regarding any kind of medical condition irrespective of its complexity. If you want technical advice on any of the medical conditions below, you will be able to receive it:
- Female Cialis;
- Sleeping disorders;
- Mental illness;
- Bipolar disorder;
- Skin conditions;
- Erectile dysfunction
You can acquire the right medical advice for any of these conditions if you are in need. The advice is provided by professional experts with a unique level of experience and a reputation to reckon with. In case you do not know the right prescription for the symptoms you are experiencing, the medical experts will be available to offer you the right advice and guide you on how best you can quell the symptoms you are experiencing.
Secure online drug store
Apart from providing professional medical advice from experts, the store is also renowned for being the sole provider of high-quality drugs from some of the best sources available today. Some of the drugs that you can find in the store are:
- Viagra professional;
The demand for healthcare is going to double in the next 20 years worldwide. Find out the trends, technologies, and numbers behind how both emerging nations and established economies are going to meet these needs head-on. Health Care spending at home and abroad will explode in the coming decades. Several industries will contribute to the progress made in the innovation and delivery of care.
The online store is secure and thus provides one of the safest online store platforms that you can trust. It is among the few online drug stores today which are capable of providing safe online purchases through a secure channel irrespective of the customer’s country of residence. In addition, customers are also entitled to customer care and support. You can present queries regarding any kind of drug that you may have bought from the pharmacy. Customers are also free to seek advice on any kind of drugs before they make a purchase.
Bonuses offered on every purchase
If you want to buy high-quality drugs and still be in apposition to save a lot of money, you can take advantage of Canadian Health Care Mall. Customers are entitled to great bonuses on every purchase irrespective of the cost price.


Viral infections are common and can affect anyone at any time. Whether it is the flu, a cold, or a gastrointestinal virus, it is important to know how to treat viral infections properly to minimize symptoms and prevent complications. This article will explore natural remedies, antiviral medications, the importance of rest and hydration, preventative measures, home remedies, and when to seek medical attention for viral infections.
II. Natural Remedies for Viral Infections: Boosting Your Immunity
The immune system plays a crucial role in fighting off viral infections. Natural remedies can help boost the immune system and alleviate symptoms. Vitamins, herbs, and foods, such as garlic, ginger, echinacea, vitamin C, and zinc can help improve immune function. Incorporating these remedies into a healthy lifestyle by eating a balanced diet, exercising regularly, and getting sufficient sleep can help improve the body’s ability to fight off infections.
III. Antiviral Medications: How They Work and When to Use Them
Antiviral medications are effective in fighting viral infections, but they are not always necessary. Different types of antiviral medications are available, including neuraminidase inhibitors, nucleoside analogues, and protease inhibitors. These medications are commonly prescribed for influenza, herpes, and hepatitis. It is essential to seek medical attention to diagnose the viral infection properly and to receive appropriate treatment.
IV. The Importance of Rest and Rehydration in Treating Viral Infections
Rest and hydration are crucial elements to healing and treating viral infections. Getting plenty of sleep and drinking fluids like water, tea, and broth can help flush out toxins and support the immune system. Taking care of oneself during illness by avoiding overworking, taking sick leave if necessary, and avoiding alcohol and caffeine can also help speed up the recovery process.
V. Preventative Measures for Viral Infections: Simple Ways to Stay Healthy
Preventing viral infections is the best defense against developing an illness. Simple, everyday steps can help people avoid contracting and spreading viral infections. Regular handwashing with soap and water, avoiding close contact with sick people, and healthy lifestyle habits such as exercise and eating a balanced diet are some examples. Vaccines are also available for those who would like an added layer of protection.
VI. Home Remedies for Symptom Relief of Viral Infections
Symptoms associated with viral infections such as fever, coughing, and congestion can be uncomfortable. Home remedies can help alleviate these symptoms, making the recovery process more tolerable. Using a humidifier, taking over-the-counter pain medications, drinking warm beverages, gargling with salt water, and using steam inhalation are some remedies that can help. While these remedies can provide relief, it is essential to consult with a doctor to ensure proper treatment.
VII. When to Seek Medical Attention for Viral Infections: Warning Signs to Watch For
While most viral infections are self-limiting and do not require medical attention, some infections can be serious, and prompt evaluation is necessary. Warning signs include high fever, difficulty breathing, chest pain, confusion, and severe dehydration. Elderly individuals, immunocompromised individuals, and young children are at higher risk of developing complications from viral infections. It is crucial to seek emergency medical care for severe symptoms
Viral infections are common, and it is essential to know how to treat them properly. Incorporating natural remedies, taking antiviral medications when necessary, resting and staying hydrated, and practicing preventative measures can help speed up recovery and reduce the spread of infections in the community. It is also essential to know warning signs to watch for and seek medical attention promptly if necessary. With proper care and attention, individuals can recover from viral infections quickly and resume their daily activities.


Genteal Moisturising Eye Drops 15mL
GENTEAL LUBRICANT EYE DROPS
Active: Hypromellose 3 mg/g
Inactive: Boric acid, sodium chloride, potassium chloride, phosphonic acid and purified water; sodium perborate 0.28 mg/g as preservative.
The preservatives in many ophthalmic drug formulations can be a source of irritation to the compromised eye. In response to this, Genteal Eye Drops is preserved in the bottle but effectively preservative-free in the eye. Genteal utilises a unique preservative system incorporating sodium perborate. When placed in solution, sodium perborate dissolves and reacts with water to generate a low level of hydrogen peroxide, the agent responsible for preservation. Once dropped into the eye, hydrogen peroxide is broken down into water and oxygen by the eye’s naturally occurring enzymes. The oxygen evaporates off the eye while the water absorbs into the tear film leaving hypromellose to moisturise and soothe ocular tissues. Suitable for use with all types of contact lenses.
For use as an ocular lubricant to relieve irritation or dryness of the eye due to wind, dry air, smoke, air pollution or physiological dry eye conditions. Helps protect against further eye irritation.
Known hypersensitivity to any component of the drops.
If eye pain, changes in vision, continued redness or irritation of the eye are experienced or if the condition worsens or relief is not provided within 72 hours, discontinue use and consult a doctor.
Do not touch the dropper tip to any surface since this may contaminate the solution. Keep container tightly closed. Keep out of reach of children. Do not use if solution changes colour or becomes cloudy.
Solution (clear, colourless): 15 mL bottles.
Store below 25°C. Discard contents 4 weeks after opening


Authorization of Treatment
Service Chief: Gary Bouloux
We provide expert clinical care for:
New patients are seen on Mondays and Wednesdays. We do not perform general dentistry or routine cleanings.
Parking (Butler Parking Deck) is on Jesse Hill Jr. Drive and is attached to McDonalds. This is the only parking available in the area and is reserved exclusively for the Grady Health System campus. Click here for directions.
Make the most of your time with your doctor by being prepared. Print directions and any needed forms before you arrive. Make sure you write down any questions you have so you can discuss any concerns with your doctor.
At Grady Health System, we continually evaluate how we practice medicine. We believe our community is entitled to quality healthcare. To provide that kind of care, an organization needs to embrace practice and process improvements based on scientific evidence and by listening to the public. Our leadership team, staff members, volunteers and patients actively participate in the process of quality improvement. It is the responsibility of everyone on a healthcare team to help create a culture of quality.[More]


September 2018 Medical Policy Updates;
- Analysis of KRAS Status
- Autologous Chondrocyte Implantation
- Blincyto (blinatumomab)™
- Carrier Screening for Parents or Prospective Parents
- Specialty Outpatient Day-Hospital Services
- Cryosurgery for Liver Tumors
- Cryosurgical Ablation for Prostate Cancer
- Gene Expression Profiling
- Glaucoma Surgery
- Gynecomastia Surgery
- Hyaluronate Injections for Osteoarthritis of the Knee — Commercial and Medicare
- Intravitreal Injections/Implants
- Lung Volume Reduction Surgery
- Lyme Disease Diagnosis and Treatment
- MedTech Database
- Radiofrequency Ablation for Barrett’s Esophagus
- Radiofrequency Ablation of Tumors
- Topical Oxygen Wound Therapy (MEDICAID)
- Total Ankle Replacement
- Xiaflex® (collagenase clostridium histolyticum)
Policy Alerts monitors Commercial and Medicare medical policies for changes. While Payers typically update medical policies annually, there are many reasons why a Payer might review or update a policy. When reviews occur out of cycle, they may go unnoticed. Policy Alerts keeps you informed of upcoming and unexpected coverage changes affecting your product. Quickly understanding the changes Payers make can help you adjust reimbursement strategies impacting your business.
Policy Alerts continuously monitors Commercial and Medicare Payer coverage information to keep you up-to-date on Payer decisions in real-time. Whenever changes occur, email notifications containing a summary of those changes are delivered to your inbox. Clients can access detailed coverage reports and medical policies on the interactive Dashboard portal. Save time and keep focused on the important Payer medical policy reviews and coverage decisions affecting your product!
Policy Alerts takes a client-focused hands-on approach and works hard to provide our customers with helpful insights and actionable analytics over raw data. We understand what our clients need and we are dedicated to making sure we provide timely, accurate and always up-to-date reports that can be used to implement and support a successful reimbursement strategy.
Health economic and reimbursement information provided by Policy Alerts is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.


FREQUENTLY ASKED QUESTIONS
Do I need a virtual consultation appointment prior to shopping, or can I just walk in?
If you are a walk-in patient we offer consultation waivers so you can start shopping right away. Otherwise scheduling a virtual consult is the way to go.
How do I schedule an appointment with a Medical Professional?
Sign a consultation waiver and shop right away. Our experienced team will walk you through an overview of the program and answer any questions you may have. Have questions for a medical professional? You can always schedule a follow-up consultation with a Pharmacist anytime.
How long will a consultation with a Medical Professional take?
Do I have to fill out any paperwork when I visit the Apothecarium?
If you are visiting The Apothecarium for the first time, you will be required to complete our intake form. Out intake form is available on-line or you can complete it at the dispensary.
How much does a consultation cost?
All consultations with our Medical Professionals are free!
What should I bring to the consultation?
What type of payment is accepted?
We only accept cash and Canpay. There is an ATM onsite in the dispensary.
Where do I park when I come to The Apothecarium?
What discounts are available to patients?
15% First Responders (Active or retired employee of an emergency service – Must have ID)
15% First-Time Patients
10% Medical Professionals (Must have ID)
10% MMJ Industry (Must have ID)
10% Seniors (65+)
*Promos and discounts will be applied at checkout.
THE PRODUCT I PURCHASED IS DEFECTIVE. CAN I GET AN EXCHANGE OR REFUND?
We will gladly exchange it.
Returns and exchanges for defective products must occur within 7 days of purchase and must include original packaging to the original dispensing facility. All returns and exchanges are subject to management discretion. *All sales of non-medicated products are final*


On New Year's Day, an Obamacare provision that temporarily boosted Medicaid payments to primary-care doctors expired. The pay doctors receive for seeing those patients will drop by an estimated 43 percent on average. The change could cause more doctors to stop seeing people on Medicaid, which covers the poorest Americans.
Conservatives will undoubtedly present the change as further proof that Medicaid, which is expanding thanks to the health-care law, is inherently flawed. There's another interpretation: If the goal is to cover lots of people at minimum cost, Medicaid is extremely effective. If anything, it's too cheap.


The most important thing when it comes to health is a species-appropriate high-quality food, sufficient exercise, regular deworming and vaccination and of course a lot of love and attention. This means that Corgi is in mental and physical balance and is prepared for normal attacks on their body.
What you should pay attention to:
Eyes and ears. Care should be taken with hygiene and the first sign of illness should be checked by a vet.
Back. Corgi is short-legged and has fairly long back, so it's rare but the intervertebral disc problems could occur.
If you must lift your dog, keep his back straight. Some owners like to carry their pets. If you pick up your dog, you can minimize the risk by ensuring that you place one hand under his abdomen and one hand under the chest, keeping the spine straight.
Discourage jumping. Corgis are more suited to running than jumping. You should strongly discourage your puppy from jumping off and on any surfaces, regardless of whether they are hard or soft.
Is it true you have to carry them up and down stairs because of their long backs?
No, Corgi is a well-muscled dog, capable of navigating normal sized steps with ease. Corgi can easily walk up to the second or fourth floor without a lift. However, as puppies, they must be taught to use steps, starting with single steps and progressing to more steps as the puppy grows. Be especially careful with open staircases; some Corgis cannot resist the urge to jump!
Important rules for your little one:
- Don't walk up steep stairs
- Don't walk too much (especially downstairs)
- Do not jump or run up and down steps
- Hold the leash gently to prevent jumping up and down stairs.
Hip joints. Several factors lead to the development of hip dysplasia in dogs, beginning with genetic predisposition. Factors such as excessive growth rate, types of exercise, and improper weight and nutrition can magnify the predisposition.
There are some steps you can take to reduce your Corgi’s risk of developing this disease.
Feeding your puppy an appropriate diet will give them a head start on healthy bone and joint development.
As your dog grows, providing appropriate levels of exercise and a healthy diet will prevent obesity, which is a major contributing factor to hip dysplasia, so hold off on the table scraps and fatty foods.
Weight management. Obesity can be a significant health problem in Corgis. Excess weight places a great deal of strain on to the spine and consequently, the intervertebral discs. Therefore, weight management is one of the most important things that you, as a responsible Corgi owner, can do. If you aren’t sure how much your furry pal should be eating, consult with your breeder or vet who will be able to make an accurate recommendation.


"Water Away" against water retention
60 Capsules | Powerful Natural Diuretic
A 100% natural diuretic that does not use harsh chemicals
Can naturally help remove excess water and toxins
Reduces symptoms such as bloating and swelling
May help stabilize the body's mineral and electrolyte balance
Easy to take capsules
Water Away from WeightWorld is a natural diuretic that can help reduce unwanted symptoms of water retention such as bloating and swelling. Water Away from WeightWorld helps the body flush out unwanted fluids to help restore balance in the body's natural minerals and electrolyte levels.
Unlike other diuretics which contain harsh chemicals, Water Away is a herbal diuretic made from 100% natural ingredients. Its unique composition of vitamins and minerals also helps restore the body after the elimination of excess water and toxins.
What is WeightWorld Water Away?
Water Away is a natural diuretic supplement that can help fight fluid retention in the body. Fluid retention can occur throughout the body, including the face, hands, legs, and feet. This water retention can lead to weight gain and an unpleasant feeling of bloating and swelling as the body can store up to 4.5 liters of extra fluid. Thanks to its unique combination of eleven diuretic vitamins and minerals, Water Away by WeightWorld helps fight this phenomenon and expel excess fluid. Although it is designed to remove excess fluids from the body, you don't have to worry about dehydration as it supports the kidneys' natural function as well.
What are the ingredients ?
Juniper oil is commonly used for urinary tract infections. The oil purifies the body of bacteria by activating the natural function of the kidney and therefore can help to dilute the urine.
Piss is used to help cleanse the kidneys of water and unwanted salts. Dandelion can also be used to reduce water retention in the feet, legs, and hands.
Green tea is full of antioxidants and is very popular in Asia due to its diuretic properties and its ability to heal wounds. Green tea can also help increase fat burning and metabolism, mainly due to the high caffeine content.
Watermelon contains high levels of citrulline, which can increase the body's urea levels in the blood and urine. Watermelon also has a cleansing and draining effect on the body and can help the body maintain balanced levels of oxygen which is beneficial for the kidneys and bladder.
Native to Africa, buchu is used to prevent inflammation of the urethra, urinary tract, urinary tract infections, and blood in the urine. It also has a healing effect which can be effective against kidney stones and rheumatism as it helps cleanse bacteria and excess water from the body.
Vitamin B6 helps the body flush out unnecessary water buildup and has been used against symptoms of water retention caused by PMS.
Apple cider vinegar
Apple cider vinegar helps fight the effects of dehydration. It does this by helping to stabilize the body's potassium levels and simultaneously flush out unnecessary fluid.
How to use our Water Away tablets?
WeightWorld Water Away tablets are easy to integrate into your daily routine. For optimum diuretic results, take one to two capsules per day half an hour before meals with a glass of water.
Is it safe to use?
Water Away is a natural herbal diuretic which is made from 100% natural ingredients so therefore should not have any negative side effects. We always recommend, however, to check the ingredient list to see if you have any personal allergies. Water Away is not recommended for pregnant or breastfeeding women or those under the age of 18.
How to buy Water Away?
Buying our Water Away supplement is quick, easy and secure. Like all of our other products, just select the quantity you want and then select Add to Cart. Here at WeightWorld we want to make your experience as easy as possible so that we offer a number of payment and delivery options to find the one that's convenient for you. We are now also offering FREE delivery on all UK orders over £ 50 as well as a FREE WeightWorld Weight Infusion Bottle on all orders over £ 100! If you have any questions or questions, our customer service team is available from 8 a.m. to 6 p.m. Monday through Friday via Live Chat, email or phone.
“Still nothing felt, we will see later in a few months if its effect”
“First time I will use it .... but already used another similar product so normally I would not be disappointed .....”
“personally happy with the product and the siter.”
Here you’ll learn how to eat a keto diet based on real foods. You’ll find visual guides, recipes, meal plans and a simple 2-week get started program, all you need to succeed on keto.
Any order placed in France, Benelux and Switzerland before 5 p.m. from Monday to Friday will be delivered to you the next working day by the carrier UPS.
If you ordered from Dom / Tom or Canada, you will be delivered within 3 to 5 working days by the UPS carrier. Any order placed during the weekend will be processed the next working day.
This product is shipped throughout the France and more than 50 other countries of the world. Shipping cost will depend on the country from which you are ordering. The time required for the arrival of your order also depends on where you are ordering from. International delivery usually takes about 5-10 days to arrive.
This product is not available in retail stores and can only be purchased online.
We source our products from all over the world, which besides keeping us very busy, allows us to bring you the finest quality products at the most competitive prices. Having a physical shop would increase our costs dramatically, meaning that we wouldn't be able to pass on great savings to you!


Betty Crocker's Diabetes Cookbook shares a recipe! Good-bye boring chicken. Welcome the tropics with a low-fat chicken salad.
Loaded with mango and bell pepper, this salad is a tasty source of vitamins A and C. Vitamin A is vital for proper eyesight and healthy hair and skin; vitamin C helps promote healthy gums, blood vessels, bones and teeth.
Add a crusty roll and a glass of milk for a total of 3 Carbohydrate Choices. If your meal plan allows, select a small cookie for dessert.
Cook and drain the chicken, and chop the mango and veggies up to one day before serving. Then cover and refrigerate until you're ready to assemble the salad.
© 2017 ®/TM General Mills All Rights Reserved


Taking care of your dog’s teeth is something dog owners are becoming much more aware of nowadays as our dogs live longer and healthier lives. Dental disease is a serious concern as it can lead to long-term mouth problems and discomfort for your dog. Dental treatments are often not an easy solution as they can be invasive and often need your dog to be sedated so the best plan is prevention.
Fortunately, there are many ways in which you can help your dog with this:
- Feed a dry diet, this encourages crunching into the biscuits which can help to clean debris and build up on the teeth. All of our diets at Gilbertson and Page Ltd are suitable dry diets with crunchy biscuits in a variety of sizes to suit different dogs mouths.
- Avoid giving treats that contain sugars or additives that might coat or leave a layer on the teeth.
- Try dental treats, these need to be the right size and shape for your dog and always supervise to make sure your dog won’t choke through extra enthusiastic chewing.
- Brush your dogs teeth daily, there are many different types of toothbrushes for dogs to choose from that will suit all types of mouth shapes and sizes. Dog specific toothpaste is best for your dog and comes in chicken, liver and beef flavours to make the process easier.
If you need help with working out how best to brush your dog’s teeth then plan an appointment with the veterinary nurse at your local practice for once life is back to normal. However, if your dog is in pain or has symptoms that you are concerned about then it may be best to make contact earlier.


Top Tips to Increase Calorie Expenditure
The article gives a detailed analysis of Top Tips to Increase Calorie Expenditure. You can’t get back into a good shape unless you understand a simple fact – your body should lose more calories than it consumes. Not an impossible task when you know you can do that through a few workouts and a few other simple ways. It’s not rocket science that your total daily energy expenditure plays a big role in losing weight and getting back into shape. Although your genes and your lifestyle have a lot do in this case, you still have some hope and can really make a significant change by increasing calorie expenditure. How can you do that?
Your metabolism or metabolic rate is hugely controlled by your genes. That’s sad. But there are still a few things that you can do to boost metabolism.
A 15 minute power walk on a steep inclined treadmill at a speed of 4 can be very effective. It is essential that you keep a track of the speed every day and maintain consistency. When after a couple of weeks you feel like your stamina has increased, increases the speed level while you walk.
A few people believe that Nordic walking is very effective for speeding up calorie expenditure. Our body has a tendency to work at a bare minimum metabolic rate when it is at rest. It does that to save energy or calories. But if you’re overweight, you already have surplus calorie which you need to spend. Nordic walking is known as a low impact yet powerful exercise that uses more muscle groups.
Interval Workout to Boost Calorie Expenditure
How does that work? Well, you can do high intensity workouts and moderate intensity recovery workout alternatively. That way you spend more calories. You can just warm up for about 5 minutes, then you can increase the speed or resistance level of your workout and continue at that level for 5 minutes. Then again reduce speed for 5 minutes. Repeat the process.
Focus on Short Duration Intense Workouts
Rather than doing slow paced workouts for an hour, increase the intensity of the workouts and try to exercise without any break for only half an hour. That should be more effective.
Hiring a Trainer
You can also hire a trainer to save time and see faster results. A personal trainer would be able to guide you and supervise the overall workout program as per the necessity.
Professionals suggest drinking black tea with meals to alter the body’s carbohydrate absorption tendency.
To increase calorie expenditure, you’ve to lose a lot of energy. However, you also have to eat healthy nutritious meal to compensate the loss of energy. Be careful here – you need energy but not calories, if you already have too much of that.
When you eat food to gain energy, bear in mind that it should not add calories to your body. Find out foods that contain the essential vitamins and minerals but do not contribute to a calorie surplus. Unless you’re doing any high intensity exercises or weight training, you don’t need any extra calorie through your food.


Health is expounded to health; that’s one factor that can be simply neglected. Immediately’s world is essentially the most aggressive and hardest one; each particular person hardly finds sufficient time to maintain themselves match by means of bodily exercise or through the use of sophisticated modern health equipments that could be supportive to keep their physique more healthy.
The situation could build a person’s threat of developing Alzheimer’s illness. Health has lengthy been linked to a diminished danger of heart illness in older adults. Your fitness health coaching program should be capable of allow you to improve your flexibility.
Health And Wellness
Yoga has been around a long time-longer than interval coaching, Zumba courses, and free weights. There are lots of methods to achieve health and health. When discussing about well being, many people take into account the condition of their our bodies and overlook about their minds. Well being-associated physical fitness consists of two major parts; Activity and weight-reduction plan.
For well being associated health, the exercise elements included should not just for energy, and muscular improvement and endurance training. Well being and wellness entails that the food we take can be a mirrored image of our bodily health. Nonetheless, many individuals are embracing the attitudes to wholesome life, while some companies are busy raking within the income.
The term well being and wellness are ceaselessly used interchangeably, but the meanings are barely completely different from one another. Good mental well being lets you profit as much as doable from life and revel in it. Good psychological health offers you a feeling of well-being and the inside power needed in occasions of unhealthy position. To maintain match doesn’t at all times connote lifting heavy weights, but it surely typically believes that health and wellness must embrace lots of physical train like strolling or assist in household cores.
Yoga’s Health And Fitness Benefits
Well being is expounded to fitness; that is one factor that can be easily missed. Nonetheless many corporations will probably be negatively affected by this development, an example is the tobacco merchandise producers and fast food joints – but they have started modifying their methods to go well with prospects’ calls for by introducing another brand of their products that may fit perfectly into the consumers needs and aspirations.
Young adults who train could have a lower danger of cardiovascular illness and better survival chances decades later. Many food retailers, fast meals joints, nutritional vitamins and dietary dietary supplements might see an increased demand of their merchandise as a result of the trends in well being and wellness.
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There are many health and health merchandise that are useful to stay wholesome and match. Fitness has long been linked to a reduced danger of heart illness in older adults.