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Such programmes often include physical education safe meclizine 25mg, nutrition and food services buy meclizine 25 mg without prescription, health promotion for school personnel and outreach to the community buy meclizine 25mg on-line. Many school health programmes focus on preventing the risk factors associated with leading causes of death, disease and disability, such as tobacco, drug and alcohol use, dietary practices, sexual behaviour and physical inactivity. In comparative studies of public health interventions, the World Bank concluded that school health programmes are highly cost-effective. Activities included training health person- as well as some regions of Yunnan Province, nel, health education, health counselling and covering a population of 90 million. The nutrition project was activities in four fields: institutional devel- integrated into the existing three-level health-care opment and policy reform, human resource structure in the Tianjin project area without alloca- development, surveillance and community tion of additional resources. Among the outcomes reported trained to increase their knowledge about the rela- was a reduction in the prevalence of male adult tionship between salt intake and blood pressure, cigarette smokers from 59% to 44%. In Beijing and were taught how to give practical advice to there were substantial increases in high blood patients on this issue. Leaflets disease of more than 15% in the last year of were distributed door-to-door, and posters and the project. Low sodium salt Health has established a total of 32 demonstra- was also introduced, and the project cooperated tion sites for chronic disease prevention and with salt manufacturers and shops to ensure that control across the country. Notable outcomes so far have included edge about salt intake than residents in an area a reduction in the annual heart disease and not taking part. In the intervention area, average stroke deaths in those patients with high blood salt intake was significantly lower in men, and also pressure who were being managed, from 1. In Shenyang, nificant decrease in systolic blood pressure in the there was a reduction in the prevalence of adult intervention area for both men and women. In con- smokers from 29% to 13% between 1997 and trast, both salt intake and systolic blood pressure 2002 and an increase in the proportion of people increased significantly during the same period in participating in planned regular physical activity men who did not take part. It students in decisions related to vending machine was designed to decrease cardiovascular risk factors choices and the maintenance and location of the in children through: machines was important to success (19, 20). Workplace interventions for chronic disease prevention Furthermore, intervention children maintained their and control are a feasible and often successful means results for three years without further interventions. Interven- After five years of follow-up and no further tions tend to focus on chronic diseases and risk fac- intervention: tors that substantially inhibit productivity and incur the » menus from 50% of the former intervention cafete- most serious health and economic burdens. Improvements can be seen in worker produc- time spent in moderate-to-vigorous physical activ- tivity, reduced levels of absenteeism, and employer ity in the intervention schools had been maintained, cost-saving. Staff training is an important factor in institu- Programmes that address multiple risk factors for tionalizing such programmes (18). These programmes allow employees to decide what risk factors they want to improve and define their own goals (22). A seeks to reduce behavioural and psychosocial comprehensive approach including both risk factors, increase healthy behaviours, detect policies and programmes, rather than disease early, and manage chronic diseases. The either in isolation, increases the likeli- programme provides preventive services as well as hood that employees will participate. After almost three years, improvement was seen The most effective workplace tobacco in eight out of 13 risk categories for employees. These savings increased of a test to identify individuals at risk of substantially after the second year (26, 27). The goal is for people who have not sought medical attention to benefit from further investigation or direct preventive action. Effectively implemented medical screening can prevent disability and death and improve quality of life. Screening tests are available for some chronic diseases, including cardiovascular disease, diabetes, and several site- specific cancers (24). The disease or disorder to be considered for screening must be well defined, of public health importance and of known prevalence in the population. An effective, affordable and acceptable treatment must be available to all those who require it (25). In general, the number of proven screening procedures is limited, although notable exceptions include the following: » screening for elevated risk of cardiovascular disease using an overall risk approach; » screening for early detection of breast and cervical cancer, in coun- tries with sufficient resources to provide appropriate treatment. There are a number of highly effective clinical interventions that, when properly delivered, can reduce death Cervical cancer remains a major health problem, and disease and improve the quality of life of particularly in low and middle income countries. Effec- These include supporting behaviour change, the tive screening programmes for cervical cancer in low use of pharmacological agents and surgery. One and middle income countries can help reduce cervi- example – combination drug therapy (aspirin, cal cancer incidence and mortality. For example, in a beta blocker, diuretic, statin) for people with an number of Latin American countries, cervical cytology estimated overall risk of a cardiovascular event screening programmes have been in place for more above 5% over the next 10 years – was shown to than three decades and show some positive results. Although the incidence of cervical cancer remained » Treatment approaches based on overall risk, which stable from 1983 to 1991, it declined significantly more take into account several risk factors at once, are recently, with a 3. Individuals are at highest risk when they have several risk factors or when they have established disease. To reduce the likelihood of disease onset among high-risk individuals, screening and treatment need to be based on an assessment of overall risk (as determined by multiple rather than single risk factors). Cut points for defining individuals at high risk and requiring clinical intervention need to be based on consideration of the desires of informed patients, the availability of cost-effective interventions and the risks and benefits of interventions, as well as their cost. Ideally, the assessment of future risk should be based on locally relevant data; unfortunately this is not usually available and risks are often assessed on the basis of data from other populations (29). The overall risk of new cardiovascular disease events can be estimated by taking into account several risk factors. These charts estimate the risk of a cardiovascular event per 100 people over the next five years among people without previous symptomatic cardiovascular disease. They are used by identifying the category relating to a person’s sex, diabetic status, tobacco-use history and age (30). The benefits of the intervention must, however, clearly outweigh any danger, such as unwanted pharmacological effects. Interventions should be evidence-based, and they should also consider local needs and resource constraints. Sufficient resources must be available to provide the intervention to all those identified as in need. The major difference is that the likelihood of future clinical events is much greater once disease is established. When the systolic and diastolic values fall in different risk levels, the higher category applies. People who fall exactly on a threshold between cells are placed in the cell indicating higher risk. When the systolic and diastolic values fall in different risk levels, the higher category applies. People who fall exactly on a threshold between cells are placed in the cell indicating higher risk. They include the following: » Behavioural interventions: including those for tobacco cessation, increased physical activity and dietary change, with the promotion of weight loss if appropriate. Together, these may achieve a risk reduction of over 60% in people with established heart disease, and are also a key part of achieving good blood glucose control in people with diabetes (31). A combination of all four of these is expected to reduce the risk of recurrent myocardial inf- arction by 75%. Following successful implemen- diovascular death and account for half tation in these areas, the services were made available across of all cardiovascular deaths. Smokers set a date with the help of their people, international guidelines recom- adviser, and are then supported through the first stages of their mend long-term antiplatelet, blood pres- attempt to stop smoking and followed-up after four weeks. A sure lowering and cholesterol lowering large increase in funding was made available and a demanding therapies. However, treatment gaps national target was set: 800 000 smokers to have stopped at the are substantial in all countries, in part four-week follow-up stage by March 2006. It is planned that an because of the cost and complexity of electronic appointments system will be available to smokers to multiple drug use. One strategy that has been proposed Results for the period April 2004–March 2005 show that around to reduce these barriers is a fixed dose 300 000 smokers had successfully stopped at the four-week fol- combination pill (now commonly known low-up stage compared with about 205 000 the year before (an as a polypill).

Fernández Herrera Breast characteristics and dosimetric data in X ray mammography — A large sample worldwide survey N meclizine 25mg without a prescription. Geeraert Ovary and uterus dose assessment of female patients undergoing some selected radiographic examinations P cheap meclizine 25 mg amex. Hunstad Quality control for the radiography instrument Philips Duo Diagnost used in Mother Teresa Hospital purchase 25mg meclizine visa, Tirana, Albania D. Kishta Quality control of ionization chambers in the range of diagnostic radiology L. Pereira Study of patient doses in radiography and establishment of national reference levels in Ukraine M. Pylypenko Comparing the stability of two ionization chambers in standard mammography radiation beams and using a 90Sr+90Y check device J. Silva Studies on estimation of effective dose in common X ray diagnostic examinations in India A. Sonawane Comparison of paediatric patient dose in portable chest radiography in two hospitals J. Wambani Potential applications of dose-tracking and active dosimetry systems to encourage X ray image optimization and minimize staff dose H. Lunelli Dose reduction in trauma patients performed using portable equipment at Kenyatta National Hospital, Kenya C. Muchuki Dosimetry and the use of a lead apron in dental radiographic modalities D. Assessing the role of clinical audits in avoiding unnecessary patient imaging and radiation exposure R. Sanchez Radiation protection training for dental students: Experience in Bulgaria J. O’Connor Trends in patients’ radiation protection: Manufacturers’ research strategy as outlined in industrial property documents B. Spyropoulos The need to foster collaboration between medical physicists and manufacturers through standards in the area of radiation protection of patients A. Ghezaiel Estimate of the annual dose from background radiation inside hospitals and health centres of Kurdistan region and its impact on workers and patients A. Ismail The consequences of the lack of specialists in radiation protection in health services and different ways to overcome it R. Katumba Operation of radioprotection committees in hospitals that do not have a specialized radiation protection service R. Lunardon Academic education, clinical training and professional recognition of medical physicists in Argentina M. Mairal Failure on the steps of simulation, planning and delivery of radiation dose in radiotherapy — A reality in clinical practice L. Radiation dose to paediatrics during chest and abdomen X ray examinations at Muhimbili National Hospital (Tanzania): Initial results W. Muhogora Safety education and training in radiation protection for medical workers — A developing country’s experience M. Paci Awareness and attitude of radiographers towards radiation protection in Bangladesh S. Rao Argentina’s situation in tomography and the use of reference levels as a tool to optimize dose in procedures R. Sapiin Adherence to radiation protection rules and procedures in developing countries — A case for Uganda M. Seguya Overview of occupational radiation protection of medical workers in Estonia 2001-2011 J. Shubina Evolution of regulations to ensure radiological safety in diagnostic radiology — Practice in India A. Sonawane Strategy of Indonesia’s nuclear energy regulatory agency to control patient dose in the utilization of radiology diagnostic equipment A. Sutrisno Results of a national program of radiation protection of patients conducted by the relevant medical societies (8 years’ experience) R. Akahane Managing radiation protection and safety in the hospital — Success factors and challenges A. Almén Estimation of population doses from diagnostic radiological and nuclear medicine procedures: A tool for authorities to promote justification and optimization R. Bly Individual radiosensitivity and increasing medical doses: Two serious risk factors for patients M. Bourguignon First results of population dose assessment from X ray and nuclear medicine examinations in Serbia O. Guibelalde Education and training in radiation protection for health care professionals — A survey in Finland R. Pesznyák Methodology and inaccuracies in the estimation of collective effective dose from diagnostic and interventional procedures in a university hospital E. Setting the Scene for the The conference was held in Bonn, 3–7 December 2012, and aimed, in particular, to: Next Decade • Indicate gaps in current approaches to radiation protection in medicine; • Identify tools for improving radiation protection in medicine; • Review advances, challenges and opportunities in the field of radiation protection in medicine; Proceedings of an • Assess the impact of the International Action Plan for the International Conference Radiation Protection of Patients, in order to prepare new international recommendations, taking into account newer 3–7 December 2012 developments. It resulted in the Bonn Call for Action, which will focus efforts Bonn, Germany in radiation protection in medicine in the next decade, and maximize the positive impact of such efforts. Key: b Ref: Myocardial Infarction (591) Davidson’s Principles and Practice of Medicine. A thirty five year old man presents in a clinic with history of chronic productive cough that is worse in the morning and brought on by changes in posture. Key: b Ref: Bronchiectasis (Page 684) Davidson’s Principles and Practice of Medicine. Key: c Ref: Adverse Reaction of First Line Anti Tuberculosis Drugs (Page 702) Davidson’s Principles and Practice of Medicine. A fifteen year old boy who is diabetic presents with pain abdomen, vomiting and shortness of breath. Key: a Ref: Diabetic Ketoacidosis (Page 820) Davidson’s Principles and Practice of Medicine. A ten year old boy gives history of swelling of body starting from face and more on getting up in the morning. On examination his blood pressure is normal, pallor is absent and jugular venous pressure is not raised. Key: e Ref: Nephrotic Syndrome (Page 480) Davidson’s Principles and Practice of Medicine. A young girl comes in the cardiology ward with history of breathlessness and palpitations for last one year. After auscultation of precordium cardiology registrar makes diagnosis of mitral stenosis. The most important sign on which this diagnosis is based is: a) Ejection systolic murmur. Key: b Ref: Mitral Stenosis (Page 619) Davidson’s Principles and Practice of Medicine. Key: a Ref: Rheumatic Fever (Page 618) Davidson’s Principles and Practice of Medicine. An old lady presents with history of fever and left sided chest pain for one month. Examination of respiratory system shows decreased chest movements, stony dull percussion note and absent breath sounds on left side. Key: d Ref: Clinical Exam of Respiratory System (Page 649) Davidson’s Principles and Practice of Medicine. A forty year old woman gives history of fever for last three weeks accompanied by dry cough, night sweats and weight loss. Key: a Ref: Tuberculosis (Page 696) Davidson’s Principles and Practice of Medicine. A young girl complains of nocturnal cough and shortness of breath which disturbs her sleep. Key: c Ref: Bronchial Asthma (Page 673) Davidson’s Principles and Practice of Medicine. A fifteen year old girl presents with history of fever, bleeding from gums and pallor for last fifteen days. Key: a Ref: Acute Leukemia (Page 1040) Davidson’s Principles and Practice of Medicine.

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New treatments or tests described in a study without any control group also fall under this category of case reports and case series discount meclizine 25 mg on line. At best meclizine 25 mg lowest price, these descriptive studies can suggest future directions for research on the treatment or test being reported 25 mg meclizine. They are cheap, relatively easy to do with existing medical records, and potential clini- cal material is plentiful. If you see new presentations of disease or interesting cases, you can easily write a case report. These studies do not provide explanations and cannot show asso- ciation between cause and effect. Since no comparison is made to any control group, contributory cause cannot be proven. A good general rule for case studies is to “take them seriously and then ignore them. Called the “all-or- none case series,” this occurs when there is a very dramatic change in the out- come of patients reported in a case series. First, all patients died before the treatment became available and some in the case series with the treatment survive. Second, some patients died before the treatment became available, but none in the case series with the treatment die. This all-or-none idea is roughly what happened when penicillin was first intro- duced. The credibility of these all-or-none case reports depends on the numbers of cases reported, the relative severity of the illness, and the accuracy and detail of the case descriptions given in the report. In the scene, two children are unsure if they will like the new cereal Life, so they ask their little brother, Mikey, to try it. Too often, a series of cases is presented showing apparent improvement in the condition of several patients that is then attributed to a particular therapy. The authors con- clude that this means it should be used as a new standard of care. The fact that everyone got better is not proof that the therapy or intervention in question is causative. Cross-sectional studies record events and observations and describe diseases, causes, outcomes, effects, or risk factors in a single population at a single instant in time. The strengths of cross-sectional studies are that they are relatively cheap, easy, and quick to do. The data are usually available through medical records or sta- tistical databases. They are useful initial exploratory studies especially to screen or classify aspects of disease. They are only capable of demonstrating an asso- ciation between the cause and effect. In order to draw conclusions from this study, patient exposure to the risk factor being studied must continue until the outcome occurs. If the exposure began long before the outcome occurs and is intermittent, it will be more difficult to associate the two. If done properly, cross-sectional studies are capable of calculating the prevalence of disease in the population. Prevalence is the percentage of people in the population with the outcome of interest at any point in time. Since all the cases are looked at in one instant of time, cross-sectional studies cannot calculate incidence, the rate of appearance of new cases over time. Another strength of cross-sectional stud- ies is that they are ideal study designs for studying the operating characteristics of diagnostic tests. We compare the test being studied to the “gold standard” test in a cross-section of patients for whom the test might be used. The trade-off to the ease of this type of study is that the rules of cause and effect for contributory cause cannot be fulfilled. Since the risk factor and outcome are measured at the same time, you cannot be certain which is the cause and which the effect. A cross-sectional study found that teenagers who smoked early in life were more likely to become anxious and depressed as adults than those who began smoking at a later age. Does teenage smoking cause anxiety and depres- sion in later years, or are those who have subclinical anxiety or depression more likely to smoke at an early age? It is impossible to tell if the cause preceded the effect, the effect was responsible for the cause, or both are related to an unknown third factor called a confounding or surrogate variable. Confounding or surro- gate variables are more likely to apply if the time from the cause to the effect is short. For example, it is very common for people to visit their doctor just before their death. The visit to the doctor is not a risk factor for death but is a “surro- gate” marker for severe and potentially life-threatening illness. These patients visit their doctors for symptoms associated with their impending deaths. Prevalence– incidence bias is defined as a situation when the element that seems to cause an outcome is really an effect of or associated with that cause. This occurs when a risk factor is strongly associated with a disease and is thought to occur before 60 Essential Evidence-Based Medicine the disease occurs. Thus the risk factor appears to cause the disease when in reality it simply affects the duration or prognosis of the disease. The antigen was not a risk factor for the disease but an indicator of good prognosis. Longitudinal studies Longitudinal study is a catchall term describing either observations or interven- tions made over a given period of time. There are three basic longitudinal study designs: case–control studies, cohort studies, and clinical trials. These are ana- lytic or inferential studies, meaning that they look for a statistical association between risk factors and outcomes. Case–control studies These studies were previously called retrospective studies, but looking at data in hindsight is not the only attribute of a case–control study. There is another unique feature that should be used to identify a case–control study. The sub- jects are initially selected because they either have the outcome of interest – cases – or do not have the outcome of interest – controls. They are grouped at the start of the study by the presence or absence of the outcome, or in other words, are grouped as either cases or controls. This type of study is good to screen for potential risk factors of disease by reviewing elements that occurred in the past and comparing the outcomes. The ratio between cases and controls is arbitrar- ily set rather than reflecting their true ratio in the general population The study then examines the odds of exposure to the risk factor among the cases and com- pares this to the odds of exposure among the controls. The strengths of case–control studies are that they are relatively easy, cheap, and quick to do from previously available data. They can be done using current patients and asking them about events that occurred in the past. They are well suited for studying rare diseases since the study begins with subjects who already have the outcome. Each case patient may then be matched up with one or more suitable control patients. Ideally the controls are as similar to the cases as pos- sible except for the outcome and then their degree of exposure to the risk fac- tor of interest can be calculated. Case–controls are good exploratory studies and can look at many risk factors for one outcome. Unfortunately, there are many potentially serious weaknesses in case–control studies, which in general, make them only fair sources of evidence. Data often come from a careful search of the medical records of the cases and controls.

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The traditional measurements/dosages are used primarily based on the minimum found to be effective order meclizine 25mg online. There are a few herbs/botanicals which are toxic or can cause negative reactions due to an overdose meclizine 25 mg visa. Water infusions/tea: Medicinal teas are a time-honoured meclizine 25mg on-line, traditional usage of herbs and botanicals. A preferred method is to get one of those silvery tea balls, stuff it full of crushed, not powdered, dried herb, put it in a cup, pour boiling water into the cup, let sit (steep) covered if possible, for about 10 minutes. The dosage varies - 68 - Survival and Austere Medicine: An Introduction with the herb, but a cup 3-4 times a day is reasonably standard. The exception to this would be using a very mild herbal tea for infants and children - smaller body mass and weight so teas need to be less strong and ,therefore, more palatable for them. Oil infusion: Oil infusions are handy for skin infections, itchy, dry skin, burns, and as ear drops. Take dried herbs, crush (not powder) put enough in a glass baking pan to cover the bottom thinly, and cover the herbs with olive oil. Olive oil will not go rancid so you can make this ahead of time and store on the shelf. Stir the oil and herbs to make sure all herbs are coated with oil, then cover with more oil to at least 1/2 inch. If you have a gas stove with an oven pilot light just leave the pan of herbs and oil in the oven overnight. Alternatively, set the pan of herbs and oil in the sun for about 2 weeks with some sort of lightweight fabric covering it to protect from bugs. Strain the oil out through a cloth with a tight weave, bottle it, and use as needed topically. It is too soft add more beeswax to the pot; if too hard add a bit more oil to the pot. The perfect salve should stay hard for a few seconds as you gently press your finger on it then suddenly soften from your body heat. Decoction: Decoctions are herbs/botanicals prepared in boiling water used primarily for compresses and syrups. Use approximately a heaping palmful of dried, crushed (not powdered) herb per pint of water. Boil together for about 15 minutes, cool, strain and add sufficient water to bring the volume back to a pint. Put 1-2 hands full of dried, crushed (not powdered) herb or fresh (best if available as whole leaf) into a large pot filled with water. Bring the water to a boil with the herbs in the water, place pot on a table, cover the head and pot with a towel, hang head over the pot, and breathe deep. When the herbs no longer have a scent in the stream you can add more and continue the treatment until desired relief is achieved. Tinctures: Tinctures are an alcohol-based extraction that is medicinally the most potent herbal treatment. When you dry herbs/botanicals the medicinal components are concentrated with the removal of the water. Soaking (tincturing) the dried herb/botanical in alcohol extracts those concentrated medicinal components and makes them available. An additional bonus is that alcohol-based tinctures are medicinally potent for years if stored in dark bottles or jars. We tincture most of our herbs and botanicals so they are immediately available for use, and we can be confident they are potent in an acute situation. We also keep dried herbs available for infant/child usage as teas, and also particular dried herbs available for poultices, and compress, and topical usage. To prepare the tincture you need quart canning jars with lids, dried herbs/botanicals, and at least 90 proof Vodka. Everclear is excellent to use also and in a pinch you could use another grain-based product. You want the alcohol to become saturated with the medicinal components of the herb/botanical, and other alcohol liquors/whiskey have components already saturating the alcohol so it probably won’t be as medicinally potent, but it would still have more potency that other preparation methods. Fill the quart jar about 1/3 full of dried herb/botanical, chopped root, or crushed (not powdered) leaf, fill the jar to the "shoulder" with vodka/Everclear, secure the lid, shake, and put in a dark cool place. In 10-14 days strain the liquid into dark bottles or jars, cap tightly, and label. The commonly accepted tincture dosage is 1-2 eye droppers full, 1 dropper full equals approximately 1/2 teaspoon. Alternatively, you can use the dropper to place the tincture in gelatine capsules. You can buy empty gelatine capsules in health food stores by the capsule or by the bag of 1000. Just pop the capsule apart, fill the larger section with finely crushed (powdered) dried herb, put - 70 - Survival and Austere Medicine: An Introduction back together, and take with water. Poultice: A poultice is warm, mashed, fresh, or finely crushed dried herb applied directly to the skin to relieve inflammation, bites, eruptions, boils, and abscesses. Depending on the size of the area to be treated put enough herbs in a glass dish/pot, cover with enough olive oil, or water, or decoction of the same herb to thoroughly saturate the herb, heat gently until a comfortable temperature to the skin, apply directly to the area to be treated covering it completely, and then cover with a sterile bandage. Bolus/Suppository: These are made using vegetable glycerine or cocoa butter mixed with a dried powdered herb to the consistency of bread dough. This method allows the herb to be in direct contact with the area needing treatment. Syrup: To about a pint of decoction you add enough honey and/or eatable glycerine to thicken slightly. Especially good for children to treat coughs, congestions, and sore throat as it will coat these areas slightly ,and keep the medicinal components in direct contact with the tissues. Specific Herbs and Botanicals We have tried to refine a list of herbs/botanicals, both wildcrafted and home grown, that would be most useful in treating the most common illnesses or diseases that may manifest in a survival situation. From the reading you have been doing in your newly acquired herb information books you now realize the vast amount of information and herbs available for use. Just use this list as a starting point to adjust and personalize according to your needs and medical situations. Wildcrafting: The following 7 herbs and botanicals grow almost universally all over the U. It has a blood cleanser effect (detoxifier) and is nutritive to the liver; also mildly diuretic. Dandelion (Taraxacum officinale): Harvest 2nd year roots in the spring or fall; young leaves in the spring for fresh eating. The root has been used for centuries to treat jaundice as it has a powerful alterative effect on the liver. Echinacea (Echinacea angustifolia): Harvest 2nd and 3rd year roots in early winter after the plant has totally died back (see, you do need your map! Echinacea purpurea: Harvest flower heads with seeds before petals drop in late summer. Tincture, water infusion, oil infusion, decoction, poultice, compress, bolus, syrup, capsule. Using these two varieties together gives increases the potency of your treatments. For strengthening the immune system dosage suggested is a dropper full (1/2 tsp) daily for a 10-day course, no herb for 7 days, then repeat the 10-day course, etc. One option now is to purchase 1# of cut and sifted Echinacea angustifolia root (currently $23/lb), tincture half of it right now, and save half for future decoctions and poultices. This will give you some time to gather your own root, and the tincture will be medicinally potent for at least 10 years. Echinacea root tincture has activity against influenza, herpes, and other viruses which includes virus which cause the common colds. Just soak a cotton ball or swab in the decoction and apply directly to the gums twice daily until the disease is resolved. Mullein (Verbascum thapsus): Harvest leaves before flowering taking no more than 1/3 of the total. It has expectorant action, soothes the throat, has bactericidal activity, and helps stop muscle spasms that trigger coughs.

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