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The problem is that the economic incentives and political forc- es to do this will be very difficult to change discount viagra super active 50mg visa. No matter how well intentioned buy cheap viagra super active 25mg line, I’m not sure any administration or government can change these competing forces discount 100 mg viagra super active amex, but I do know that you can change, making the above political dilemma a moot point. You can make yourself healthy by just doing the 9 Simple Steps daily and consistently. And truly, there is nothing more straightforward with a one-to-one response of effort to results than applying these steps to your health. Americans could dramatically reduce occurrence of chronic disease, solve the healthcare crisis, and increase national produc- tivity within months with these simple, cost-effective changes in lifestyle. A simple five-food-group diet of vegetables, fruit, beans, nuts and seeds, and whole grains—with minimal or no animal products (plus exercise)—can create this dramatic change. After a twenty-two-week worksite research study on this diet, there was a reduction in body weight of more than eleven pounds and waist circumference reduction of more than two inches. Rip has shown how well this diet and lifestyle approach works in reducing weight and cardiovascular risk in a hard-working, all-American fireman in the heart of Texas. Fine, but don’t blame the government or anyone else for spiraling healthcare costs! After the country is “lean and fit,” if you have to add in some ani- mal foods, then you can do it, though I don’t recommend it. Healthy aging cultures do not eat as much animal foods as Americans do, and when they do, they don’t eat mass-produced, factory-farm ani- mals. Virtually none of these “Blue Zone” or “Cold Spot” healthy aging societies eat the highly processed, high-fat, high-sugar, and highly refined grain diets that we do as well. A “Cold Spot” is an area where a specific chronic disease occurs very infrequently or not at all. After you read this book, you will have that simple, basic knowledge, and you’ll have simple daily steps to make this happen in the busy, modern world—quickly! The kind of change I am talking about is not only possible but also simple, affordable, and can even be fun. A small minor- ity of people might not feel well applying these principles initially. Still, if you follow the guidelines presented in this book and re- member nothing else but these 9 Simple Steps to Optimal Health, - 34 - preventive care vs. No society can function efficiently in the long run with any devised healthcare system if it has a predominantly disease care model in which you let disease happen—especially the chronic dis- eases mentioned here repeatedly—and then try to treat them with pharmaceuticals and surgery as your main medical approaches. Prevention and treatment by diet, exercise, and lifestyle have to be the mainstays of any healthcare delivery system. Until some real incentive comes for keeping people well—or unless people themselves see the light—things won’t change. There will be more drugs prescribed, more disability and suffering, and more loss of national economic productivity. Let’s get on with how to create the best health insurance we can: a self-managed wellness lifestyle that will dramatically reduce these chronic diseases and allow us to control our health destiny if we choose to. Urbanization provides easier access to a variety of whole, nutrient-dense plant foods, such as vegetables, fruit, beans, nuts, seeds, whole grains, and greater op- portunities for exercise. Good health is about applying very simple principles on a con- sistent and daily basis. Fortunately for us, such a transition is not dependent upon new scientific breakthroughs or the creation of brand new social models. All we must do is look to successfully ag- - 36 - the good news: chronic disease is preventable and reversible ing cultures, such as the Okinawan centenarians, Nicoyans in Costa Rica, Sardinians in Italy, Seventh Day Adventists in the greater Los Angeles area, and others from around the world—or Blue Zone populations (see The Blue Zone by Dan Buettner, 2008). These cultures are examples of the fact that it is possible, practical, and pleasurable to lead healthy and functional lives into advanced age, with reduced chronic disease, if only we would slow down, edu- cate ourselves, and apply some basic principles. Global Strategy on Diet, Physical Activity and Health: Diet, World Health Organization. Both dietary guidelines recommend eating more fruit and vegetables, more whole grains, and less fat and sugar. Those are big recommendations and would go a long way to safely normal- izing weight, which would reduce all chronic diseases. In other words, animal foods generally contain more calories per weight or volume than unprocessed plant foods, leading to excess calories, weight gain, and inflammation. Trans-fatty acids increase cholesterol levels and cardiovascular risk and may alter inflammation and neurologic function by alter- ing cell membrane structure. I know some purists are thinking that we should eat only eat organic fruit and vegetables that are locally grown and in season. Physical activity, on the other hand, is fundamental to energy balance and weight control, reduces the risk of coronary heart disease and stroke, reduces the risk of type 2 diabetes, and reduces the risk of some cancers. At least thirty minutes (preferably sixty) of regular, moderately intense physical activity on most days reduces the risk of cardiovascular disease, diabetes, colon cancer, and breast cancer. Muscle strengthening and balance training can reduce falls and increase function in old- er individuals. In fact, it is probably a lifesaver if used properly and could cheaply and effectively improve the world’s health the way few, if any, approaches could. The cancers of the skin that arise from excessive or improper sun exposure (squamous or basal cell cancers) are generally not as lethal, with squamous cell causing more deaths (2,500 deaths per year) than basal cell cancers which causes few deaths but can be very disfiguring. They aren’t sunbathing either, but they are outside doing physical labor such as gardening, farming, herding, fishing, or other necessary work for daily survival. They also eat unprocessed diets that are rich in protective antioxidants and phytochemicals. Generally you get vitamin D from sunlight exposure (the best way, in my opinion), fortified foods (usually not enough), or supplementation (the average per- son has to do this). Dermatologists—actually all doctors—should routinely mea- sure (and correct) vitamin D levels for all their patients several times per year and at the time of diagnosis of their cancers. Vitamin D levels are easy and cheap to correct with supplementation (and/or judicious sun exposure). I realize sun exposure and skin cancer is a tremendously con- troversial topic and getting sunburned is not a good thing, but “throwing the baby out with the bath water” with complete sun avoidance and “chemical” protection doesn’t make total sense either. Again, look at the “Blue Zone” cultures that live a long time and don’t get cancers in general. They are not housebound and sun avoiders (nor sunbath- ers) lathering on sunblock. They also don’t eat highly processed foods but rather nutrient-dense and antioxidant-rich foods that can protect their skin from sun damage and cancer in general. Reducing the Diabetic Epidemic Without urgent action, diabetes-related deaths worldwide will increase by more than 50 percent in the next ten years. Nine- ty to ninety-five percent of diabetes in the United States is type 2 diabetes (five to ten percent type 1). In fact, type 2 diabetes is reversible most of the time, and this epidemic need not exist. We should not be using the mindset of “controlling” type 2 diabetes with a little lifestyle change, a lot of medicine, and more research. We should expect the eradication of type 2 diabetes by getting lean, physically active, and consuming an unprocessed, whole-food diet that is high in fiber, low in fat, and rich in complex carbohydrates from beans, fruit, vegetables, whole grains, small amounts of nuts and seeds, and small amounts of free-ranged animal foods if you - 42 - the good news: chronic disease is preventable and reversible think you must eat animal foods (optional, though not recom- mended). This approach has been proven to normalize weight and lower blood sugar and insulin levels. This unrefined, unprocessed plant-based diet rich in vegetables, beans, fruit, nuts, and seeds, and whole grains (unprocessed carbohydrates) that is very low in fat, is the simplest way to reverse the diabetes epidemic. In fact, type 2 diabetes is rare in cul- tures in which people eat their traditional, more agrarian, and/or indigenous diets of simple, fresh, local whole foods that have low glycemic indexes and are physically active as a result of manual labor (and they are lean). Diabetes (Type 2) Reversal Is Possible Over the last several years, I have had the great privilege of interviewing five of the world’s experts on using diet to prevent, slow, and many times reverse diabetes: • Dr. Joel Fuhrman, family physician and best-selling author and speaker (Eat To Live, 2011, Eat For Health, 2008) famous for his concept of consuming the most nutrient-dense foods per calorie for weight control, chronic disease reversal (in- cluding diabetes), and optimal health. McDougall’s Health and Medical Center and the McDougall Program, a ten-day residential program in Santa Rosa, California.

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There were signifcant difference between clude epilepsy viagra super active 100mg on-line, neurological symptoms cheap viagra super active 50 mg visa, cognitive impairment proven 50mg viagra super active, anxi- 2 groups in educational year, weighted index of comorbidity, com- ety, depression or post-traumatic stress disorder. Only a ffth of the bined condition and age-related score, etiology of stroke, initial patients have no residual symptoms. The patient underwent en- bilitation department were different from those of not transferred dovascular neurosurgery (coiling technique). Although the level of severity of stroke in transferred group tions were minimal - right Abducens nerve paralysis, slight motor was much higher than that in not transferred group, the former defcit on the right arm and leg with minimum reduction of muscle showed signifcant time effect and time cross group interaction to strength. After 10 days of intensive medical treatment, the patient recover their physiologic function. Thus, early transfer to rehabili- started the rehabilitation program in the neurosurgery unit, and after tation department for post-stroke rehabilitation is very important 3 weeks, he was transferred to the rehabilitation department. The re- not only to improve stroke patient’s functional recovery but also to habilitation protocol included psychological support, dietary regime show a positive interaction including time effect. Maeshima1 lowing brain injury include physical limitations and diffculties with 1 thinking and memory. Recovery and prognosis are highly variable Fujita Health University Nanakuri Memorial Hospital, Rehabili- and largely dependent on the severity of the initial status. Results: Before treatment, experimental group and control group the balance function scores were no signifcant difference (p>0. Popa” University of Medicine and Pharmacy Iais- Roma- nia, Medical Rehabilitation, Iasi, Romania, 2Clinic Emmergency Hospital “ Prof. We started using it as a wearable patient moni- rating scale was used to assess the paralyzed Shoulder joint move- tor to screen our stroke patients during their post-acute rehabilita- ment function in the patients with stroke, before and after treatment. The Fugl-Meyer movement function out between Oct 2013, and Jul 2015, with 56 positive and 12 nega- score in the treatment group was obviously higher than the control tive results. Conclusion: Peripheral magnetic stimulation com- patients were confrmed by the detailed investigation of the Sleep bined with routine rehabilitation reduces or prevents shoulder joint Centre. The higher rate of the positive results is explained by our double or triple 475 selection criteria. Material and Methods: 23 healthy cal therapy in a patient with cerebrovascular disease who showed subjects walked on treadmill at 0. Mirror therapy is a technique that uses visual feedback about motor performance to 480 improve rehabilitation outcomes. Gomez Diaz10 group underwent 20 minutes of mirror therapy consisting of wrist 1 Complejo Hospitalario Universitario De Ourense, Neurological and fnger fexion and extension movements, while the control 2 group performed sham therapy with similar duration, 5 days a week Rehabilitation, Ourense, Spain, Complejo Hospitalario Universi- tario De A Coruna, Epidemiology Unit, A Coruna, Spain, 3Centro for 4 weeks. After treatment both groups showed statisti- Augusti, Intensive Care, Lugo, Spain, 8Complejo Hospitalario cally signifcant improvement in all outcome measures. Moreover Universitario A Coruna, Neurological Rehabilitation, A Coruna, patients in the mirror therapy group had greater improvement in Spain, 9Hospital Clinic, Psychiatry, Barcelona, Spain, 10Complejo upper extremity Fugl-Meyer motor scale values compared to the Hospitalario Universitario A Coruna, Anesthesioloy, A Coruna, control group (p=0. Conclusion: Regaining motor function in Spain the upper extermities is often more diffcult than in lower extremi- ties, which can seriously effect the progress in rehabilitation. Mir- Introduction/Background: Stroke rehabilitation is an essential part ror therapy is a simple, inexpensive and above all patient oriented of improvement after stroke because recovers patient’s independ- treatment. Implementing mirror therapy in addition to conventional ence and modify your quality of life. The purpose of this study is therapy in upper extremity rehabilitation has supplemental beneft to determine recovery subsequently rehabilitation therapy in sur- for stroke patients in improving upper extremity motor function. Omar1 points collected were age, gender, unit admission, pre-stroke liv- 1 ing area, type of stroke, laterality of impairment, length of stay, University of Malaya, Rehabilitation Medicine, Kuala Lumpur, and discharge destination. The term problems at different points in their recovery, and sometimes effciency was characterized as the ratio between the increase of may not be captured in standard outcome measures. All patients were also scored with modifed there are no signifcant differences between groups (30. Re- the effciency by etiology, is observed that the ischemic group is sults: There were 113 subjects who ft the criteria, with the median more effcient because it improves more in less time, with no sig- of age 61 (30–77), stroke ischemic 82. The patients in both syndrome, the knowledge on its clinical presentation is important experimental or placebo groups would need to wear a wristwatch as an early recognition of its symptoms can reduce the disabling cueing device on their affected wrist 3 hours per day for 4 weeks, impact to the patient hence allowing them to be more independ- with a vibration cue emitted from the device every 10 mins. The involvement of multidisciplinary team in managing this patients in the experimental group had to follow customized upper condition can ensure that such impairment does not limit patient’s extremity movement exercise upon every cue. Chan1 cebo groups presented relative more recovery than these allocated 1Tan Tock Seng Hospital- Singapore, Rehabilitation Centre, Sin- to the control group, however, there were no signifcant differences gapore, Singapore, 2University of Southampton- United Kingdom, between-group in the outcomes. Our fndings showed that placebo Faculty of Health Sciences- Rehabilitation and Health Technolo- effect of remind-to-move by means of sensory cueing is stronger gies Research Group, Southampton, United Kingdom especially increasing movement control, whereas sensory cueing itself prompt more hand use daily life. Conclusion: Placebo effect Introduction/Background: Impaired trunk control is commonly is strong in remind-to-move treatment. Our recent cross-sectional sensory cueing for various arm impairments is recommended. The Health Policy and Informatics, Tokyo, Japan, 4National Center for rate of change of the recovery curves of trunk control and up- Global Health and Medicine, Department of Rehabilitation, Tokyo, per extremity impairment was found to be similar over time. Early rehabilitation was defned as that started J Rehabil Med Suppl 55 Poster Abstracts 143 within 3 days after admission. Intensive rehabilitation was defned as tients continue to experience long-term disability. The multivariable logistic regression analysis showed that spective cohort study was conducted in a tertiary referral centre the early rehabilitation group exhibited signifcant improvement in in Kuala Lumpur. Suhaimi1 years old, married and employed pre-injury were observed to have 1University of Malaya, Rehabilitation Medicine, Kuala Lumpur, good functional outcome. Conclusion: Good functional outcome in Malaysia, 2The National University of Malaysia, Rehabilitation other developed countries were associated with shorter duration of Unit, Kuala Lumpur, Malaysia post traumatic amnesia and good education background. However, it is still too early to understand the factors associated with good Introduction/Background: To identify the presence of cardiovascular outcome in our study population as the study is still ongoing. Nevertheless, people with bet- 3Gazi University School of Medicine, Physical Medicine and Reha- ter mobility and clinical status showed signifcantly higher level bilitation, Ankara, Turkey of integration for home, social and productive activity. Trues- an upper extremity Brunstroom stage of 6/6, hand stage of 5/6 and 3 4 dale , M. She had complaints such 1 as, overeating, weight gaining, palmo-plantar hiperhidrosis, amen- Royal Melbourne Hospital, Department of Rehabilitation Medi- cine, Parkville, Australia, 2Royal Melbourne Hospital, Trauma Ser- orrhea, polyuria, and nocturia. There was edema and a livedoid-like 3 appearance in upper and lower extremities, more prominent on the vices, Parkville, Australia, Royal Melbourne Hospital, Emergency Services, Parkville, Australia, 4University of Melbourne, Depart- left presented with hiperhidrosis. Serum prolactin and morning cortisol levels were high, vasopressin, luteinizing and follicular ment of Medicine Royal Melbourne Hospital, Parkville, Australia stimulating hormone, estradiol levels were low. Thyroid stimulating Introduction/Background: With advances in medical care, the sur- hormone, adrenocorticotropic hormone, growth hormone and so- vival rates and functional outcomes of persons with traumatic brain matomedin-C were normal. The aim of this study was to examine factors impact- were evaluated as hypothalamic pituitary axis dysfunction second- ing long-term functional and psychological outcomes in persons with ary to trauma. Three months after the discharge, hospital Trauma Database from 2009 to 2010) current activity and hiperhidrosis was decreased, and biochemical parameters related to restriction in participation using validated questionnaires. Measures: thyroid functional tests, prolactin and cortisol levels were found to Global outcomes: Glasgow Outcome Scale-Extended, Functional be normal. Questionnaire, Community Integration Measure, Satisfaction With Life Scale; Caregiver outcomes: Caregiver Strain Index, Caregiver 489 self-reported burden. Participants were well-adjusted to Introduction/Background: A successful integration into community community-living, however, reported high levels of depression. More focus on participation carried out in a single tertiary centre with rehabilitation services and aging with disability in these persons is needed. Kondo4 intravenous immunoglobuline treatment and 2 weeks of inpatient 1International University of Health and Welfare Hospital, Rehabili- rehabilitation therapy, fascial paralysis was improved, dysphasia tation Medicine, Nasushiobara, Japan, 2Fujita Health University and dysarthria were recovered and, he was discharged to home with School of Health Sciences, Faculty of Rehabilitation, Toyoake, Ja- functional independence measurement motor subscore of 68/91 pan, 3Nagoya University Graduate School of Medicine, Preventive and he was ambulatory with a cane. The questionnaires were administered in one of tralia, Australian Catholic University, Faculty of Health Sciences, three modes: by self-report (mail), self-report (participant present at Melbourne, Australia the clinic), face-to-face interview. Signifcant morbidity can be observed articles, extracted data, assessed study methodological quality and at the site of this formation of new bone, including pain and loss rated the clinimetric properties and clinical utility. Conclusion: Although preliminary; our re- 1Fujita Health University, School of Health Sciences, Toyoake, Ja- sults indicate that screening all admissions may not be necessary. Results: Average ing cognitive emotional disorder, attention defcit, memory loss, score (21. Especially, it was exhibited that female changed results showed that the patient was in a low arousal state, and had “traditional” roles expected to perform (like housework) in Japa- attention defcit, memory loss, executive and intellectual dysfunc- nese community. The most frequent non traumatic factors are spinal stenosis, tumors, and infections.

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Another problem cheap 100mg viagra super active, particularly in adolescents buy viagra super active 50 mg amex, is the psychological adjustment to the condition; the rebellious teenage years may lead to non-compliance with insulin therapy and nutritional management discount viagra super active 100 mg otc. Dental management of diabetes The well-controlled diabetic child with no serious complications can have any dental treatment but should receive preventive care as a priority. Uncontrolled diabetes can result in varied problems, which mainly relate to fluid imbalance, an altered response to infection, possible increased glucose concentrations in saliva, and microvascular changes. There may be decreased salivary flow, and an increased incidence of dental caries has been reported in uncontrolled young diabetics. There is also well- documented evidence of increased periodontal problems and susceptibility to infections, particularly with Candida sp. Dental appointments should be arranged at times when the blood sugar levels are well controlled; usually a good time is in the morning immediately following their insulin injection and a normal breakfast. General anaesthetics are a problem because of the pre-anaesthetic fasting that is required, and so these are normally carried out on an in-patient basis to enable the insulin and carbohydrate balance to be stabilized intravenously. However, problems in the dental management of patients with steroid insufficiency are more likely to occur in children who are being prescribed steroid therapy for other medical conditions; for example, in the suppression of inflammatory and allergic disorders, acute leukaemia, and to prevent acute transplant rejection. In children, the risks of taking corticosteroids are greater than in adults and they should only be used when specifically indicated, in minimal dosage, and for the shortest possible time. If a child has adrenal insufficiency and/or is receiving steroid therapy, then any infection or stress may precipitate an adrenal crisis. For routine restorative treatment no additional steroid supplementation is usually necessary. However, if extractions under local anaesthesia or more extensive procedures are planned and/or if the patient is particularly apprehensive, then the oral steroid dosage should be increased. Dental management should present no problems if the thyrotoxic patient is medically well controlled; however, liaison with the physicians is important. Left untreated, sufferers would die of infections but fortunately the majority respond to treatment using corticosteroids, usually prednisolone. The kidney undergoes a complex developmental and migratory process leading to a high frequency of congenital anomalies, such as polycystic disease and unilocular cysts. Acute pyelonephritis is more common when there is a congenital abnormality present and so, even though it is simply treated with antibiotics, children often undergo further medical investigations to rule out congenital abnormality. Therefore, children with renal problems are likely to be, or have been, under specialist medical care. From a dental viewpoint, children with reduced renal function, or more importantly, progressive renal failure need extra consideration when prescribing drugs. Child cancer patients largely reflect the child population in general and as such, represent a cross-section of the population. Cancer causes more childhood deaths between the ages of 1 and 15 years than any other disease, but is still considerably behind trauma as the most common reason for mortality. The incidence of malignant tumours in children under 15 years of age in developed countries is estimated to be in the region of 1 in 10,000 children per year but the mortality rate is high, at between 30% and 40%. Although leukaemia is the most common form of childhood cancer, tumours of the central nervous system and neural crest cells and lymphomas also form a significant proportion (Table 16. Prognosis varies with the type of tumour, the stage at which it was diagnosed, and upon the adequacy of treatment. Major advances have been made in the treatment of childhood malignancy in the last few decades, largely as a result of advances in chemotherapy and bone- marrow transplantation. Dental management of children with cancer The children may have untreated caries and, since many are under 5 years of age, and may not have had a previous dental examination. The immediate problems include mucositis (oral ulceration) and exacerbations of common oral diseases that may become life threatening and are usually managed by paediatric dentistry specialists in liaison with their medical colleagues. Child cancer survivors later present with long-term problems relating to: - growth; puberty, and reproduction; cardiac; thyroid; cognitive deficit; and social function. Oral and dental development can also be impeded and specialist advice might again be required. Key Points • Children with cancer need the combined care of primary and specialist dental services; • There are immediate and long-term effects of cancer treatment; • Disease prevention is vital. Bone marrow transplants are the treatment of choice for children with aplastic anaemia, those who fail conventional therapy for leukaemia, and for some immune deficiency disorders. Although children with end-stage renal disease can be kept alive by haemodialysis, their quality of life is considerably improved by kidney transplantation. Children who require organ transplantation are considered to be at a high caries risk and so prevention is important. Whenever possible, active dental disease should be treated before the transplant procedure and any teeth with doubtful prognoses extracted. This may present difficulties as many pretransplant patients can be seriously ill and have various associated medical problems. Children undergoing bone marrow transplantation are prone to infection, bleeding, and delayed healing due to leucopenia and thrombocytopenia. However, the majority of children awaiting liver transplantation due to biliary atresia are of a very young age and have not experienced dental caries, though their teeth may have intrinsic green staining due to biliverdin deposition in the developing dental tissues. This is a time when intensive oral hygiene instruction and preventive advice and therapy are of paramount importance in helping to minimize later potential oral problems. Prophylactic antibiotics will probably be required in patients with cardiac problems and depressed white blood cell counts. Any significant alterations in bleeding times and/or coagulation status must be checked. There are also certain drugs that should be avoided inpatients with end-stage liver or kidney disease. Azathioprine results in leucopenia, thrombocytopenia, and anaemia; hence, children in this immediate post-transplant phase may be even more prone to infections and haemorrhage than before. Cyclosporin (Neoral) and Tacrolimus are largely replacing azathioprine but these may cause severe kidney and liver changes leading to hypertension and bleeding problems. Full supportive dental care is required and children complain of nausea and may develop severe oral ulceration. Routine oral hygiene procedures can become difficult but the use of chlorhexidine as a mouthwash, spray, or on a disposable sponge, together with local anaesthetic preparations is helpful. Steroid therapy is discontinued in children with liver transplants after 3 months but may be continued for longer periods than this in those with other organ transplants. Antifungal prophylaxis is usually given in the first few months after transplantation to prevent oral candidal infections. Dental problems, apart from oral ulceration and those associated with immunosuppression and bleeding tendencies, include delayed eruption and exfoliation of primary teeth and ectopic eruption of permanent teeth. These are related to the gingival overgrowth associated with cyclosporin and nifedipine medication (Fig. Key Points Transplant immunosuppression: • leucopenia; • thrombocytopenia; • gingival enlargement. This combination of drugs is required to prevent rejection and to control his blood pressure. Oral care is extremely important in enhancing the quality of life by reducing the morbidity and mortality of oral conditions, and by allowing the child to eat without pain and so gain optimal nutrient intake. An increasing number of children with complex medical problems now survive due to improvements in medical care, and present difficulties in oral management. An accurate, detailed medical history must be obtained for all children before any dental treatment is undertaken. An aggressive preventive regimen is required for all children with significant medical problems; this must encompass dietary counselling, suitable fluoride therapy, fissure sealant applications, and oral hygiene instruction. Many of these malformations require prophylactic antibiotics prior to carrying out any invasive dental procedures. Children with anaemia, whether from iron deficiency or from such inherited conditions as sickle-cell anaemia or thalassaemia, represent general anaesthetic risks in particular. Leukaemia is the most common form of childhood cancer and the first disseminated cancer to respond completely to chemotherapy in a significant number of children. Dental management of affected children needs to consider their haematological status as well as their immunocompromised condition. Asthma is a leading cause of chronic illness in childhood; severe asthmatics may be on systemic steroid therapy, which has implications for dental care. Convulsions are common in children, occurring in approximately 5%, but many of these are associated with episodes of high fever in the child and not with epilepsy. Diabetes mellitus is the most common endocrine/metabolic disorder of childhood; if there is good control of blood sugar levels with insulin therapy and nutritional management, then diabetic complications are minimized and dental care should be routine.

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