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Specifically order 20mg levitra amex erectile dysfunction gnc, the Administration for Children and Families identifies five protective factors for child abuse prevention:Nurturing and attachment ??? involves developing a bond and expressing love between parent and child cheap levitra 10 mg online drugs for erectile dysfunction ppt. Early positive relationships also lead to better grades, social interactions, healthier behaviors and an increased ability to cope with stress in the future. Knowledge of parenting and of child and youth development ??? parents that have an understanding of the importance of their role in the development of their children are more motivated to create a positive environment. Factors that are known to create a positive effect on child development include respectful communication and listening, consistent rules and expectations and safe opportunities for independence. Parental resilience ??? involves the ability to cope with the stresses of everyday life, as well as the occasional crisis. This resilience allows the parent to deal with stress in a healthy way rather than possibly put the child in abusive situations when stress from raising the child occurs. Social connections ??? parents with connections to family and friends have a support network to help them deal with family stressors. Isolated parents are known to be at greater risk for child abuse and neglect. Concrete supports for parents ??? involves ensuring parents have all they require to meet the basic needs such as food, shelter, transportation and clothing for their family. Additionally, the ability to access essential services, such as healthcare and childcare, reduce stress and prevent child abuse and neglect. Preventing child abuse risk factors involves numerous efforts including child sexual assault prevention classes. This is done by educating children on physical abuse and sexual abuse, as well as how to avoid risky situations. Additionally, knowing how to respond to abuse, if it takes place, is also part of child abuse prevention programs. Home visitation can also be a powerful tool in preventing child abuse. Home visits can alert professionals to developing risky situations and provide parents with the information needed to avoid them becoming full-blown child abuse cases. It is a fact that child abuse can happen to any family, no matter what their race, religion or socioeconomic background. Sometimes, families who appear to have everything are hiding deadly secrets within. Children of all ages and backgrounds are abused in the United States every year. Other child abuse statistics include:Victims less than one year old had the greatest rate of child abuse with more than 2% of children being victims of child abuseGirls were victimized slightly more often than boys at 51. As in previous years, most children suffered from neglect. Statistics on the type of child abuse include:Approximately 78% of child abuse victims suffered neglect Approximately 18% of child abuse victims suffered physical abuse Approximately 9% of child abuse victims suffered sexual abuse Child abuse statistics show that there were 510,824 child abuse perpetrators in fiscal year 2010 and a significant number of them committed more than one act of child abuse. Statistics on perpetrators of child abuse include:Parents were responsible for more than 80% of child abuse and neglect casesOther family members were responsible for 6. But ??? noticing just one sign of child abuse may hint that a closer look is in order. While people rarely openly abuse children, certain signs of physical child abuse can indicate a need for further investigation. Please note that these basic signs may not be readily apparent in some physically abused children. Unexplained or frequent bone fracturesBruises in areas of the body not typically injured by accident vs normal childhood activitiesBurns on the arms, legs, or around genitaliaBruises shaped like objects, such as a hand or belt buckleUnexplained lacerations or cutsMarks around the wrists or ankles, indicating someone may have tied the child upWithdrawal from friends and social activitiesPoor (unbelievable) or inconsistent explanations of injuriesAvoidance of eye contact with adults or older kidsExcessive fear of caretakers ??? this could be fear of the parent(s) or of a nanny or babysitterAnti-social behavior (older kids) like truancy, drug abuse, running away from homeChild seems overly watchful, on edge, as if anticipating something bad is going to happenExpresses a reluctance to go homeDemeans the child. Sees him or her as wholly bad and burdensomeExpresses little concern for the child and his or her performance in school, visible injuries, etc. The image below shows a child with the circular burn typically caused by a cigarette. Not all abused children have injuries on exposed areas. Some abusers cleverly inflict the injury on areas of the body usually covered by clothing.

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Complicating the diagnosis is the fact that many anorexic patients will also pursue bulimic behaviors (approx 20mg levitra fast delivery erectile dysfunction treatment in vijayawada. And many persons with bulimia nervosa will have wide fluctuations in weight as well order levitra 10mg line erectile dysfunction circumcision. Both illness are highly dangerous with significant morbidity and mortality. The third major eating disorder is the most recently defined.... This is similar to bulimia nervosa, but without the compensatory purging behavior. Many of these individuals are at an above normal weight because of their eating pattern. In addition to the basics that I have outlined thus far... Brandt: There are many factors that are involved and I will highlight three major areas. We are obsessed with thinness as a culture to the point where there is a tremendous emphasis on weight, shape, and appearance. This has increased through the decades, to the point now where just about everybody is worried about their weight. This even includes people who are at a perfectly normal or appropriate weight. As people attempt to manipulate their weight with dieting, they are at greater risk of developing one of these illnesses. We see many common psychological themes in our patients with severe eating disorders. The final area I would highlight from the perspective of etiology or "why" is the biological arena. There has been an explosion in research about the control of hunger and fullness and weight regulation, and there are many important new developments in our understanding of these highly complex problems. Perhaps we can explore some of these in more detail this evening. Bob M: What are the treatments for an eating disorder? And is there such a thing as a "cure" for an eating disorder? If not, is there a possibility of a cure in the future? Brandt: The treatment of eating disorders begins with a diagnostic evaluation, and is guided by the nature and degree of symptoms and difficulties. A first step is to rule out any immediate medical danger in persons dealing with any of the eating disorders. Then, one needs to assess whether the individual can be treated on an outpatient basis, or whether a more structured, hospital-based setting is necessary. Often, persons with less severe eating disorders can be treated on an outpatient basis with some combination of psychotherapy, nutritional counseling, perhaps medication if indicated. If a person is unable to block the dangerous behaviors of the disorder on an outpatient basis, then we encourage the patient to consider inpatient or day treatment or intensive outpatient programs. Bob M: Is there a cure though for an eating disorder, or one coming in the near future, or is it something that an individual deals with forever? Brandt: Some patients do extremely well with appropriate treatment and may be considered "recovered. It is our hope that the treatment of these illnesses will continue to improve as we learn more about the causes and new therapeutic strategies emerge. Also, there are a number of new pharmacological strategies. And psychotherapies are becoming increasingly refined. It is possible that it is unrelated to your eating it is also possible that your eating disorder is complicating the problem.

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In managing overdosage cheap 10mg levitra with visa erectile dysfunction medication online, consider the possibility of multiple drug involvement cheap 20mg levitra amex erectile dysfunction medication reviews. Several weeks (up to 8 weeks) may pass before you feel the full effect of this medicine. If you miss a dose of this medicine and you are taking 1 dose daily, take the missed dose if you remember the same day. Skip the missed dose if you do not remember until the next day. If you miss a dose of this medicine and you are taking more than 1 dose a day, skip the missed dose and go back to your regular dosing schedule. The recommended starting dose for fluvoxamine maleate is 50 mg, administered as a single daily dose at bedtime. In the controlled clinical trials establishing the effectiveness of fluvoxamine maleate in OCD, patients were titrated within a dose range of 100 to 300 mg/day. Consequently, the dose should be increased in 50 mg increments every 4 to 7 days, as tolerated, until maximum therapeutic benefit is achieved, not exceed 300 mg per day. It is advisable that a total daily dose of more than 100 mg should be given in two divided doses. If the doses are not equal, the larger dose should be given at bedtime. Dosage for Elderly or Hepatically Impaired Patients: Elderly patients and those with hepatic impairment have been observed to have a decreased clearance of fluvoxamine maleate. Consequently, it may be appropriate to modify the initial dose and the subsequent dose titration for these patient groups. Maintenance/Continuation Extended Treatment: Although the efficacy of fluvoxamine maleate beyond 10 weeks of dosing for OCD has not been documented in controlled trials, OCD is a chronic condition, and it is reasonable to consider continuation for a responding patient. Dosage adjustments should be made to maintain the patient on the lowest effective dosage, and patients should be periodically reassessed to determine the need for continued treatment. I know that every teacher and every parent in this Commonwealth fundamentally agrees that no young person ? gay or straight ? should be driven to take her or his life because of isolation and abuse. This is a tragedy we must all work together to prevent. We can take the first step toward ending gay youth suicide by creating an atmosphere of dignity and respect for these young people in our schools. Weld, speaking at a Gay and Lesbian Youth Commission Teacher Training, Arlington Street Church, June 30, 1993. Suicide among adolescents is a national and statewide tragedy. The Massachusetts Department of Education asked more than 3,000 students in 1994 to answer questions anonymously and found that 10 percent had attempted suicide compared with 6 percent in 1990, 20 percent "made plans" to commit suicide compared with 14 percent in 1990. Adolescent suicide has increased threefold in the last 10 years, making it the second most frequent cause of death among youths aged 15-24 (10 per 100,000 deaths per year). The incidence of suicide among adolescents between the ages of 15 and 19 had jumped from 2. It is estimated that suicide attempts are 40 to 100 times more common than completed suicides. An additional 500,000 youths of all sexual orientations attempt suicide annually. They may comprise up to 30 percent of (the estimated 5,000) completed youth suicides annually. The report recommended that "mental health and youth service agencies can provide acceptance and support for young homosexuals, train their personnel on gay issues, and provide appropriate gay adult role models; schools can protect gay youth from abuse from their peers and provide accurate information about homosexuality in health curricula; families should accept their child and work toward educating themselves about the development and nature of homosexuality. We welcome this report and hope it will lead to action that will save lives. After the findings, William Dannemeyer, who was at the time a conservative Republican member of the U. House of Representatives from California, called for then-president Bush to "dismiss from public service all persons still employed who concocted this homosexual pledge of allegiance and sealed the lid on these misjudgments for good.

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Published 8/00: Sex Roles: A Journal of ResearchThis research focused on the meaning of psychological intimacy to partners in heterosexual and same-gender relationships that have lasted for an average of 30 years buy levitra 20mg low cost erectile dysfunction pills free trials. In-depth interviews were used to explore the meaning of intimacy to 216 partners in 108 relationships purchase 10mg levitra free shipping erectile dysfunction treatment in jamshedpur. The participants were whites, blacks, and Mexican-Americans, with Catholic, Jewish, and Protestant religious backgrounds; they were employed in both blue-and white collar occupations. Psychological intimacy was defined as the sense that one could be open and honest in talking with a partner about personal thoughts and feelings not usually expressed in other relationships. Factors that had a significant role in shaping the quality of psychological intimacy in the last 5 to 10 years of these relationships (recent years) were the absence of major conflict, a confrontive conflict management style between partners, a sense of fairness about the relationship, and the expression of physical affection between partners. Women in same-gender relationships, compared to their heterosexual and gay counterparts, were more likely to report that psychologically intimate communication characterized their relationships. The findings are important for understanding factors that contribute to psychological intimacy in long-term relationships and how the gender roles of partners may shape the quality of psychologicalintimacy in heterosexual and same-gender relationships. This paper explores the meaning of psychological intimacy from the perspectives of 216 partners in 108 heterosexual and same-gender relationships that have lasted an average of 30 years. The paper adds to the existing literature on relational intimacy. Most previous studies of intimacy have sampled younger participants in relationships that have not lasted as long as those in this study. Our research focused on the meaning of psychological intimacy among partners in middle and old age. In contrast to the white, middle class samples utilized in many studies, we focused on couples in long-term relationships who were diverse in terms of race, educational level, and sexual orientation. Most research on relational intimacy has employed quantitative methodology; we used in-depth interviews to explore the meaning of psychological intimacy from the perspective of each partner in these relationships. The research on which this paper is based started 10 years ago and was conducted in two phases. In the second or current phase, we recoded the interview data so as to analyze them from both a qualitative and quantitative perspective. The goal of the paper is to develop an understanding of factors that contributed to reported psychological intimacy in recent years, defined as the last 5 to 10 years of these relationships. What does being psychologically intimate mean to individual partners (i. What factors are associated with the quality of psychological intimacy during the recent years of these relationships? The paper is organized as follows: Perspectives on defining psychological intimacy are discussed, which is followed by a review of recent empirical studies of intimacy, and the theoretical framework for the current study. The research methodology of the current study is summarized. A definition of psychological intimacy, the dependent variable, based on the reports of participants is presented, followed by the definitions of the independent variables that contributed to reported psychological intimacy in recent years. The findings are presented, including a chi-square analysis of those variables related significantly to psychological intimacy in recent years, correlations of the independent variable with the dependent variables, a logistic regression analysis of factors that contribute to psychological intimacy in recent years, and an examination of the qualitative data that help to clarify the effects of gender and sexual orientation on psychological intimacy during recent years. Defining Psychological Intimacy Despite the widespread attention in the professional literature to studies of intimate behavior, there has been little agreement about the meaning of intimacy in human relationships. Any attempt to define intimacy in a meaningful way must attend to various perspectives on the subject as well as clarify the potential linkages between differing perspectives. In addition, the meaning of intimacy must be differentiated from related concepts, such as communication, closeness, and attachment (Prager, 1995). If we are to be meaningful, not to mention relevant to human relationships in general, Prager cautions that any definition of intimacy needs to be compatible with everyday notions about the meaning of psychological intimacy. Because of the contextual and dynamic nature of relationships over time, however, a simple and static definition of intimacy is probably "unobtainable" (Prager, 1995). Most frequently, intimacy has been used synonymously with personal disclosure (Jourard, 1971) which involves "putting aside the masks we wear in the rest of our lives" (Rubin, 1983, p. To be intimate is to be open and honest about levels of the self that usually remain hidden in daily life.

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In one study discount levitra 10mg with mastercard erectile dysfunction 38 years old, alcohol use preceded the violence in 90% of batterings while in another study the number was reported at 60%This is not to suggest that alcohol causes wife battering ??? because it does not ??? but it does indicate that wife batterers are more likely to be violent generic 10mg levitra with mastercard erectile dysfunction korean red ginseng, and the violence may be more severe when they are drinking or when they are withdrawing from alcohol. Wife batterers may also use alcohol as an excuse for their behaviour. Like batterers, battered wives often come from a history of abuse. In fact, many battered wives initially got married to escape the abuse present at home and may have been married young, very quickly and with no engagement period. Those suffering from battered woman syndrome also tend to have a uniform response to violence including:Agitation and anxiety verging on panicApprehension of imminent doomThe inability to relax or sleepNightmares of violence or dangerFeelings of hopelessness and despairDue to these extreme reactions to violence in the relationship, those suffering from battered woman syndrome react to any perceived danger (real or not) by pacing, increased activity, screaming and crying. Battered wives seek medical help far more often than non-battered women and so it would be natural to assume that doctors would diagnose battered wife syndrome frequently; however, they do not. Doctors often fail to ask about domestic violence even when a woman repeatedly sees them. Battered wives are often from homes where they are taught to be compliant and not voice their concerns and this leads them into a similar adult relationship. Men who have been in homes where wife battering occurred as children, are more likely to grow up into wife batterers themselves. A battered wife can be of any race, socioeconomic status or educational background ??? anyone can be a victim of wife beating. No wife or any situation can cause a person to beat another. Within a relationship, though, there is typically a pattern to wife battering (read Cycle of Violence and Abuse ). The phases are typically: A tension building phaseA wife battering episodeA "honeymoon" phase where there is a respiteDuring the tension building phase, the wife often "walks on eggshells" around her batterer and is aware of the fact that the tension is building. These minor infractions produce unreasonable tension in the relationship. This tension eventually explodes in an acute wife battering episode. The battering may be a more minor push or slap or may be a major beating leading to broken bones or worse. The batterer may prevent the victim from receiving healthcare for their injuries and threaten the victim or others if the victim threatens to tell anyone about the abuse. Once the acute battering is over, the batterer often tries to charm his way out of what has happened; promising to never to do it again and attempting to make amends by doing things like buying flowers and being extra attentive. Often convincing a battered wife to leave their batterer is about convincing them that their false thoughts about the abuse are wrong. Taking care of the needs and safety of the wife as well as any children, and sometimes pets (which may also be abused), involved in the situation can help a woman decide to leave her batterer. This may make them even more reluctant to leave their wife batterer. Battered women generally need help to leave an abusive relationship. This is because battered women tend to by financially, psychologically and sometimes physically dependent on their abuser. Sources of help for battered woman can be found through healthcare professionals, community organizations, faith organizations and websites. While some services are specific to women, many services help men too as men can be the victims of battering just like women can. For the purposes of this article, the victim of battery is considered to be a woman and the perpetrator a man. It can be very difficult for a battered woman to leave a relationship. Battered women tend to fear their abuser and fear what will happen to them and their children if they try to leave; this makes even the thought of leaving painful and frightening.

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