Child Care Centers

Child Care Centers care for children in groups. All states require centers to be licensed. The definition of licensed child care varies by state or territory.
 Licensing does not insure quality but it does set minimum health, safety and caregiver training standards which centers must maintain. All states inspect centers at least once a year.
 Parents choose centers because they believe that larger groups, multiple caregivers and state inspections make programs safer for their children and make the arrangement more dependable. They respect the reputation of the child care program or the institution sponsoring the program.
 Many parents believe that more staff, space, equipment, toys and organized activities provide a better learning environment for their children.

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5 Steps To Choosing Care

Start Early
Start looking as far in advance as you can. No matter what type of care you are considering - a child care center or care in someone else's home - finding the right child care option can take some time.
Make a Call
Begin your search by calling your local experts - your Child Care Resource and Referral (CCR&R) agency. CCR&Rs can give you the facts about child care, and a list of child care options in your area that may meet your needs. In addition to what is in this brochure, make sure to ask your CCR&R:

• What are the licensing requirements in my area?
• How can I get information about complaints and licensing violations?
• Does my family qualify for any child care financial assistance programs?

Visit and Ask Questions
Visit the child care options you are considering. Find out about these key indicators of quality:

• Adult to Child Ratio. Ask how many children there are for each adult. The fewer the children for each adult, the better for your child. You want your child to get plenty of attention. The younger your child, the more important this is. Babies need an adult to child ratio of no more than 1:4 (one adult for four infants), while four-year-olds can do well with a ratio of 1:10 (one adult for 10 children).
• Group Size. Find out how many children are in the group. The smaller the group, the better. Imagine a group of 25 two-year olds with five adults, compared to a group of 10 with two adults. Both groups have the same adult to child ratio. Which would be calmer and safer? Which would be more like a family?
• Caregiver Qualifications. Ask about the caregivers' training and education. Caregivers with degrees and/or special training in working with children will be better able to help your child learn. Are the caregivers involved in activities to improve their skills? Do they attend classes and workshops?
• Turnover. Check how long caregivers have been at the center or providing care in their homes. It's best if children stay with the same caregiver at least a year. Caregivers who come and go make it hard on your child. Getting used to new caregivers takes time and energy that could be spent learning new things.
• Accreditation. Find out if the child care provider has been accredited by a national organization. Providers that are accredited have met voluntary standards for child care that are higher than most state licensing requirements.The National Association for the Education of Young Children (NAEYC) and The National Association for Family Child Care (NAFCC) are the two largest organizations that accredit child care programs.

Make a Choice
Think about what you saw at each visit, and make the best choice for your child and family.
Stay Involved
The work isn't over when you find good care for your child. You and your child's caregiver are partners now.
Here are some ways to be involved:

• Have parent-caregiver meetings regularly, and ask questions.
• Offer to volunteer time when needed, like participating in clean up days, fixing broken toys.
• Be there for your child's birthday party.
• Visit your child at child care and read a book aloud.
• Join in special events, like field trips, Career Day, Black History Month, or other holidays.

Even if you can't get time off from work during the day, you can still check in at drop-off and pick-up times. Ask the caregiver how things are going, and how your child is doing.
Visiting and participating in events at your child's provider sends a strong message. It tells your child and your child's caregiver that you think what your child is doing and learning is important.

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Epidural steroid injections

An epidural injection, or epidural steroid injection, may be used to help reduce the pain caused by a herniated disc, degenerative disc disease, or stenosis (cervical spinal stenosis or lumbar spinal stenosis). These spinal disorders often affect the cervical (neck) and lumbar (lower back) areas of the spine.
The medicine used in the injection is usually a combination of a local anesthetic (e.g. bupivacaine) and a steroid (e.g. triamcinolone). The technique and risks of the procedure are similar to those for standard epidural analgesia. The effects of an epidural steroid injection vary, but permanent benefit is unlikely.^[18] The technique is believed to work by reducing the inflammation or swelling, or both, of the nerves in the epidural space.
Some patients who have some residual pain after the first injection may receive a second or third epidural steroid injection. Patients who do not receive any relief from the first injection are unlikely to benefit from a second injection.

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Kidney Stone and Symptoms

A kidney stone, also known as a renal calculus (from the Latin ren, "kidney" and calculus, "pebble") is a solid concretion or crystal aggregation formed in the kidneys from dietary minerals in the urine. Urinary stones are typically classified by their location in the kidney (nephrolithiasis), ureter (ureterolithiasis), or bladder (cystolithiasis), or by their chemical composition (calcium-containing, struvite, uric acid, or other compounds). Kidney stones are a significant source of morbidity. 80% of those with kidney stones are men. Men most commonly experience their first episode between age 30–40 years, while for women the age at first presentation is somewhat later.
Kidney stones typically leave the body by passage in the urine stream, and many stones are formed and passed without causing symptoms. If stones grow to sufficient size (usually at least 3 millimeters (0.12 in) they can cause obstruction of the ureter. Ureteral obstruction causes postrenal azotemia and hydronephrosis (distension and dilation of the renal pelvis and calyces), as well as spasm of the ureter. This leads to pain, most commonly felt in the flank (the area between the ribs and hip), lower abdomen and groin (a condition called renal colic). Renal colic can be associated with nausea, vomiting, fever, blood in the urine, pus in the urine, and painful urination. Renal colic typically comes in waves lasting 20 – 60 minutes, beginning in the flank or lower back and often radiating to the groin or genitals. The diagnosis of kidney stones is made on the basis of information obtained from the history, physical examination, urinalysis, and radiographic studies. ultrasound examination and blood tests may also aid in the diagnosis.
When a stone causes no symptoms, watchful waiting is a valid option. For symptomatic stones, pain control is usually the first measure, using medications such as non-steroidal anti-inflammatory drugs (NSAIDs) or opioids. More severe cases may require surgical intervention. For example, some stones can be shattered into smaller fragments using extracorporeal shock wave lithotripsy (ESWL). Some cases require more invasive forms of surgery. Examples of these are cystoscopic procedures such as laser lithotripsy, or percutaneous techniques such as percutaneous nephrolithotomy. Sometimes, a tube (ureteral stent) may be placed in the ureter to bypass the obstruction and alleviate the symptoms.

kidney stones symptoms and signs?

 

While some kidney stones may not produce symptoms (known as "silent" stones), people who have kidney stones often report the sudden onset of excruciating, cramping pain in their low back and/or side, groin, or abdomen. Changes in body position do not relieve this pain. The abdominal, groin, and/or back pain typically waxes and wanes in severity, characteristic of colicky pain (the pain is sometimes referred to as renal colic). It may be so severe that it is often accompanied by nausea and vomiting. Kidney stones also characteristically cause blood in the urine. If infection is present in the urinary tract along with the stones, there may be fever and chills. Sometimes, symptoms such as difficulty urinating, urinary urgency, penile pain, or testicular pain may occur due to kidney stones.

How are kidney stones diagnosed?

The diagnosis of kidney stones is suspected by the typical pattern of symptoms when other possible causes of the abdominal or flank pain are excluded. Imaging tests are usually done to confirm the diagnosis. A helical CT scan without contrast material is the most common test to detect stones or obstruction within the urinary tract. Formerly, an intravenous pyelogram (IVP; an X-ray of the abdomen along with the administration of contrast dye into the bloodstream) was the test most commonly used to detect urinary tract stones, but this test has a greater risk of complications, takes longer, and involves higher radiation exposure than the non-contrasted helical CT scan. Helical CT scans have been shown to be a significantly more effective diagnostic tool than the IVP in the diagnosis of kidney or urinary tract stones.
In pregnant women or those who should avoid radiation exposure, an ultrasound examination may be done to help establish the diagnosis.

 

Treatment for kidney stones? How long does it take to pass a kidney stone?

Most kidney stones eventually pass through the urinary tract on their own within 48 hours, with ample fluid intake. Ketorolac (Toradol), an injectable anti-inflammatory drug, and narcotics may be used for pain control when over-the-counter pain-control medications are not effective. Intravenous pain medications can be given when nausea and vomiting are present.
Although there are no proven home remedies to dissolve kidney stones, home treatment may be considered for patients who have a known history of kidney stones. Since most kidney stones, given time, will pass through the ureter to the bladder on their own, treatment is directed toward control of symptoms. Home care in this case includes the consumption of plenty of fluids. Ibuprofen (Advil) may be used as an anti-inflammatory medication if there is no contraindication to its use. If further pain medication is needed, stronger narcotic pain medications may be recommended.
There are several factors which influence the ability to pass a stone. These include the size of the person, prior stone passage, prostate enlargement, pregnancy, and the size of the stone. A 4 mm stone has an 80% chance of passage while a 5 mm stone has a 20% chance. Stones larger than 9 mm-10 mm rarely pass without specific treatment.
Some medications have been used to increase the passage rates of kidney stones. These include calcium channel blockers such as nifedipine (Adalat, Procardia, Afeditab, Nifediac) and alpha blockers such as tamsulosin (Flomax). These drugs may be prescribed to some people who have stones that do not rapidly pass through the urinary tract.
For kidney stones that do not pass on their own, a procedure called lithotripsy is often used. In this procedure, shock waves are used to break up a large stone into smaller pieces that can then pass through the urinary system.
Surgical techniques have also been developed to remove kidney stones when other treatment methods are not effective. This may be done through a small incision in the skin (percutaneous nephrolithotomy) or through an instrument known as an ureteroscope passed through the urethra and bladder up into the ureter.

 

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Pain management Articles

What is Pain management
Low Back Pain
Heart-to-Heart: Beyond Pain
Kidney Stone and Symptoms 
Hip Pain

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Low back pain

Low back pain (or lumbago, English pronunciation: /lʌmˈbeɪgoʊ/) is a common musculoskeletal disorder affecting 80% of people at some point in their lives. In the United States it is the most common cause of job-related disability, a leading contributor to missed work, and the second most common neurological ailment — only headache is more common.^[1] It can be either acute, subacute or chronic in duration. With conservative measures, the symptoms of low back pain typically show significant improvement within a few weeks from onset.

What is the anatomy of the low back?

The first step to understanding the various causes of low back pain is learning about the normal design (anatomy) of the tissues of this area. Important structures of the low back that can be related to symptoms there include the bony lumbar spine (vertebrae, singular = vertebra), discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
The bony lumbar spine is designed so that vertebrae "stacked" together can provide a movable support structure while also protecting the spinal cord from injury. The spinal cord is composed of nervous tissue that extends down the spinal column from the brain. Each vertebra has a spinous process, a bony prominence behind the spinal cord, which shields the cord's nervous tissue from impact trauma. Vertebrae also have a strong bony "body" (vertebral body) in front of the spinal cord to provide a platform suitable for weight bearing of all tissues above the buttocks. The lumbar vertebrae stack immediately atop the sacrum bone that is situated in between the buttocks. On each side, the sacrum meets the iliac bone of the pelvis to form the sacroiliac joint of the buttocks.
The discs are pads that serve as "cushions" between the individual vertebral bodies. They help to minimize the impact of stress forces on the spinal column. Each disc is designed like a jelly donut with a central softer component (nucleus pulposus) and a surrounding outer ring (annulus fibrosus). The central portion of the disc is capable of rupturing (herniating) through the outer ring, causing irritation of adjacent nervous tissue and sciatica as described below.
Ligaments are strong fibrous soft tissues that firmly attach bones to bones. Ligaments attach each of the vertebrae to each other and surround each of the discs.
The nerves that provide sensation and stimulate the muscles of the low back as well as the lower extremities (the thighs, legs, feet, and toes) exit the lumbar spinal column through bony portals, each of which is called a "foramen."
Many muscle groups that are responsible for flexing, extending, and rotating the waist, as well as moving the lower extremities, attach to the lumbar spine through tendon insertions.
The aorta and blood vessels that transport blood to and from the lower extremities pass in front of the lumbar spine in the abdomen and pelvis. Surrounding these blood vessels are lymph nodes (lymph glands) and tissues of the involuntary nervous system that are important in maintaining bladder and bowel control.
The uterus and ovaries are important pelvic structures in front of the pelvic area of women. The prostate gland is a significant pelvic structure in men. The kidneys are on either side of the back of the lower abdomen, in front of the lumbar spine.
The skin over the lumbar area is supplied by nerves that come from nerve roots that exit from the lumbar spine.

The majority of lower back pain stems from benign musculoskeletal problems, and are referred to as non specific low back pain; this type may be due to muscle or soft tissues sprain or strain,^[3] particularly in instances where pain arose suddenly during physical loading of the back, with the pain lateral to the spine. Over 99% of back pain instances fall within this category.^[4] The full differential diagnosis includes many other less common conditions.

• Mechanical:
  • Apophyseal osteoarthritis
  • Diffuse idiopathic skeletal hyperostosis
  • Degenerative discs
  • Scheuermann's kyphosis
  • Spinal disc herniation ("slipped disc")
  • Thoracic or lumbar spinal stenosis
  • Spondylolisthesis and other congenital abnormalities
  • Fractures
  • Leg length difference
  • Restricted hip motion
  • Misaligned pelvis - pelvic obliquity, anteversion or retroversion
  • Abnormal Foot Pronation

• Inflammatory:
  • Seronegative spondylarthritides (e.g. ankylosing spondylitis)
  • Rheumatoid arthritis
  • Infection - epidural abscess or osteomyelitis

• Neoplastic:
  • Bone tumors (primary or metastatic)
  • Intradural spinal tumors

• Metabolic:
  • Osteoporotic fractures
  • Osteomalacia
  • Ochronosis
  • Chondrocalcinosis

• Psychosomatic
  • Tension myositis syndrome

• Paget's disease

• Referred pain:
  • Pelvic/abdominal disease
  • Prostate Cancer
  • Posture

• Depression^[5]
• Oxygen deprivation

What is the treatment for low back pain?

So, how is low back pain treated? Well, as described above, the treatment very much depends on the precise cause of the low back pain. Moreover, each patient must be individually evaluated and managed in the context of the underlying background health status and activity level.
As has been highlighted by research presented at the national meeting of the American College of Rheumatology, a very important aspect of the individual evaluation is the patient's own perception of their particular situation. British researchers found that those who believed that their symptoms had serious consequences on their lives and that they had, or treatments had, little control over their symptoms were more likely to have a poor outcome. This research points out to physicians the importance of addressing the concerns and perceptions that patients have about their condition during the initial evaluations.
Finally, it should be noted that the conditions listed above are intended for general review. There are many other causes of back pain, including upper back pain, that have not been discussed.

 

 

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Heart-to-Heart: Beyond Pain

Heart-to-Heart: Beyond Pain

Listen to an 18-minute program on pain control that dispels common myths that many people -- including doctors -- have about pain medications. This segment explains how good pain management can help you keep going as best you can. But getting good pain management may be difficult due to poor physician training, concerns about drug addiction, and laws that can get in the way of needed pain medications. The extract is taken from the Heart-to-Heart: Caring for the Dying documentary series, which provides three hours of audio education on end-of-life care. [Audio requires Microsoft Media Player]

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