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Neverthe- less buy escitalopram 10mg on-line anxiety symptoms like ms, because walking problems are often caused by chronic conditions that increase with age escitalopram 10mg otc anxiety symptoms videos, the sheer numbers of people living in our communities with mobility problems will grow dramatically in the early twenty-first century. Only revolutionary changes in preventing or treating chronic de- bilitating conditions will slow this trend. Who Has Mobility Difficulties / 13 70 60 50 40 30 20 10 0 Age DEGREE OF DIFFICULTY Minor Moderate Major Cumulative Total Figure 1. Siebens, Mobility Difficulties Are Not Only a Problem of Old Age, Journal of General Internal Medicine 16, no. First and foremost it leads to treatment, even if therapies merely slow progression of impairments. Although few chronic diseases or disorders that cause walking problems can now be cured, some treatments can substantially restore function, diminish pain, and improve quality of life. For example, knee or hip replacements can stop pain and return mobil- ity to many people with arthritis. Diagnoses suggest the future extent of mobility problems and types of symptoms people will have. Second, the cause often affects how people feel about their walking problems and their sense of control, as well as how society and even med- ical professionals view them. Knowing the cause allows people to get on with their lives, to plan and make choices, despite a sometimes unpre- dictable future. Candy Stoops, now in her late thirties, was newly married when her symptoms started nearly ten years ago: “I was dropping things. It’s al- most like your brain is saying, “Do something, do something,” and your whole body is not responding. My dad and my grandfather happened to be over, and they heard this kind of thump. Based on Candy’s description of her symptoms, the neurologist immedi- ately diagnosed myasthenia gravis, a disease affecting the junction be- tween nerves and muscles and causing profound weakness. Although the condition is not curable, treatment does reduce the episodes of weakness and risk of falls. Now Candy has “bad days” when she has trouble walking, but only once in a while. Specific causes can also shape perceptions of society and even medical professionals. These public perceptions can, in turn, sometimes affect how people with mobility problems feel about themselves. As discussed later, much of society’s concern revolves around whether the person with the mobility problem should qualify for special assistance, such as Social Secu- rity disability payments or workers’ compensation. Questions about control, including assuming responsibility and accept- ing credit or blame, dominate many discussions in American popular and political culture. These issues also surface when considering basic func- tions, such as being able to walk. Today’s self-help industry ironically casts greater responsibility on individuals to solve problems that even advanced medical technology cannot touch. This perspective affects how people feel about themselves and whether they put up a good fight. Tom Norton, a re- tired business executive in his early seventies, developed a neurologic problem with his left foot thirty years ago. Nonetheless, he spent years exercising, “try- ing to beat it,” without success. His wife, Nelda, accused Tom of being “in denial,” of deluding himself that he was making a difference. Nelda felt that Tom had wasted time and money on expensive exercise equipment Who Has Mobility Difficulties / 15 and personal trainers, searching for the perfect exercise cure. Each stereotype affixes blame or innocence and suggests whether people have control over their conditions and fu- tures. People “crippled” from birth or young adulthood by diseases or health conditions are the classic victims, without control over their fates. Tiny Tim, created by Charles Dickens for his 1843 story A Christmas Carol, ex- emplifies this stereotype.

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If your questionnaire looks clut- tered purchase escitalopram 20mg with amex anxiety symptoms on kids, respondents will be less likely to fill it in generic escitalopram 10 mg otc anxiety symptoms treated with xanax. Collecting personal information Opinion is divided about where personal information should be included on a questionnaire. I tend to include it at the end, as I believe people are more likely to fill in this information when they have already invested time HOW TO CONSTRUCT QUESTIONNAIRES/ 95 and energy in completing the rest of the form. As the re- searcher, you need to think about collecting only that type of personal information which is completely relevant to your research. Be sensitive to the type of information peo- ple will be reluctant to give. This form may seem short, but it is important not to ask for too much personal information as respondents will become suspicious and want to know why you want the information. You also need to assure them that you understand and will comply with the Data Protection Act (see Chapter 13). PILOTING THE QUESTIONNAIRE Once you have constructed your questionnaire, you must pilot it. This means that you must test it out to see if it is obtaining the results you require. First of all, ask people who have not been involved in its construction to read it through and see if there are any ambiguities which you have not noticed. Once this has been done, alter the ques- tions accordingly, then send out a number of question- naires to the type of people who will be taking part in the main survey. Make sure they know it is a pilot test and ask them to forward any comments they may have about the length, structure and wording of the question- naire. Go through each response very carefully, noting comments and looking at the answers to the questions as this will help you to discover whether there are still am- biguities present. If you have had to undertake major alterations, you may need to pilot the questionnaire again. Personal profile form HOW TO CONSTRUCT QUESTIONNAIRES/ 97 This may seem a rather long and laborious process, but it is incredibly important, especially if you’re intending to send out a large number of questionnaires. OBTAINING A HIGH RESPONSE Questionnaires are big business and as more and more fall through our letterboxes we become less willing to spend the time completing them. You need to make yours stand out so that all your careful planning and construc- tion is not wasted. There are many simple measures you can take to try to ensure a high response rate. X Is the questionnaire relevant to the lives, attitudes and beliefs of the respondents? X Can the respondents read if they are to be given a self- administered questionnaire? For example, illegal immigrants may be less likely to fill in a questionnaire than legal immigrants. X Are the instructions straightforward and realistic about how long it will take to complete? X Has the respondent been told who the research is for and what will happen to the results? X Has the respondent been reassured that you under- stand and will comply with the Data Protection Act? X Can your respondents see some personal benefit to be 98 / PRACTICAL RESEARCH METHODS gained by completing the questionnaire? X Has a follow-up letter and duplicate questionnaire been sent in cases of none response? QUESTIONNAIRE DESIGN CHECKLIST X Make your questionnaire as short as possible. X Don’t assume knowledge or make it seem that you expect a certain level of knowledge by the way your questions are worded. X Decide whether you’re interested in behaviour, beliefs, attitudes or characteristics or a combination of the above. X Make sure you have made the right decisions concern- ing open-ended questions, closed-ended questions or a combination of both. X Decide whether your questionnaire is to be self-admi- nistered or interviewer administered. X Include a covering letter with information about who the research is for and what will happen to the results.

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For this reason escitalopram 10mg lowest price anxiety job interview, especially in children with simple febrile seizures buy escitalopram 10mg with amex anxiety vitamins, reassurance and counseling rather than drugs are the preferred treatment options. In this section, we will first review the available treatment options and then present an approach to the management of the child with both simple and complex febrile seizures (Table 1). Chronic prophylaxis with phenobarbital or valproate will reduce the risk of recurrent febrile seizures. However, it does not reduce the risk of subsequent epilepsy and is associated with significant morbidity and is therefore no longer recommended. Carbamazepine and phenytoin are ineffective in preventing further febrile seizures. There are insufficient data on any of the newer antiepileptic drugs to justify their use in this setting at the present time. Intermittent treatment with benzodiazepines given orally or rectally at time of fever reduces the risk of recurrent febrile seizures. It must be given every time the Table 1 Treatment of the Child with Simple and Complex Febrile Seizures Chronic AEDs (phenobarbital and valproate) Not indicated Diazepam (oral or rectal) at the time of fever Not routine for simple febrile seizures Consider for complex or multiple simple febrile seizures Rectal diazepam at the time of seizure First-line therapy for prolonged febrile seizures Rapid, simple, safe, and effective 76 Shinnar child has an intercurrent illness, which can become an issue given the frequency of febrile illnesses in early childhood. There is also the theoretical concern about seda- tion masking signs of more serious illness such as meningitis. Even when effective, it does not reduce the risk of subsequent epilepsy. Furthermore, children who have a seizure as the first manifestation of their febrile illness are both at higher risk to have another one and least likely to benefit. This treatment does have a limited role in selected cases with frequent recurrences. Data from controlled clinical trials suggest that this treatment is no more effective than placebo in prevent- ing recurrence. While antipyretics are generally benign and may make the child more comfortable, recommendations for their use should recognize their relative lack of efficacy and avoid creating undue anxiety and guilt feelings in the parents. Abortive therapy with rectal diazepam (dose based on weight) at the time of sei- zure does not alter the risk of recurrence but is effective in preventing prolonged feb- rile seizures, which are often the main concern. Children with prolonged febrile sei- zures are good candidates for this form of therapy. Rectal diazepam can also be used in cases with a high risk of recurrence, for families who live far away from medical care and for families where the parents are very anxious. In these cases it avoids the need for chronic or intermittent therapy unless a seizure actually occurs and lasts more than 5 min. In many cases, particularly those with simple febrile seizures, reassurance and education about the benign nature of the condition are all that is needed. The American Academy of Pediatrics 1999 practice parameter recommends no treatment for children with simple febrile seizures. The specific treatment option chosen depends on the goals of therapy and spe- cific features individual to each case. For simple febrile seizures, the American Acad- emy of Pediatrics recommends no treatment except reassurance; a recommendation the author fully agrees with. In parents who live far away from medical care or who are particularly anxious, a prescription for rectal diazepam may be appropriate and further minimize anxiety and risk. However, even in this setting, chronic AED therapy is very, very rarely appropriate. For children with complex febrile seizures, current therapeutic options include no treatment, which is appropriate in many cases, intermittent diazepam at the time of fever, and rectal diazepam should a seizure occur and last longer than 5 min. As treatment does not alter long-term outcome and only very prolonged febrile seizures have been causally associated with subsequent epilepsy, a rational goal of treatment would be to prevent prolonged febrile seizures. Therefore, when treatment is indicated, particularly in those at risk for prolonged or multiple febrile seizures or those who live far away from medical care, rectal diazepam used as an abortive agent at the time of seizure would seem the most logical therapeutic option. The above discussion assumes the child is not actively convulsing at the time of decision making which will be true in the vast majority of cases. If a child arrives in the emergency department in the midst of a seizure, they should be treated using the current pediatric status epilepticus protocol, which is covered in Chapter ___.

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