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A survey of ambulance workers in service at fire stations in the northern Gyeonggi province was conducted from Feb impotence at 46 purchase 100 mg extra super cialis with visa. That of workers not younger than 35 years was higher than that of workers younger than 30 years vyvanse erectile dysfunction treatment order cheap extra super cialis line. That of fire engineers or fire lieutenants was shown to be higher than that of firefighters erectile dysfunction medications comparison purchase discount extra super cialis on line. That when less than three workers were mobilized was shown to be higher than that when three workers and more were mobilized erectile dysfunction causes stress order cheap extra super cialis online. Self-efficacy showed a positive correlation with emotional intelligence but a negative correlation with job stress. Improvements/Applications: To reduce the job stress, the health should be improved and the field response capability should be enhanced by establishing the strategy to enhance the emotional intelligence. Keywords: Emotional Intelligence, Self-effectiveness, Job Stress, Health Promotion, Health Condition Introduction the fire fighter encounters many direct traumatic events in various accident sites that he(she) is in fear of physical injury or life. Since the accident such as industrial accident, building collapse, natural disaster, Corresponding author: Jee-Hee Kim, kjh1962@kangwon. As of 2018, the activity of 119 Rescue Center was 2,788,101 cases and occupies more than 68% out of 4,066,201 mobilization cases of fire fighting. Firefighting officer carries out the job hard to bear physically and mentally and belongs to stress high risk group due to frequent exposure to the traumatic event, irregular shift and standby for mobilization, health risk and physical Medico-legal Update, January-March 2020, Vol. Emotional intelligence[1] is the positive emotional propensity and understands the feeling of not only himself (herself) but also other surrounding people exactly and is the ability to utilize and regulate his/her own feelings[2]. Han[4] said that as the individual having high positive emotional propensity has relatively excellent positive problem solving ability and makes effort to solve the problem actively, the stress level was very low. Gist and Mitchell[6] have stated that persons with a high level of self-efficacy can effectively perform their jobs and make continuous efforts for the goals without giving up. Job stress can be said to be the level at which one personally perceives psychological and physical adverse effects caused by business ability and environment of an organization member due to requirements of individuals and difference in opinions depending on the job. It means psychological and emotional tension level of perceiving the imbalance in the relation between an individual and the job environment[7]. The factors having effect on the job stress are personal characteristics, social support, job characteristics, personal health condition, working environment and organization characteristics and there are lots of researches for them but the research on the mental health of fire fighter has been made mainly on the post-traumatic stress disorder. The purpose of this study is to provide the basic data for effective job stress reduction by identifying the effect of the emotional intelligent perceived by the fire fighter on the self-efficacy and job stress and the mediating effect of self-efficacy. Its total score ranges from 16 to 80 and, with higher score indicating higher level of emotional intelligence. Personal Efficacy Beliefs Scale developed by Riggs and Knight[9] was used after translation. This tool has a total of 14 questions: five questions for job requirements, three questions related to the authority to make decisions and job autonomy, and six questions related to availability of skill. Data Collection and Analysis A survey of ambulance workers in service at the fire stations in the northern Gyeonggi province was conducted from Feb. Results and Discussion Demographic characteristics of study subjects are summarized in Table 1. Regarding education level, the number of graduates from a 4-year college or higher level was 88 (55 %) and the number of graduates from a 2-year college was 68 (42. Regarding service career, the number of workers with service career between 1 and 3 years was 52 (32. Although self-efficacy and job stress of females were higher than those of males, differences between the two were not statistically significant. Emotional intelligence of workers not younger than 35 years was found to be higher than that of workers younger than 30 years (p =. Job stress of workers younger than 30 years was higher than that of workers not younger than 35 years (p =. However, self-efficacy did not show any statistically significant difference among age groups. According to education level, self-efficacy of graduates from a college or a graduate school was higher than that of high school graduates (p =.

The main sources will be excreta and salivary contamination icd 9 code erectile dysfunction 2011 purchase on line extra super cialis, with vomit as a further potential source erectile dysfunction at age 26 buy 100mg extra super cialis with amex. If the patient vomits what causes erectile dysfunction yahoo extra super cialis 100mg for sale, the resulting contamination can be widespread zma impotence cheap 100 mg extra super cialis otc, requiring extensive decontamination. Accident/emergency procedures Possible eventualities which require planning include: · · · · Vomiting; Incontinence; Death; Respiratory or cardiac arrest. Every hospital should prepare its own response procedures for the above, and there is obviously no single procedure which can be used. The following protocols and procedures however, adapted from a real hospital radiation safety manual, give a guide as to what should be considered. Vomiting/contamination Vomiting is an uncommon, but possible, occurrence in the first 48 hours or so following patient dose administration. The nuclear medicine department must provide an emergency spill kit containing the basic materials required to deal with contamination. Contaminated objects may need treatment to reduce radioactivity levels, or even storage for decay. Washing should be continued until the radiation level is less than about three times background level, or until it can be reduced no further. Plates and all utensils should be placed in a plastic bag after use which should be kept in the room until checked for contamination. If the patient vomits, or urinates in the bed, it must be assumed, until proven otherwise, that the contamination is radioactive. Even with prophylactic anti-nausea medication, the patient vomited during the night. When in the morning the nursing staff came to check on the patient, it was found that the patient had cleaned up the contamination using contamination kit, placed all contaminated materials including gloves in a waste bag, labelled it and placed it in the shower recess in the bathroom! As far as possible, patients should be screened for potential incontinence, and catheterised prior to treatment, and remain so until discharge, or for the first 48 hours of hospital stay at least. The patient should be, as usual, encouraged to drink freely, and the staff should empty the catheter bag frequently to avoid a large accumulation of activity. Patients who are confined to their bed for other reasons, even if showing no signs of incontinence, should seriously be considered for catheterisation to avoid the close staff contact and potential for contamination involved in use of bedpans. Patients treated with Iodine-131 Patients with thyrotoxicosis or thyroid carcinoma are treated with oral Iodine-131, which is absorbed through the gut over a period of some hours. Till few hours following administration, the gut may contain a significant amount of radioactive material, rapidly decreasing with time. As intubation, catheterisation or a nasogastric tube may be necessary, staff is to be gowned and wear gloves when handling the patient. Attempt to contain any urine, gastric contents or 147 any other body fluids by means of absorbent pads, and hold the pads in a contaminated waste bag for contamination checking. Similarly any suction bottles or urine bags used must not be discarded until checked. Case Study 5 A male patient being treated with radioiodine suffered a respiratory arrest. The doctor called for assistance, and when the arrest team arrived, she left the room. Death of the patient There are two particular problems which may arise from the death of a radioiodine therapy patient. A number of special precautions must be taken in the case of the death of a patient who contains radioactive material for therapeutic purposes. The equipment used during the autopsy should later be decontaminated by thorough rinsing in a detergent solution (preferably with a soluble iodine agent added) followed by washing in running water. The disappearing patient If the patient suffers dementia, or is very uncooperative, he/she could leave the bedroom undetected and thus become a potential public health hazard. If this is at all likely, a radiation alarm mounted outside the bedroom could be considered, which would sound an alarm if the patient left the room. Other preventative measures could be to site the treatment bedroom within sight of the nursing station, but in particular to educate the patient that it is imperative they do not leave the room without permission.

Remember that these young patients often become uncooperative impotence essential oils buy 100mg extra super cialis mastercard, and may require general anesthesia for the simple removal of the object erectile dysfunction yahoo best extra super cialis 100mg, especially if prior attempts have been made to remove it sudden erectile dysfunction causes purchase extra super cialis once a day. Therefore erectile dysfunction pills cialis generic extra super cialis 100 mg without a prescription, unless certain, easy, nontraumatic, removal of the foreign body is completely assured, refer to an otolaryngologist. Button batteries can cause severe burns and should be removed emergently to prevent or minimize long-term complications. Later in this chapter, we will more specifically discuss esophageal foreign bodies as a cause of stridor. Tonsillectomy In the pre-antibiotic era, the indication for a tonsillectomy was the presence of tonsils, as it was the only treatment available for recurrent infections. Chronic Tonsillitis Chronic low-grade infection of the tonsils can occur in older children, adolescents, and adults. The lymph nodes in the neck are usually inflamed from constant tonsillar infection. Indications for tonsillectomy include recurrent episodes of tonsillitis or chronic upper airway obstruction resulting in sleep apnea. Daytime lethargy, obstructive symptoms, growth retardation, behavioral problems, including poor school performance and hyperactivity, and nocturnal enuresis are often associated with the obstructive sleep disorder. If the diagnosis of obstruction is substantiated, tonsillectomy and adenoidectomy is often curative, although in some populations persistent or recurrent symptoms may occur. Special perioperative management is indicated with morbidly obese children, children with craniofacial deformities, including clefts, and children with neuromuscular disorders. Asymmetric tonsils in children are usually more apparent than real, with assymmetry of the soft palate and anterior pillars or recurrent scarring from infections as factors in the apparent discrepancy. Careful assessment of the adult patient with tonsillar asymmetry is necessary to determine if a lymphoma or other malignancy is present and surgical intervention is warranted. Peritonsillar Abscess An abscess that collects in the potential space between the pharyngeal constrictor and the tonsil itself is termed a peritonsillar abscess or "quinsy. The classic signs of a peritonsillar abscess are fullness of the anterior tonsillar pillar, deviated uvula, "hot-potato voice" (somewhat muffled sound to voice), and severe dysphagia. Most of these patients also have trismus (inability to open the jaw) to some extent. Treatment is either aspiration with a large needle or incision and drainage done under local or general anesthesia. Usually, patients are hydrated, treated with appropriate high-dose antibiotic therapy, and sent home on oral antibiotics (assuming they can tolerate intake by mouth). Many surgeons routinely prefer urgent tonsillectomy, because they feel it most effectively drains the abscess and prevents recurrence. When the adenoids are enlarged, symptoms of airway compromise arise, such as nasal obstruction, chronic mouth breathing, and snoring. Adenoidectomy is often performed in older children who have recurrent acute otitis media or chronic otitis media with effusion, especially if effusion has returned after tympanostomy tube extrusion. Tonsillectomy is often combined with adenoidectomy for children who snore loudly or have apnea with nasal obstruction. Stridor 124 Children are also commonly referred to the otolaryngologist for stridor, a high-pitched, noisy respiration emanating from the larynx or upper trachea that is a sign of respiratory obstruction. Stridor can be caused by a number of conditions, including several that can be life threatening: acute epiglottitis, croup, or foreign body aspiration. This fatal disease was common 20 years ago, but the incidence has decreased dramatically with widespread use of the H. If you suspect acute epiglottitis, immediately call an otolaryngologist, anesthetist, and pediatrician. Most pediatric hospitals have a specific protocol that automatically activates a team of airway experts once the diagnosis of acute epiglottitis is suspected. Remember: If the child obstructs acutely, the airway can almost always be maintained with a bag and mask.

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Syndromes

• Deafness
• Thirst is accompanied by other unexplained symptoms, such as blurry vision and fatigue
• Delayed sexual maturity
• With glaucoma, there may be tunnel vision and missing areas of vision
• Metaproterenol (Alupent, Arm-a-Med Metaproterenol, Dey-Dose Metaproterenol, Dey-Lute Metaproterenol, Metaprel)
• Tumors of the brain or kidneys
• Has not urinated for 6 hours
• Hydrocephalus

The starting point for spermatogenesis is the seminiferous tubules of the testes erectile dysfunction exercise video cheap extra super cialis master card, where the stem cells that are adjacent to the inner tubule wall divide in a centripetal direction (moving towards the lumen) erectile dysfunction doctor generic extra super cialis 100 mg. The following table and illustration demonstrate the most important points from fertilization to implantation incidence of erectile dysfunction with age buy extra super cialis 100mg on line. Ectoderm ­ the ectoderm is the more superficial tissue low testosterone erectile dysfunction treatment buy discount extra super cialis 100mg on line, they include: - - - Surface Ectoderm: Epidermis, Lining of the epithelium, Lens of the eye, and the adenohypophysis. The cells of the endoderm being as squamous cells, but finally change into columnar cells. The tissues of the endoderm include: - - - Mesoderm ­ the mesoderm is the middle germal layer, giving rise to many different tissues. Some mesodermal tissues contain the ability to differentiate into a diverse range of tissues, such as the bone marrow. The umbilical vein is responsible for supplying the fetus with oxygenated blood, while the arteries are responsible for carrying deoxygenated blood from the fetus. Approximately half of this blood enters the fetal ductus venosus and is carried to the inferior vena cava, with the other half entering the liver. As the blood enters the right atrium of the heart, most of it flows through the foramen ovale and into the left atrium (bypassing the pulmonary circulation). The blood then moves into the left ventricle and is pumped through the aorta to the body. Some of the blood traveling through the body enters the internal iliac arteries and to the umbilical arteries, re-entering the placenta and disposing of carbon dioxide and other waste products (which travel to the maternal circulation). Note that there is a connection between the aorta and the pulmonary artery called the ductus arteriosus, which shunts most blood away from the lungs because they are not used until the fetus is born. Upon birth of the infant, the first breath causes a decrease in the resistance of the pulmonary vasculature, increasing the pressure in the left atrium relative to the pressure of the right atrium. There is also a closure of the ductus arteriosus because the increased concentration of oxygen causes the prostaglandin levels to decrease. This closure prevents the blood from bypassing the pulmonary circulation, allowing the lungs to function properly. Multiple anomalies, most commonly: Developmental delay, hydrocephalus, agenesis of corpus collosum, meningoencephalocele, midfacial hypoplasia. Abnormal facies, microcephaly, growth deficiency, mental retardation, hypoplastic nails, hypoplastic phalanges. Microphthalmia, hydrocephalus, microtia, cleft palate, blindness, deafness, heart disease, thymic agenesis. Fetal alcohol syndrome Spontaneous abortion, increased risk of placental abruption or previa, preterm delivery, and premature rupture of membranes. The Dizygotic twins are aka "Fraternal Twins", and have 2 placentas, 2 amniotic sacs, and 2 chorions. Monozygotic twins are "identical twins", and contain 1 placenta, 1 chorion, and 2 amniotic sacs. The thymus functions in production of T-lymphocytes, which are essential parts of the adaptive immune system. The cortex of the thymus is dense with immature T cells, while the medulla contains the mature T cells. The thyroid connects to the tongue via the thyroglossal duct (disappears in normal development). Due to the anatomy and relationship of the thyroid to the tongue, ectopic thyroid tissue is most commonly found in the tongue. Ventral Pancreatic Bud а Pancreatic head, Uncinate process, and main pancreatic duct. Dorsal Pancreatic Bud а Body of pancreas, tail of pancreas, Isthmus, Accessory pancreatic duct. Develops into: Fallopian Tube, Uterus, Upper part of vagina Cortex = Dense, immature T cells.