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How to cite this online viagra prescription article:Singh OP. Psychiatry research in India. Closing the online viagra prescription research gap.

Indian J Psychiatry 2020;62:615-6Research is an important aspect of the growth and development of medical science. Research in India in general and medical research in particular is always being criticized for lack of innovation and originality required for the delivery of online viagra prescription health services suitable to Indian conditions. Even the Indian Council of Medical Research (ICMR) which is a centrally funded frontier organization for conducting medical research couldn't avert criticism.

It has been criticized heavily for not producing quality research papers which are pioneering, ground breaking, or pragmatic solutions for health issues plaguing India. In the words of a leading daily, The ICMR could not even list one practical application of its hundreds of research papers published in various national and international research journals which helped cure any disease, or diagnose it with better accuracy or in less time, or online viagra prescription even one new basic, applied or clinical research or innovation that opened a new frontier of scientific knowledge.[1]This clearly indicates that the health research output of ICMR is not up to the mark and is not commensurate with the magnitude of the disease burden in India. According to the 12th Plan Report, the country contributes to a fifth of the world's share of diseases.

The research conducted elsewhere may not be generalized to the Indian population owing to differences in biology, online viagra prescription health-care systems, health practices, culture, and socioeconomic standards. Questions which are pertinent and specific to the Indian context may not be answered and will remain understudied. One of the vital elements in improving this situation is the need for relevant research base that would equip policymakers to take informed health policy decisions.The Parliamentary Standing Committee on Health and Family Welfare in the 100th report on Demand for Grants (2017–2018) of the Department of Health Research observed that “the biomedical research output needs to be augmented substantially to cater to the health challenges faced by the country.”[1]Among the various reasons, lack of fund, infrastructure, and resources is the prime cause which is glaringly evident from the inadequate budget allocation for biomedical research.

While ICMR has a budget of 232 million dollars per year on health research, it is zilch in comparison to the annual budget expenditure of the National Institute of Health, USA, on biomedical research which is 32 billion dollars.The lacuna of quality research is not merely online viagra prescription due to lack of funds. There are other important issues which need to be considered and sorted out to end the status quo. Some of the factors which need our immediate attention are:Lack of research training and teachingImproper allocation of research facilitiesLack of information about research work happening globallyLack of promotion, motivation, commitment, and passion in the field of researchClinicians being overburdened with patientsLack of collaboration between medical colleges and established research institutesLack of continuity of research in successive batches of postgraduate (PG) students, online viagra prescription leading to wastage of previous research and resourcesDifficulty in the application of basic biomedical research into pragmatic intervention solutions due to lack of interdisciplinary technological support/collaboration between basic scientists, clinicians, and technological experts.Majority of the biomedical research in India are conducted in medical institutions.

The majority of these are done as thesis submission for fulfillment of the requirement of PG degree. From 2015 onward, publication of papers had been made an obligatory requirement online viagra prescription for promotion of faculty to higher posts. Although it offered a unique opportunity for training of residents and stimulus for research, it failed to translate into production of quality research work as thesis was limited by time and it had to be done with other clinical and academic duties.While the top four medical colleges, namely AIIMS, New Delhi.

PGIMER, Chandigarh. CMC, Vellore online viagra prescription. And SGIMS, Lucknow are among the top ten medical institutions in terms of publication in peer-reviewed journals, around 332 (57.3%) medical colleges have no research paper published in a decade between 2004 and 2014.[2]The research in psychiatry is realistically dominated by major research institutes which are doing commendable work, but there is a substantial lack of contemporary research originating from other centers.

Dr. Chittaranjan Andrade (NIMHANS, Bengaluru) and Dr. K Jacob (CMC, Vellore) recently figured in the list of top 2% psychiatry researchers in the world from India in psychiatry.[3] Most of the research conducted in the field of psychiatry are limited to caregivers' burden, pathways of care, and other topics which can be done in limited resources available to psychiatry departments.

While all these areas of work are important in providing proper care and treatment, there is overabundance of research in these areas.The Government of India is aggressively looking forward to enhancing the quality of research and is embarking on an ambitious project of purchasing all major journals and providing free access to universities across the country. The India Genome Project started in January, 2020, is a good example of collaboration. While all these actions are laudable, a lot more needs to be done.

Following are some measures which will reduce the gap:Research proposals at the level of protocol can be guided and mentored by institutes. Academic committees of different zones and journals can help in this endeavorBreaking the cubicles by establishing a collaboration between medical colleges and various institutes. While there is a lack of resources available in individual departments, there are universities and institutes with excellent infrastructure.

They are not aware of the requirements of the field of psychiatry and research questions. Creation of an alliance will enhance the quality of research work. Some of such institutes include Centre for Neuroscience, Indian Institute of Science, Bengaluru.

CSIR-Institute of Genomics and Integrative Biology, New Delhi. And National Institute of Biomedical Genomics, KalyaniInitiation and establishment of interactive and stable relationships between basic scientists and clinical and technological experts will enhance the quality of research work and will lead to translation of basic biomedical research into real-time applications. For example, work on artificial intelligence for mental health.

Development of Apps by IITs. Genome India Project by the Government of India, genomic institutes, and social science and economic institutes working in the field of various aspects of mental healthUtilization of underutilized, well-equipped biotechnological labs of nonmedical colleges for furthering biomedical researchMedical colleges should collaborate with various universities which have labs providing testing facilities such as spectroscopy, fluoroscopy, gamma camera, scintigraphy, positron emission tomography, single photon emission computed tomography, and photoacoustic imagingCreating an interactive, interdepartmental, intradepartmental, and interinstitutional partnershipBy developing a healthy and ethical partnership with industries for research and development of new drugs and interventions.Walking the talk – the psychiatric fraternity needs to be proactive and rather than lamenting about the lack of resource, we should rise to the occasion and come out with innovative and original research proposals. With the implementation of collaborative approach, we can not only enhance and improve the quality of our research but to an extent also mitigate the effects of resource crunch and come up as a leader in the field of biomedical research.

References 1.2.Nagoba B, Davane M. Current status of medical research in India. Where are we?.

Walawalkar Int Med J 2017;4:66-71. 3.Ioannidis JP, Boyack KW, Baas J. Updated science-wide author databases of standardized citation indicators.

PLoS Biol 2020;18:e3000918. Correspondence Address:Dr. Om Prakash SinghAA 304, Ashabari Apartments, O/31, Baishnabghata, Patuli Township, Kolkata - 700 094, West Bengal IndiaSource of Support.

None, Conflict of Interest. NoneDOI. 10.4103/indianjpsychiatry.indianjpsychiatry_1362_2Abstract Background.

The burden of mental illness among the scheduled tribe (ST) population in India is not known clearly.Aim. The aim was to identify and appraise mental health research studies on ST population in India and collate such data to inform future research.Materials and Methods. Studies published between January 1980 and December 2018 on STs by following exclusion and inclusion criteria were selected for analysis.

PubMed, PsychINFO, Embase, Sociofile, Cinhal, and Google Scholar were systematically searched to identify relevant studies. Quality of the included studies was assessed using an appraisal tool to assess the quality of cross-sectional studies and Critical Appraisal Checklist developed by Critical Appraisal Skills Programme. Studies were summarized and reported descriptively.Results.

Thirty-two relevant studies were found and included in the review. Studies were categorized into the following three thematic areas. Alcohol and substance use disorders, common mental disorders and sociocultural aspects, and access to mental health-care services.

Sociocultural factors play a major role in understanding and determining mental disorders.Conclusion. This study is the first of its kind to review research on mental health among the STs. Mental health research conducted among STs in India is limited and is mostly of low-to-moderate quality.

Determinants of poor mental health and interventions for addressing them need to be studied on an urgent basis.Keywords. India, mental health, scheduled tribesHow to cite this article:Devarapalli S V, Kallakuri S, Salam A, Maulik PK. Mental health research on scheduled tribes in India.

Indian J Psychiatry 2020;62:617-30 Introduction Mental health is a highly neglected area particularly in low and middle-income countries (LMIC). Data from community-based studies showed that about 10% of people suffer from common mental disorders (CMDs) such as depression, anxiety, and somatic complaints.[1] A systematic review of epidemiological studies between 1960 and 2009 in India reported that about 20% of the adult population in the community are affected by psychiatric disorders in the community, ranging from 9.5 to 103/1000 population, with differences in case definitions, and methods of data collection, accounting for most of the variation in estimates.[2]The scheduled tribes (ST) population is a marginalized community and live in relative social isolation with poorer health indices compared to similar nontribal populations.[3] There are an estimated 90 million STs or Adivasis in India.[4] They constitute 8.6% of the total Indian population. The distribution varies across the states and union territories of India, with the highest percentage in Lakshadweep (94.8%) followed by Mizoram (94.4%).

In northeastern states, they constitute 65% or more of the total population.[5] The ST communities are identified as culturally or ethnographically unique by the Indian Constitution. They are populations with poorer health indicators and fewer health-care facilities compared to non-ST rural populations, even when within the same state, and often live in demarcated geographical areas known as ST areas.[4]As per the National Family Health Survey, 2015–2016, the health indicators such as infant mortality rate (IMR) is 44.4, under five mortality rate (U5MR) is 57.2, and anemia in women is 59.8 for STs – one of the most disadvantaged socioeconomic groups in India, which are worse compared to other populations where IMR is 40.7, U5MR is 49.7, and anemia in women among others is 53.0 in the same areas.[6] Little research is available on the health of ST population. Tribal mental health is an ignored and neglected area in the field of health-care services.

Further, little data are available about the burden of mental disorders among the tribal communities. Health research on tribal populations is poor, globally.[7] Irrespective of the data available, it is clear that they have worse health indicators and less access to health facilities.[8] Even less is known about the burden of mental disorders in ST population. It is also found that the traditional livelihood system of the STs came into conflict with the forces of modernization, resulting not only in the loss of customary rights over the livelihood resources but also in subordination and further, developing low self-esteem, causing great psychological stress.[4] This community has poor health infrastructure and even less mental health resources, and the situation is worse when compared to other communities living in similar areas.[9],[10]Only 15%–25% of those affected with mental disorders in LMICs receive any treatment for their mental illness,[11] resulting in a large “treatment gap.”[12] Treatment gaps are more in rural populations,[13] especially in ST communities in India, which have particularly poor infrastructure and resources for health-care delivery in general, and almost no capacity for providing mental health care.[14]The aim of this systematic review was to explore the extent and nature of mental health research on ST population in India and to identify gaps and inform future research.

Materials and Methods Search strategyWe searched major databases (PubMed, PsychINFO, Embase, Sociofile, Cinhal, and Google Scholar) and made hand searches from January 1980 to December 2018 to identify relevant literature. Hand search refers to searching through medical journals which are not indexed in the major electronic databases such as Embase, for instance, searching for Indian journals in IndMed database as most of these journals are not available in major databases. Physical search refers to searching the journals that were not available online or were not available online during the study years.

We used relevant Medical Subject Heading and key terms in our search strategy, as follows. €œMental health,” “Mental disorders,” “Mental illness,” “Psychiatry,” “Scheduled Tribe” OR “Tribe” OR “Tribal Population” OR “Indigenous population,” “India,” “Psych*” (Psychiatric, psychological, psychosis).Inclusion criteriaStudies published between January 1980 and December 2018 were included. Studies on mental disorders were included only when they focused on ST population.

Both qualitative and quantitative studies on mental disorders of ST population only were included in the analysis.Exclusion criteriaStudies without any primary data and which are merely overviews and commentaries and those not focused on ST population were excluded from the analysis.Data management and analysisTwo researchers (SD and SK) initially screened the title and abstract of each record to identify relevant papers and subsequently screened full text of those relevant papers. Any disagreements between the researchers were resolved by discussion or by consulting with an adjudicator (PKM). From each study, data were extracted on objectives, study design, study population, study duration, interventions (if applicable), outcomes, and results.

Quality of the included studies was assessed, independently by three researchers (SD, SK, and AS), using Critical Appraisal Checklist developed by Critical Appraisal Skills Programme (CASP).[15] After a thorough qualitative assessment, all quantitative data were generated and tabulated. A narrative description of the studies is provided in [Table 1] using some broad categories. Results Search resultsOur search retrieved 2306 records (which included hand-searched articles), of which after removing duplicates, title and abstracts of 2278 records were screened.

Of these, 178 studies were deemed as potentially relevant and were reviewed in detail. Finally, we excluded 146 irrelevant studies and 32 studies were included in the review [Figure 1].Quality of the included studiesSummary of quality assessment of the included studies is reported in [Table 2]. Overall, nine studies were of poor quality, twenty were of moderate quality, and three studies were of high quality.

The CASP shows that out of the 32 studies, the sample size of 21 studies was not representative, sample size of 7 studies was not justified, risk factors were not identified in 28 studies, methods used were not sufficiently described to repeat them in 24 studies, and nonresponse reasons were not addressed in 24 studies. The most common reasons for studies to be of poor-quality included sample size not justified. Sample is not representative.

Nonresponse not addressed. Risk factors not measured correctly. And methods used were not sufficiently described to repeat them.

Studies under the moderate quality did not have a representative sample. Non-responders categories was not addressed. Risk factors were not measured correctly.

And methods used were not sufficiently described to allow the study to be replicated by other researchers.The included studies covered three broad categories. Alcohol and substance use disorders, CMD (depression, anxiety, stress, and suicide risk), socio-cultural aspects, and access to mental health services.Alcohol and substance use disordersFive studies reviewed the consumption of alcohol and opioid. In an ethnographic study conducted in three western districts in Rajasthan, 200 opium users were interviewed.

Opium consumption was common among both younger and older males during nonharvest seasons. The common causes for using opium were relief of anxiety related to crop failure due to drought, stress, to get a high, be part of peers, and for increased sexual performance.[16]In a study conducted in Arunachal Pradesh involving a population of more than 5000 individuals, alcohol use was present in 30% and opium use in about 5% adults.[17] Contrary to that study, in Rajasthan, the prevalence of opium use was more in women and socioeconomic factors such as occupation, education, and marital status were associated with opium use.[16] The prevalence of opium use increased with age in both sexes, decreased with increasing education level, and increased with employment. It was observed that wages were used to buy opium.

In the entire region of Chamlang district of Arunachal Pradesh, female substance users were almost half of the males among ST population.[17] Types of substance used were tobacco, alcohol, and opium. Among tobacco users, oral tobacco use was higher than smoking. The prevalence of tobacco use was higher among males, but the prevalence of alcohol use was higher in females, probably due to increased access to homemade rice brew generally prepared by women.

This study is unique in terms of finding a strong association with religion and culture with substance use.[18]Alcohol consumption among Paniyas of Wayanad district in Kerala is perceived as a male activity, with many younger people consuming it than earlier. A study concluded that alcohol consumption among them was less of a “choice” than a result of their conditions operating through different mechanisms. In the past, drinking was traditionally common among elderly males, however the consumption pattern has changed as a significant number of younger men are now drinking.

Drinking was clustered within families as fathers and sons drank together. Alcohol is easily accessible as government itself provides opportunities. Some employers would provide alcohol as an incentive to attract Paniya men to work for them.[19]In a study from Jharkhand, several ST community members cited reasons associated with social enhancement and coping with distressing emotions rather than individual enhancement, as a reason for consuming alcohol.

Societal acceptance of drinking alcohol and peer pressure, as well as high emotional problems, appeared to be the major etiology leading to higher prevalence of substance dependence in tribal communities.[20] Another study found high life time alcohol use prevalence, and the reasons mentioned were increased poverty, illiteracy, increased stress, and peer pressure.[21] A household survey from Chamlang district of Arunachal Pradesh revealed that there was a strong association between opium use and age, occupation, marital status, religion, and ethnicity among both the sexes of STs, particularly among Singhpho and Khamti.[15] The average age of onset of tobacco use was found to be 16.4 years for smoked and 17.5 years for smokeless forms in one study.[22]Common mental disorders and socio-cultural aspectsSuicide was more common among Idu Mishmi in Roing and Anini districts of Arunachal Pradesh state (14.2%) compared to the urban population in general (0.4%–4.2%). Suicides were associated with depression, anxiety, alcoholism, and eating disorders. Of all the factors, depression was significantly high in people who attempted suicide.[24] About 5% out of 5007 people from thirty villages comprising ST suffered from CMDs in a study from West Godavari district in rural Andhra Pradesh.

CMDs were defined as moderate/severe depression and/or anxiety, stress, and increased suicidal risk. Women had a higher prevalence of depression, but this may be due to the cultural norms, as men are less likely to express symptoms of depression or anxiety, which leads to underreporting. Marital status, education, and age were prominently associated with CMD.[14] In another study, gender, illiteracy, infant mortality in the household, having <3 adults living in the household, large family size with >four children, morbidity, and having two or more life events in the last year were associated with increased prevalence of CMD.[24] Urban and rural ST from the same community of Bhutias of Sikkim were examined, and it was found that the urban population experienced higher perceived stress compared to their rural counterparts.[25] Age, current use of alcohol, poor educational status, marital status, social groups, and comorbidities were the main determinants of tobacco use and nicotine dependence in a study from the Andaman and Nicobar Islands.[22] A study conducted among adolescents in the schools of rural areas of Ranchi district in Jharkhand revealed that about 5% children from the ST communities had emotional symptoms, 9.6% children had conduct problems, 4.2% had hyperactivity, and 1.4% had significant peer problems.[27] A study conducted among the female school teachers in Jharkhand examined the effects of stress, marital status, and ethnicity upon the mental health of school teachers.

The study found that among the three factors namely stress, marital status, and ethnicity, ethnicity was found to affect mental health of the school teachers most. It found a positive relationship between mental health and socioeconomic status, with an inverse relationship showing that as income increased, the prevalence of depression decreased.[28] A study among Ao-Nagas in Nagaland found that 74.6% of the population attributed mental health problems to psycho-social factors and a considerable proportion chose a psychiatrist or psychologist to overcome the problem. However, 15.4% attributed mental disorders to evil spirits.

About 47% preferred to seek treatment with a psychiatrist and 25% preferred prayers. Nearly 10.6% wanted to seek the help of both the psychiatrist and prayer group and 4.4% preferred traditional healers.[28],[29] The prevalence of Down syndrome among the ST in Chikhalia in Barwani district of Madhya Pradesh was higher than that reported in overall India. Three-fourth of the children were the first-born child.

None of the parents of children with Down syndrome had consanguineous marriage or a history of Down syndrome, intellectual disability, or any other neurological disorder such as cerebral palsy and epilepsy in preceding generations. It is known that tribal population is highly impoverished and disadvantaged in several ways and suffer proportionately higher burden of nutritional and genetic disorders, which are potential factors for Down syndrome.[30]Access to mental health-care servicesIn a study in Ranchi district of Jharkhand, it was found that most people consulted faith healers rather than qualified medical practitioners. There are few mental health services in the regions.[31] Among ST population, there was less reliance and belief in modern medicine, and it was also not easily accessible, thus the health-care systems must be more holistic and take care of cultural and local health practices.[32]The Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health project was implemented in thirty ST villages in West Godavari District of Andhra Pradesh.

The key objectives were to use task sharing, training of primary health workers, implementing evidence-based clinical decision support tools on a mobile platform, and providing mental health services to rural population. The study included 238 adults suffering from CMD. During the intervention period, 12.6% visited the primary health-care doctors compared to only 0.8% who had sought any care for their mental disorders prior to the intervention.

The study also found a significant reduction in the depression and anxiety scores at the end of intervention and improvements in stigma perceptions related to mental health.[14] A study in Gudalur and Pandalur Taluks of Nilgiri district from Tamil Nadu used low cost task shifting by providing community education and identifying and referring individuals with psychiatric problems as effective strategies for treating mental disorders in ST communities. Through the program, the health workers established a network within the village, which in turn helped the patients to interact with them freely. Consenting patients volunteered at the educational sessions to discuss their experience about the effectiveness of their treatment.

Community awareness programs altered knowledge and attitudes toward mental illness in the community.[33] A study in Nilgiri district, Tamil Nadu, found that the community had been taking responsibility of the patients with the system by providing treatment closer to home without people having to travel long distances to access care. Expenses were reduced by subsidizing the costs of medicine and ensuring free hospital admissions and referrals to the people.[34] A study on the impact of gender, socioeconomic status, and age on mental health of female factory workers in Jharkhand found that the ST women were more likely to face stress and hardship in life due to diverse economic and household responsibilities, which, in turn, severely affected their mental health.[35] Prevalence of mental health morbidity in a study from the Sunderbans delta found a positive relation with psycho-social stressors and poor quality of life. The health system in that remote area was largely managed by “quack doctors” and faith healers.

Poverty, illiteracy, and detachment from the larger community helped reinforce superstitious beliefs and made them seek both mental and physical health care from faith healers.[36] In a study among students, it was found that children had difficulties in adjusting to both ethnic and mainstream culture.[27] Low family income, inadequate housing, poor sanitation, and unhealthy and unhygienic living conditions were some environmental factors contributing to poor physical and mental growth of children. It was observed that children who did not have such risk factors maintained more intimate relations with the family members. Children belonging to the disadvantaged environment expressed their verbal, emotional need, blame, and harm avoidances more freely than their counterparts belonging to less disadvantaged backgrounds.

Although disadvantaged children had poor interfamilial interaction, they had better relations with the members outside family, such as peers, friends, and neighbors.[37] Another study in Jharkhand found that epilepsy was higher among ST patients compared to non-ST patients.[31] Most patients among the ST are irregular and dropout rates are higher among them than the non-ST patients. Urbanization per se exerted no adverse influence on the mental health of a tribal community, provided it allowed preservation of ethnic and cultural practices. Women in the ST communities were less vulnerable to mental illness than men.

This might be a reflection of their increased responsibilities and enhanced gender roles that are characteristic of women in many ST communities.[38] Data obtained using culturally relevant scales revealed that relocated Sahariya suffer a lot of mental health problems, which are partially explained by livelihood and poverty-related factors. The loss of homes and displacement compromise mental health, especially the positive emotional well-being related to happiness, life satisfaction, optimism for future, and spiritual contentment. These are often not overcome even with good relocation programs focused on material compensation and livelihood re-establishment.[39] Discussion This systematic review is to our knowledge the first on mental health of ST population in India.

Few studies on the mental health of ST were available. All attempts including hand searching were made to recover both published peer-reviewed papers and reports available on the website. Though we searched gray literature, it may be possible that it does not capture all articles.

Given the heterogeneity of the papers, it was not possible to do a meta-analysis, so a narrative review was done.The quality of the studies was assessed by CASP. The assessment shows that the research conducted on mental health of STs needs to be carried out more effectively. The above mentioned gaps need to be filled in future research by considering the resources effectively while conducting the studies.

Mental and substance use disorders contribute majorly to the health disparities. To address this, one needs to deliver evidence-based treatments, but it is important to understand how far these interventions for the indigenous populations can incorporate cultural practices, which are essential for the development of mental health services.[30] Evidence has shown a disproportionate burden of suicide among indigenous populations in national and regional studies, and a global and systematic investigation of this topic has not been undertaken to date. Previous reviews of suicide epidemiology among indigenous populations have tended to be less comprehensive or not systematic, and have often focused on subpopulations such as youth, high-income countries, or regions such as Oceania or the Arctic.[46] The only studies in our review which provided data on suicide were in Idu Mishmi, an isolated tribal population of North-East India, and tribal communities from Sunderban delta.[24],[37] Some reasons for suicide in these populations could be the poor identification of existing mental disorders, increased alcohol use, extreme poverty leading to increased debt and hopelessness, and lack of stable employment opportunities.[24],[37] The traditional consumption pattern of alcohol has changed due to the reasons associated with social enhancement and coping with distressing emotions rather than individual enhancement.[19],[20]Faith healers play a dominant role in treating mental disorders.

There is less awareness about mental health and available mental health services and even if such knowledge is available, access is limited due to remoteness of many of these villages, and often it involves high out-of-pocket expenditure.[35] Practitioners of modern medicine can play a vital role in not only increasing awareness about mental health in the community, but also engaging with faith healers and traditional medicine practitioners to help increase their capacity to identify and manage CMDs that do not need medications and can be managed through simple “talk therapy.” Knowledge on symptoms of severe mental disorders can also help such faith healers and traditional medicine practitioners to refer cases to primary care doctors or mental health professionals.Remote settlements make it difficult for ST communities to seek mental health care. Access needs to be increased by using solutions that use training of primary health workers and nonphysician health workers, task sharing, and technology-enabled clinical decision support tools.[3] The SMART Mental Health project was delivered in the tribal areas of Andhra Pradesh using those principles and was found to be beneficial by all stakeholders.[14]Given the lack of knowledge about mental health problems among these communities, the government and nongovernmental organizations should collect and disseminate data on mental disorders among the ST communities. More research funding needs to be provided and key stakeholders should be involved in creating awareness both in the community and among policy makers to develop more projects for ST communities around mental health.

Two recent meetings on tribal mental health – Round Table Meeting on Mental Health of ST Populations organized by the George Institute for Global Health, India, in 2017,[51] and the First National Conference on Tribal Mental Health organized by the Indian Psychiatric Society in Bhubaneswar in 2018 – have identified some key areas of research priority for mental health in ST communities. A national-level policy on mental health of tribal communities or population is advocated which should be developed in consultation with key stakeholders. The Indian Psychiatric Society can play a role in coordinating research activities with support of the government which can ensure regular monitoring and dissemination of the research impact to the tribal communities.

There is a need to understand how mental health symptoms are perceived in different ST communities and investigate the healing practices associated with distress/disaster/death/loss/disease. This could be done in the form of cross-sectional or cohort studies to generate proper evidence which could also include the information on prevalence, mental health morbidity, and any specific patterns associated with a specific disorder. Future research should estimate the prevalence of mental disorders in different age groups and gender, risk factors, and the influence of modernization.

Studies should develop a theoretical model to understand mental disorders and promote positive mental health within ST communities. Studies should also look at different ST communities as cultural differences exist across them, and there are also differences in socioeconomic status which impact on ability to access care.Research has shown that the impact and the benefits are amplified when research is driven by priorities that are identified by indigenous communities and involve their active participation. Their knowledge and perspectives are incorporated in processes and findings.

Reporting of findings is meaningful to the communities. And indigenous groups and other key stakeholders are engaged from the outset.[47] Future research in India on ST communities should also adhere to these broad principles to ensure relevant and beneficial research, which have direct impact on the mental health of the ST communities.There is also a need to update literature related to mental health of ST population continuously. Develop culturally appropriate validated instruments to measure mental morbidity relevant to ST population.

And use qualitative research to investigate the perceptions and barriers for help-seeking behavior.[48] Conclusion The current review helps not only to collate the existing literature on the mental health of ST communities but also identify gaps in knowledge and provide some indications about the type of research that should be funded in future.Financial support and sponsorshipNil.Conflicts of interestThere are no conflicts of interest. References 1.Gururaj G, Girish N, Isaac MK. Mental.

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Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 2004;291:2581-90. 9.Ministry of Health and Family Welfare, Government of India and Ministry of Tribal Affairs, Report of the Expert Committee on Tribal Health.

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A pre-post evaluation of the SMART Mental Health project in rural India. J Global Health 2017;7:1-13. 15.16.Ganguly KK, Sharma HK, Krishnamachari KA.

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18.Chaturvedi HK, Mahanta J, Bajpai RC, Pandey A. Correlates of opium use. Retrospective analysis of a survey of tribal communities in Arunachal Pradesh, India.

BMC Public Health 2013;13:325. 19.Mohindra KS, Narayana D, Anushreedha SS, Haddad S. Alcohol use and its consequences in South India.

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Reasons for substance use. A comparative study of alcohol use in tribals and non-tribals. Indian J Psychol Med 2012;34:242-6.

[PUBMED] [Full text] 21.Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global burden of disease attributable to mental and substance use disorders. Findings from the Global Burden of Disease Study 2010.

Lancet 2013;382:1575-86. 22.Janakiram C, Joseph J, Vasudevan S, Taha F, DeepanKumar CV, Venkitachalam R. Prevalence and dependancy of tobacco use in an indigenous population of Kerala, India.

Oral Hygiene and Health 2016;4:1 23.Manimunda SP, Benegal V, Sugunan AP, Jeemon P, Balakrishna N, Thennarusu K, et al. Tobacco use and nicotine dependency in a cross-sectional representative sample of 18,018 individuals in Andaman and Nicobar Islands, India. BMC Public Health 2012;12:515.

24.Singh PK, Singh RK, Biswas A, Rao VR. High rate of suicide attempt and associated psychological traits in an isolated tribal population of North-East India. J Affect Dis 2013;151:673-8.

25.Sushila J. Perception of Illness and Health Care among Bhils. A Study of Udaipur District in Southern Rajasthan.

2005. 26.Sobhanjan S, Mukhopadhyay B. Perceived psychosocial stress and cardiovascular risk.

Observations among the Bhutias of Sikkim, India. Stress Health 2008;24:23-34. 27.Ali A, Eqbal S.

Mental Health status of tribal school going adolescents. A study from rural community of Ranchi, Jharkhand. Telangana J Psychiatry 2016;2:38-41.

28.Diwan R. Stress and mental health of tribal and non tribal female school teachers in Jharkhand, India. Int J Sci Res Publicat 2012;2:2250-3153.

29.Longkumer I, Borooah PI. Knowledge about attitudes toward mental disorders among Nagas in North East India. IOSR J Humanities Soc Sci 2013;15:41-7.

30.Lakhan R, Kishore MT. Down syndrome in tribal population in India. A field observation.

J Neurosci Rural Pract 2016;7:40-3. [PUBMED] [Full text] 31.Nizamie HS, Akhtar S, Banerjee S, Goyal N. Health care delivery model in epilepsy to reduce treatment gap.

WHO study from a rural tribal population of India. Epilepsy Res Elsevier 2009;84:146-52. 32.Prabhakar H, Manoharan R.

The Tribal Health Initiative model for healthcare delivery. A clinical and epidemiological approach. Natl Med J India 2005;18:197-204.

33.Nimgaonkar AU, Menon SD. A task shifting mental health program for an impoverished rural Indian community. Asian J Psychiatr 2015;16:41-7.

34.Yalsangi M. Evaluation of a Community Mental Health Programme in a Tribal Area- South India. Achutha Menon Centre For Health Sciences Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Working Paper No 12.

2012. 35.Tripathy P, Nirmala N, Sarah B, Rajendra M, Josephine B, Shibanand R, et al. Effect of a participatory intervention with women's groups on birth outcomes and maternal depression in Jharkhand and Orissa, India.

A cluster-randomised controlled trial. Lancet 2010;375:1182-92. 36.Aparajita C, Anita KM, Arundhati R, Chetana P.

Assessing Social-support network among the socio culturally disadvantaged children in India. Early Child Develop Care 1996;121:37-47. 37.Chowdhury AN, Mondal R, Brahma A, Biswas MK.

Eco-psychiatry and environmental conservation. Study from Sundarban Delta, India. Environ Health Insights 2008;2:61-76.

38.Jeffery GS, Chakrapani U. Eco-psychiatry and Environmental Conservation. Study from Sundarban Delta, India.

Working Paper- Research Gate.net. September, 2016. 39.Ozer S, Acculturation, adaptation, and mental health among Ladakhi College Students a mixed methods study of an indigenous population.

J Cross Cultl Psychol 2015;46:435-53. 40.Giri DK, Chaudhary S, Govinda M, Banerjee A, Mahto AK, Chakravorty PK. Utilization of psychiatric services by tribal population of Jharkhand through community outreach programme of RINPAS.

Eastern J Psychiatry 2007;10:25-9. 41.Nandi DN, Banerjee G, Chowdhury AN, Banerjee T, Boral GC, Sen B. Urbanization and mental morbidity in certain tribal communities in West Bengal.

Indian J Psychiatry 1992;34:334-9. [PUBMED] [Full text] 42.Hackett RJ, Sagdeo D, Creed FH. The physical and social associations of common mental disorder in a tribal population in South India.

Soc Psychiatry Psychiatr Epidemiol 2007;42:712-5. 43.Raina SK, Raina S, Chander V, Grover A, Singh S, Bhardwaj A. Development of a cognitive screening instrument for tribal elderly population of Himalayan region in northern India.

J Neurosci Rural Pract 2013;4:147-53. [PUBMED] [Full text] 44.Raina SK, Raina S, Chander V, Grover A, Singh S, Bhardwaj A. Identifying risk for dementia across populations.

A study on the prevalence of dementia in tribal elderly population of Himalayan region in Northern India. Ann Indian Acad Neurol 2013;16:640-4. [PUBMED] [Full text] 45.Raina SK, Chander V, Raina S, Kumar D.

Feasibility of using everyday abilities scale of India as alternative to mental state examination as a screen in two-phase survey estimating the prevalence of dementia in largely illiterate Indian population. Indian J Psychiatry 2016;58:459-61. [PUBMED] [Full text] 46.Diwan R.

Mental health of tribal male-female factory workers in Jharkhand. IJAIR 2012;2278:234-42. 47.Banerjee T, Mukherjee SP, Nandi DN, Banerjee G, Mukherjee A, Sen B, et al.

Psychiatric morbidity in an urbanized tribal (Santal) community - A field survey. Indian J Psychiatry 1986;28:243-8. [PUBMED] [Full text] 48.Leske S, Harris MG, Charlson FJ, Ferrari AJ, Baxter AJ, Logan JM, et al.

Systematic review of interventions for Indigenous adults with mental and substance use disorders in Australia, Canada, New Zealand and the United States. Aust N Z J Psychiatry 2016;50:1040-54. 49.Pollock NJ, Naicker K, Loro A, Mulay S, Colman I.

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50.Silburn K, et al. Evaluation of the Cooperative Research Centre for Aboriginal Health (Australian institute for primary care, trans.). Melbourne.

Correspondence Address:S V. Siddhardh Kumar DevarapalliGeorge Institute for Global Health, Plot No. 57, Second Floor, Corporation Bank Building, Nagarjuna Circle, Punjagutta, Hyderabad - 500 082, Telangana IndiaSource of Support.

None, Conflict of Interest. NoneDOI. 10.4103/psychiatry.IndianJPsychiatry_136_19 Figures [Figure 1] Tables [Table 1], [Table 2].

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Anti-microbial substances online viagra prescription may kill or inhibit the growth of microorganisms. Some examples of anti-microbial substances include, but are not limited to. Silver copper Nanoform Graphene fabric coatings saltTo date, Health Canada has not received any data that support the safety and effectiveness of these substances when used with masks or face coverings.

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Limitations to the claimsBacterial Fiation Efficiency (BFE) is a measurement of a medical mask material's resistance to online viagra prescription penetration of aerosolized droplets of a culture suspension of Staphylococcus aureus (3.0 um or 3000 nm in size). Results are reported as percent efficiency and correlate with the ability of the fabric to resist bacterial penetration. Higher BFE percentages in this test indicate better barrier efficiency.

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If it is claimed that the mask online viagra prescription can be washed, then instructions for washing should be provided. In addition, evidence must be provided that the performance claims made (for example, in 6 and 9 above) are maintained after a proposed maximum number of wash cycles as indicated in the device labelling. International activityThe U.S.

Food and Drug Administration regulates face coverings with anti-microbial claims as medical devices.Self-sanitizing claims are detergent claims that are overseen by the Pest Management Regulatory Agency in Canada and the Environmental Protection Agency in the United States. Related links Glossary of terms Face coverings (also known as non-medical masks) online viagra prescription. Source control masks (to help control an infected wearer from transmitting the viagra to others) that are made from a variety of woven fabrics.

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The fabrics and/or materials used in face coverings are not the same as the ones used in medical masks or respirators. Medical device online viagra prescription. A device within the meaning of the Food and Drugs Act, but does not include any device that is intended for use in relation to animals.

Medical masks. Includes surgical, procedural, isolation and other control devices intended to offer protection online viagra prescription to the wearer. They are designed with 3-4 layers of non-woven materials and meet labelled fiation levels (≥ 95%) using recognized standards.

Personal protective equipment (PPE). Personal protective equipment consists of gowns, gloves, masks, facial protection (masks and eye protection, face shields or masks with online viagra prescription visor attachment) or respirators. They can be used by health care workers to provide a barrier that will prevent potential exposure to infectious microorganisms.

Respirator. A device that is tested and online viagra prescription certified by procedures established by testing and certification agencies recognized by the authority having jurisdiction and is used to protect the user from inhaling a hazardous atmosphere. The most common respirator used in health care is a N95 half-face piece filtering respirator.

It's a personal protective device that fits tightly around the nose and mouth of the wearer. It's used online viagra prescription to reduce the risk of inhaling hazardous airborne particles and aerosols, including dust particles and infectious agents.From. Health CanadaDate published.

2021-04-07 Health Canada regulates health products, such as drugs and medical devices. We also regulate consumer and commercial products and substances, such as online viagra prescription cosmetics, pesticides, tobacco, cannabis and controlled substances. As part of our regulatory activities, we conduct inspections to mitigate risks and protect the health and safety of Canadians.

Learn more about what Health Canada does as a regulator. During the erectile dysfunction treatment viagra, we continue to take a online viagra prescription risk-based approach to inspections. Onsite work remains a key tool in helping us fulfill our mandate to deliver essential inspection activities.

Health Canada uses remote or virtual tools to complement onsite inspection activities. We're using these tools, where appropriate and without compromising the ability to verify and online viagra prescription assess compliance, for all of the products and substances that we regulate. When onsite activities are conducted, Health Canada is implementing appropriate erectile dysfunction treatment mitigation measures in adherence with public health guidance.

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These treatments aren’t perfect — according to the CDC, each yearly flu treatment bounces between about 20 and 60 percent efficacy. Even though the viagra stories injections don’t guarantee protection for everyone, they will work for some and can help rule out the possibility that any sniffles or body aches you develop stem from the flu.Speaking of those all-too-familiar aches and pains. If you develop any respiratory symptoms, a fever, headaches or gastrointestinal issues that are out of the ordinary, isolate yourself.

Stay home from work, skip social gatherings, and if there are any high-risk people in your home — individuals with diabetes, for example — keep to yourself if possible, says Sankar Swaminathan, chief of the infectious diseases division at University of Utah Health.“It would be hard for me, with most people, to get at whether they have the flu or erectile dysfunction treatment because the symptoms overlap to such a degree,” he adds. For the most part, viagra stories only a test can parse whether or not you have the flu, a cold or erectile dysfunction treatment. So until you’re able to talk to a medical professional or get results back from the lab, it’s best to take precautions and behave as if you have a erectile dysfunction treatment diagnosis.

Remember that viagra stories symptoms that look like a cold might actually be erectile dysfunction treatment related. Colds will still be circulating among people during the fall and winter, and already Maragakis has heard from patients who chalked their runny nose and sore throat up as a typical cold. To combat those kinds of assumptions, “we’re asking people to have a high index of suspicion,” she says.Since the best way to diagnose someone is to examine which (if any) viagra is living in their body, erectile dysfunction testing needs to be widespread, accessible and fast.

Right now, however, a majority of states fall viagra stories short of daily testing goals. Recent surveys suggest that about 63 percent of people tested wait longer than one to two days for results, even though that is the ideal turnaround window for contact tracing. The shortfall viagra stories may stem from national coordination issues.

"As far as I have seen, it's not a lack of willingness to provide more tests — it comes down to ability," says Maragakis. Faltering supply chains mean the essential tools needed to test and test fast are in short supply. "In my opinion, viagra stories we need a much more coordinated national response to testing in order to solve those problems." What A Test Can Doerectile dysfunction tests do more than deliver peace of mind if, say, you feel congested and learn that it’s a regular cold.

The results inform public health officials about the spread and containment of erectile dysfunction treatment and help determine what kind of care you get.For example, many people getting a erectile dysfunction test will also get an influenza test (possibly with a new two-in-one technology). If someone has viagra stories the regular flu, there are approved medications to fight off the they can take. In past flu seasons, healthcare practitioners administered influenza tests but often treated the individual as if they had the before getting results, Swaminathan says.

The odds of their illness being the flu are high enough to make that a reasonable choice. With much viagra stories more uncertainty this year about what someone might have and what treatments could help them, the prescribe-before-results habit will likely be much less common. The prospects of not knowing what kind of illness you might have, or waiting a long time for official lab results, might sound gloomy.

But there is a viagra stories bright side. It's possible that our erectile dysfunction treatment mitigation tactics, like wearing masks, social distancing and avoiding large gatherings, could reduce influenza spread as well. This scenario likely played out in the Southern Hemisphere earlier this year.

That half of the globe sees an influenza season during the Northern viagra stories Hemisphere's spring and summer, and many countries reported very low non-erectile dysfunction treatment diagnoses. To keep influenza and erectile dysfunction treatment cases low — and to keep you from playing the symptomatic guessing game with yourself — stick with those preventative health measures for the foreseeable future. "It’s not going to last forever," says Swaminathan, "but we have to be patient and we have to be vigilant.".

A potentially online viagra prescription dicey phase of http://research.ukactive.com/password-reset/ the viagra is almost here. Flu season. The yearly online viagra prescription influx of s will soon coincide with erectile dysfunction in the Northern Hemisphere. Normally, healthcare practitioners that see patients with flu-like symptoms in late fall, winter and early spring assume the individual has influenza and treat them accordingly.

This year is different. “Going into respiratory viagra season, we’re going to online viagra prescription have a much harder time knowing what is the cause of a person’s symptoms,” says Lisa Maragakis, the senior director of prevention at the Johns Hopkins Health System.Even with the potential for uncertainty, there are still some practices that physicians recommend everyone follows as the double-whammy draws near — especially if you start to develop symptoms.Take PrecautionsFor starters, get your flu shot, says Maragakis. These treatments aren’t perfect — according to the CDC, each yearly flu treatment bounces between about 20 and 60 percent efficacy. Even though the injections don’t guarantee protection for everyone, they will work for some and can help rule out the possibility that any sniffles or body aches you develop stem online viagra prescription from the flu.Speaking of those all-too-familiar aches and pains.

If you develop any respiratory symptoms, a fever, headaches or gastrointestinal issues that are out of the ordinary, isolate yourself. Stay home from work, skip social gatherings, and if there are any high-risk people in your home — individuals with diabetes, for example — keep to yourself if possible, says Sankar Swaminathan, chief of the infectious diseases division at University of Utah Health.“It would be hard for me, with most people, to get at whether they have the flu or erectile dysfunction treatment because the symptoms overlap to such a degree,” he adds. For the online viagra prescription most part, only a test can parse whether or not you have the flu, a cold or erectile dysfunction treatment. So until you’re able to talk to a medical professional or get results back from the lab, it’s best to take precautions and behave as if you have a erectile dysfunction treatment diagnosis.

Remember that symptoms that look like online viagra prescription a cold might actually be erectile dysfunction treatment related. Colds will still be circulating among people during the fall and winter, and already Maragakis has heard from patients who chalked their runny nose and sore throat up as a typical cold. To combat those kinds of assumptions, “we’re asking people to have a high index of suspicion,” she says.Since the best way to diagnose someone is to examine which (if any) viagra is living in their body, erectile dysfunction testing needs to be widespread, accessible and fast. Right now, however, a majority of online viagra prescription states fall short of daily testing goals.

Recent surveys suggest that about 63 percent of people tested wait longer than one to two days for results, even though that is the ideal viagra online turnaround window for contact tracing. The shortfall may stem from national coordination online viagra prescription issues. "As far as I have seen, it's not a lack of willingness to provide more tests — it comes down to ability," says Maragakis. Faltering supply chains mean the essential tools needed to test and test fast are in short supply.

"In my opinion, we need a much more coordinated national response to testing in order to solve those problems." What A Test Can Doerectile dysfunction tests do more than deliver online viagra prescription peace of mind if, say, you feel congested and learn that it’s a regular cold. The results inform public health officials about the spread and containment of erectile dysfunction treatment and help determine what kind of care you get.For example, many people getting a erectile dysfunction test will also get an influenza test (possibly with a new two-in-one technology). If someone has the regular flu, there are approved medications to fight off the they can online viagra prescription take. In past flu seasons, healthcare practitioners administered influenza tests but often treated the individual as if they had the before getting results, Swaminathan says.

The odds of their illness being the flu are high enough to make that a reasonable choice. With much more uncertainty this year about what someone might have and what online viagra prescription treatments could help them, the prescribe-before-results habit will likely be much less common. The prospects of not knowing what kind of illness you might have, or waiting a long time for official lab results, might sound gloomy. But there is a bright side online viagra prescription.

It's possible that our erectile dysfunction treatment mitigation tactics, like wearing masks, social distancing and avoiding large gatherings, could reduce influenza spread as well. This scenario likely played out in the Southern Hemisphere earlier this year. That half of the globe sees an influenza season during the Northern Hemisphere's spring and summer, and many countries reported very online viagra prescription low non-erectile dysfunction treatment diagnoses. To keep influenza and erectile dysfunction treatment cases low — and to keep you from playing the symptomatic guessing game with yourself — stick with those preventative health measures for the foreseeable future.

"It’s not going to last forever," says Swaminathan, "but we have to be patient and we have to be vigilant.".

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Shutterstock A donde venden viagra new report by site web Kaufman, Hall &. Associates, LLC has found that the erectile dysfunction treatment viagra will continue to affect the financial health of hospitals and health systems through 2021. The report released by the donde venden viagra American Hospital Association (AHA) Wednesday forecasts total hospital revenue in 2021 could be down by between $53 billion and $122 billion compared to pre-viagra levels. The financial pressure, the report said, could jeopardize hospital’s ability to care for their communities during the viagra, resulting in a slowdown in treatment distribution and administration, continued pressure on front-line caregivers, and diminished access to care. €œWhen we talk about the historic financial challenges hospitals face, it’s about more than dollars and cents, it’s really about making sure hospitals and health systems have the resources needed to provide essential services for their patients and communities,” AHA President donde venden viagra and CEO Rick Pollack said.

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Reps. David Kustoff (R-TN) and Abigail Spanberger (D-VA) re-introduced the Criminalizing Abused Substance Templates (CAST) Act Wednesday. The legislation would modify the Controlled Substances Act to define the criminal penalty for making counterfeit drugs donde venden viagra using a pill press. Currently, the law bans the practice but doesn’t define the penalty for doing so. The CAST Act would make possessing a pill press with donde venden viagra the intent to make counterfeit schedule I or II substances a crime and establish a sentence of up to 20 years for possession alone.

€œThe opioid epidemic has ravaged our communities in West Tennessee and across our nation. Unfortunately, as we donde venden viagra continue to battle erectile dysfunction treatment, the opioid crisis has only grown worse. We owe it to our loved ones to take stronger action to fight back against this public health emergency. The CAST Act is the much-needed, bold step forward in this fight,” Kustoff said. €œIt will increase penalties against possession of harmful drugs and pill press molds, helping to combat the illegal drug market and the dangers it presents to our citizens and our brave law enforcement officers across the nation.”The Congressmembers said the law would prevent overdoses donde venden viagra and reduce fentanyl-related deaths.

€œFamilies, businesses, and entire communities in Virginia continue to face immense challenges due to opioid abuse. As this public health crisis significantly worsens as donde venden viagra a result of the erectile dysfunction treatment viagra, we also face the threat of extremely dangerous substances — such as fentanyl — being pressed into illicit pills and sold on our streets,” said Spanberger. €œThis bill would help crackdown on the production of counterfeit drugs via illicit pill press molds. By deterring drug traffickers and those who produce illicit drugs, we would take another step in the fight against fentanyl-related deaths.”.

Shutterstock A new report by Kaufman, Hall online viagra prescription &. Associates, LLC has found that the erectile dysfunction treatment viagra will continue to affect the financial health of hospitals and health systems through 2021. The report released by the American Hospital Association (AHA) Wednesday forecasts total hospital revenue in 2021 could be down by between $53 billion and $122 billion compared to pre-viagra levels online viagra prescription. The financial pressure, the report said, could jeopardize hospital’s ability to care for their communities during the viagra, resulting in a slowdown in treatment distribution and administration, continued pressure on front-line caregivers, and diminished access to care.

€œWhen we talk about the historic financial challenges hospitals face, it’s about more than dollars and cents, it’s really about making sure hospitals and health systems have the resources online viagra prescription needed to provide essential services for their patients and communities,” AHA President and CEO Rick Pollack said. €œDuring the viagra, people have put off needed care, in some cases to the detriment of their health. In addition, the costs of labor and supplies have increased, adding to financial stress. treatments give us hope that the end is in sight, but hospitals need additional support to continue to provide access to care and to help get as many treatment shots into arms quickly.”If hospitals experience online viagra prescription a consistent and complete recovery of patient volumes, and treatment distribution and administration go smoothly, and the country continues to see a drop in erectile dysfunction treatment cases, hospitals and health systems would face $53 billion in total revenue losses this year.

However, if patient volumes recover slowly, treatment rollouts continue to face logistical challenges and delays, and the country sees more erectile dysfunction treatment surges, hospitals could face a total of $122 billion in lost revenue.In 2020, an AHA report found that hospitals and health systems lost at least $323.1 billion due to patient volume decreases and erectile dysfunction treatment. At least online viagra prescription four dozen hospitals entered bankruptcy or closed in 2020, according to Bloomberg.Shutterstock U.S. Reps. David Kustoff (R-TN) and Abigail Spanberger (D-VA) re-introduced the Criminalizing Abused Substance Templates (CAST) Act Wednesday.

The legislation would modify the Controlled Substances Act to define the criminal penalty for making counterfeit online viagra prescription drugs using a pill press. Currently, the law bans the practice but doesn’t define the penalty for doing so. The CAST Act would make possessing a pill press with the intent to make counterfeit schedule I or II substances a crime online viagra prescription and establish a sentence of up to 20 years for possession alone. €œThe opioid epidemic has ravaged our communities in West Tennessee and across our nation.

Unfortunately, as we continue to battle erectile dysfunction treatment, the opioid crisis has only grown online viagra prescription worse. We owe it to our loved ones to take stronger action to fight back against this public health emergency. The CAST Act is the much-needed, bold step forward in this fight,” Kustoff said. €œIt will online viagra prescription increase penalties against possession of harmful drugs and pill press molds, helping to combat the illegal drug market and the dangers it presents to our citizens and our brave law enforcement officers across the nation.”The Congressmembers said the law would prevent overdoses and reduce fentanyl-related deaths.

€œFamilies, businesses, and entire communities in Virginia continue to face immense challenges due to opioid abuse. As this public health crisis significantly worsens as a result of the erectile dysfunction treatment viagra, we also face the threat of extremely dangerous substances online viagra prescription — such as fentanyl — being pressed into illicit pills and sold on our streets,” said Spanberger. €œThis bill would help crackdown on the production of counterfeit drugs via illicit pill press molds. By deterring drug traffickers and those who produce illicit drugs, we would take another step in the fight against fentanyl-related deaths.”.

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