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The year 2008 marked the end of the planned extractions of wild lynxes for incorporation into the breeding population; still buy bupron sr 150 mg otc anxiety questionnaires for children, those found injured or handicapped with compromised probabilities of survival in the wild will continue to trickle into the Breeding Programme buy 150mg bupron sr with mastercard depression recipes. To provide the captive space needed to achieve the Programmes genetic goals proven bupron sr 150mg depression years after concussion, construction of two new iberian lynx breeding centers Granadilla (Extremadura) y Odelouca (Silves cheap bupron sr 150mg mastercard bipolar depression pregnancy, Portugal) is underway. An additional center in cabaeros (castille-La Mancha) is also scheduled for future construction. All breeding centers are strategically placed so they can be co-managed by administrations that commit to habitat preparation for future reintroductions. All centers considered, the captive population will be managed as a metapopulation, a genetic counterpart to the Sierra Morena and Doana free-ranging populations (Godoy et al. One of the Programmes key husbandry challenges is to strike a balance between fostering natural behaviours in captivity (hunting, territoriality, social interactions, etc. For this reason, the Breeding Programme favours naturalistic enclosures and promotes natural behaviours via environmental enrichment (Manteca, this book; Martos, this book). Some of these include obtaining regular weights by having the lynx step on a measuring scale. Such techniques are designed to avoid using invasive methods, which would stress the animals, and they also serve as a way to strengthen the trust between the animals and their keepers. Special care is taken to avoid domestication of captive lynxes, although this becomes a greater challenge in the case of hand-reared, abandoned cubs (Rivas et al. Breeding season in captivity mostly takes place throughout January and February, with most births occurring in March and April, as it is the case in the wild (Palomares et al. The actual mating period lasts between two and three days during which lynxes copulate an average of 28 times (range: 13-65; n=460 copulatory bouts in 21 pairs; Table 1). Gestation period, counted from the time of the frst copulation, ranges from 63-66 days (n=12). All parturitions that have occurred before 61 gestational days (n=4) have resulted in the birth of either dead or weak and not completely developed young, which were considered premature. Although variation between individuals is very high, most females are very consistent regarding their own timing to enter estrous and regarding the number of days they are gravid (Table 1). Labour during whelping (regarded as the time lapsed between the frst visible contractions until the delivery 63 of the last offspring) varies widely between females, with some of them delivering each young within 10-15 min intervals while others taking up to 9 hours between the delivery of each offspring (Table 1). Primiparous females have a higher rate of failure to raise their young than multiparous ones. Out of the eight females that have whelped at El Acebuche center, only two frst-time mothers Saliega and Aura managed to nurse all their young until weaning age. Two other dams Esperanza and Boj kept only one of their cubs after whelping and abandoned the rest of the offspring in their frst litter, while three other females Adelfa, Aliaga and Brisa miscarried one of their offspring and delivered the rest of the cubs prematurely during their frst gestation. This non-intrusive surveillance system has also allowed us to identify the existence of a sensitive period when iberian lynx cubs become highly competitive to the point of siblicide (Vargas et al. Spontaneous aggression erupted at 44 days of age in the frst iberian lynx litter born in captivity. The largest cub (a female) in a litter of three was killed by a brother who delivered lethal bites to the larynx and skull. Agonistic behaviour has been observed in nine of eleven subsequent iberian lynx litters of two or more cubs, with the most intensive fghting occurring around the end of the sixth and seventh post-natal weeks, respectively (Antonevich et al. This same phenomenon has been observed in the Eurasian lynx by Russian scientists at the Tcherngolovka facility who recorded aggressive behaviour in 16 of 31 litters, with deaths occurring in four cases (naidenko and Antonevich, this book). The authors indicate that the highest prevalence of agonistic behaviour in Eurasian lynx cubs occurred at 36 to 64 days of age, with the greatest frequency during the seventh post-natal week. Although siblicide in iberian lynx has not been directly observed in nature, a 1-month-old cub was found in the wild in 2003 with severe injuries compatible with bites from another cub. Sibling aggression in iberian lynx has infuenced programme husbandry as staff must be vigilant and prepared to break up aggressive bouts during the sensitive period. Because relatively little was known about the diseases affecting the iberian lynx, actions to improve our knowledge of the main diseases affecting the species was imperative. To improve the understanding of the various diseases that could potentially affect the species, the Programmes main lines of action involve the establishment of preventive disease protocols for the captive population, capacity building of veterinary staff working with in situ and ex situ populations, and conducting research on general veterinary science (Martnez et al. Research projects have helped determine the incidence and prevalence of infectious pathogens in captive and wild lynx populations (Milln, 2006; Meli et al. The results of research, protocol development, and standardization efforts, coupled with dissemination and sharing of knowledge and experience among veterinarians working in the Programme are all contributing to 65 more consistent diagnosis and treatment. Re P R o d u c t I v e P h y s I o l o g y Reproductive physiology studies and associated technologies increase the success rate of any captive-breeding programme and are important in helping with the conservation of wild felids in captivity (Wildt et al. Reproductive technologies are available for three major purposes: 1) assessing fertility and monitoring reproductive status; 2) assisting in breeding and maintenance of gene diversity; and 3) learning more about reproductive mechanisms of the endangered iberian lynx. Faecal hormone monitoring has demonstrated that females experience ovarian cycles from January through May whereas males maintain testosterone year-round (Pelican et al. But species peculiarities also have been revealed, for example, oestrogen metabolite concentrations during pregnancy are signifcantly greater than in other felid species (Pelican et al. Additionally, progestin excretion profles are unusually lengthy, largely because ovarian corpora lutea (sites of earlier ovulations) remain active much longer than in most other felids (Gritz et al. Prolonged non-pregnant luteal activity has also been described in the closely related Eurasian lynx (Lynx lynx; Jewgenow et al. Regarding male reproductive physiology, sperm traits seen in the iberian lynx are lower than those reported for some other felid species, yet higher than those reported for the Eurasian lynx and the bobcat (Gan et al. The ex situ population is also being used to explore a novel means of diagnosing pregnancy. Because all ovulating lynxes produce rising progesterone (regardless of conception), conventional hormone monitoring is not useful for identifying a gestating female (Pelican et al. However, increasing concentrations of the hormone relaxin (in blood or urine) are indicative of pregnancy in felids (Van Dorsser et al. A unique non-invasive means of collecting blood has been developed using blood-sucking Triatomine bugs (Rhodnius prolixus or Dipetalogaster maxima) placed in specially-drilled hiding holes in the lynxs cork nestbox (Voigt et al. As much as 2 ml of blood can be extracted per bug, more than adequate for the assay. Urine is captured using special collection devices distributed throughout the animals enclosure. Pregnant females express a positive relaxin signal from 32 to 56 days post-copulation of a 65-day gestation (Braun et al. The conservation of gametes will allow the Breeding Programme to extend future options without the limitation of space or the risk of disease transmission, while opening the opportunity of prolonging the possibilities of reproduction for individual animals after their death (Roldan et al. ReIntRoductIon The small size of current iberian lynx free-ranging populations renders them highly vulnerable to stochastic events. Prior to any reintroduction/translocation a detailed viability study is required (iUcn Guidelines for reintroductions: iUcn, 1998). All reintroductions and translocations must be performed using scientifc support and the iberian lynx should be no exception (calzada et al. The frst reintroduction is scheduled to take place in 2009 using wild-born individuals from the Sierra Morena population (Simn et al. Preparation for release will include maintaining animals in large preconditioning enclosures with minimal human contact and exposure to natural stimuli, including live prey. Lessons from other reintroduction programmes will be essential for the planning and implementation of the frst iberian lynx reintroduction. Education and awareness efforts should be focused on changing prevalent attitudes that contribute to habitat destruction and species extinction. One advantage enjoyed by conservation breeding programmes is their ability to gain public attention, particularly if the animal in question is charismatic and attractive to the broader public. The iberian lynx is one such case, and raising public awareness for the need for habitat conservation to guarantee survival of the species in the wild is one of the Programmes objectives. The Breeding Programme encourages, cooperates with, and supports media interest in the iberian lynx, while taking every opportunity to remind the public of the primary importance of habitat conservation. An English language version is currently in production to further expand the scope of communication and awareness efforts.

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Organic personality disorder has been described discount bupron sr 150 mg mastercard depression symptoms after giving birth, particularly among the apathetic elderly bupron sr 150 mg with visa anxiety 24 hours. Distraibility and over-arousal have also been reported cheap bupron sr 150mg without prescription depression articles, sometimes leading to persistent cognitive impairment cheap 150 mg bupron sr with visa depression brain, which may continue even after the patient is euthyroid (Stern et al, 1996). Specific cognitive difficulties in hyperthyroid patient have been described, such as deterioration of memory, concentration or visuomotor speed (MacCrimmon et al. The initial symptoms in hyperthyroidism may be quite similar to anxiety disorders, but the described, unusual symptoms of anxiety may alert the clinicians (Kathol et al. Other symptoms that should alert the physicians are the preference for cold and intolerance to heat, or loss of weight coupled with increased appetite. A careful medical history and examination are mandatory in such cases and the laboratory test would usually give unequivocal answers to the diagnostic difficulties. An accelerated pulse during sleep or cognitive difficulties are also considered to suggest the diagnosis of hyperthyroidism in such cases (Hall et al. To help in the differential diagnosis some specific scales have been developed (Iacovides et al, 2000). Transient thyroid hormone elevations, usually mild, may occur in approximately 10% of psychiatric inpatients, but should not be diagnosed of hyperthyroidism. Thyroid abnormalities have also been documented in some studies in primary affective disorders (Oomen et al. Other clinical situations may mimic the thyroid condition before the laboratory results are available, such as abuse of stimulants or drug intoxications. However, the nervousness and emotional lability in hyperthyroid patients may be wrongly diagnosed as alcohol abuse or abstinence. The clinical interest derives from the fact that it has been associated with cognitive deterioration and dementia in the elderly (Kalmijn,2000;Ceresini,2009), both in cross-sectional and longitudinal studies. While the clinical and epidemiological studies reviewed support the association of hyperthyroid function with psychopathological disturbance, the causal mechanisms are not clear (Bunevicius et al. One study suggested that the active thyroid hormone (T3) influenced mental performance in healthy subjects (Kathmann et al. The individuals overestimated time intervals and increased their word fluency, but no other cognitive problems were detected. Prez-Echeverra (1985) and Lobo et al (1988) documented direct, convincing correlations between abnormal levels of thyroid hormones and psychopathology. The abnormal psychological phenomenon seemed to be directly related to the endocrine disturbance, since non-endocrine medical patients in the same ward, and with similar levels of illness severity had lower levels of psychopathology. In general, there is a good resolution of anxiety and depression with antithyroid treatment alone, unless there is previous psychiatric history (Kathol et al. Beta-blockers such as propanolol are also considered to be effective in cases of anxiety (Trzepacz et al, 1988). However, recovery may be slow and reduced psychological well-being has been reported in a considerable proportion of remitted hyperthyroidism (Prez-Echeverra, 1985). Bunevicius also reported persistent mood and anxiety symptoms in treated hyperthyroidism (Bunevicius et al. Low potency 248 Thyroid and Parathyroid Diseases New Insights into Some Old and Some New Issues neuroleptics such as haloperidol and perphenazine have been reported, including symptoms resembling thyroid storm and malignant neuroleptic syndrome. Finally, treatment of depression is recommended if psychopathological symptoms are severe or persistent. Hypothyroidism Classical symptoms of hypothyroidism include fatigue and weakness, somnolence, weight gain, constipation and cold intolerance. However, other common symptoms may suggest primary psychiatric disease and include lethargy, progressive slowing, diminished initiative and impaired concentration and memory. Congenital hypothyroidism is also well known, and usually occurs as the consequence of thyroid dysgenesis, and more rarely as the result of inherited defects in the synthesis of thyroid hormone. This syndrome is characterized by mental retardation, aside from the classical somatic and neurological signs. Screening programs for hypothyroidism at birth are now mandatory to prevent this severe condition. The most frequent cause of adult hypothyroidism is Hashimotos thyroiditis or autoimmune thyroiditis. Treatment of Graves disease with radioactive iodine may also lead to hypothyroidism, but an important iatrogenic cause in psychiatric patients is the side effect of lithium, particularly in vulnerable individuals such as women or rapid cyclers. There are no good prevalence studies of psychiatric disturbance in hypothyroid patients, but the main psychiatric syndromes have been described in case reports and/or clinical samples. The depressive syndromes may mimic primary affective disorder, particularly in old women, and may need the checking of hormonal levels for the differential diagnosis. Marked irritability and labiliy of mood may alert to the presence of atypical syndromes, suggesting an organic condition. Thyroid replacement is required in such cases and is usually effective, although depression persists in a proportion of patients A special emphasis should be placed in subclinical hypothyroidism. The relevance of subclinical hypothyroidism is derived from the fact that depression is common and may severely affect quality of life. The same authors have recently reported that depression in such patients is more frequent than among patients with overt hyperthyroidism (Chueire et al. Furthermore, they conclude that subclinical hypothyroidism increases more than four times the risk of depression, and highlight the relevance of thyroid screening tests in Thyroid and Parathyroid Diseases and Psychiatric Disturbance 249 the elderly. It has been suggested that subclinical hypothyroidism is rather common in the general population, particularly in the adult and elderly women, but may go undetected and untreated. Delirium has been observed in approximately 10% of severe cases of hypothyroidism, and organic delusional syndromes have been documented in some case reports. Some authors have called Hashimoto`s encephalopathy the clinical picture of delirium with focal neurological signs and seizures. It has been considered to be associated with high levels of serum antithyroid antibodies, but the psychopathological symptoms probably overlap with delirium of different etiologies (Schiess & Pardo, 2008). Memory deterioration is common, but may be accompanied by impairment of other cognitive functions. While some cognitive difficulties may be associated with the depressive syndromes, some authors have reported independent, cognitive difficulties (Burmeister et al. Mild hypothyroidism has also been associated with mild cognitive difficulties (Bunevicius et al, 1999; Miller et al, 2007). While most cases of cognitive disturbance improve with hormonal treatment, some studies reported negative results (Walsh et al. Hypothyroidism used to be considered one example of reversible dementia with appropriate hormonal treatment (Cummings et al. However, most authors doubt about its effectiveness in well established cases of dementia (Clarnette & Patterson, 1994; Lobo et al. Present knowledge about the effects of thyroid hormones in the central nervous system suggests the critical influence in brain development, and probably a direct role in adult brain homeostasis. However, both the biochemical mechanisms and the physiological relevance are poorly understood. Even minor changes in thyroid hormone may induce important affective changes (Bauer et al. However, the connections between this hormone and primary affective disorder remain controversial. Some authors conclude that depressed patients are basically euthyroid (Baumgartner, 1993). Special consideration merit the cases of hypothyroidism seen in 10% of patients treated with lithium. Disregulation in the hypothalamic-pituitary-thyroid axis is commonly linked to primary affective disorders (Hendrick, 1998; Engum et al. While these findings support the connection between thyroid disorder and primary affective disorder (Stipcevic et al.

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Effects of long-term selenium supplementation on the incidence of type 2 diabetes: a randomized trial cheap bupron sr 150 mg on line mood disorder medication for children. Mechanism buy bupron sr 150mg without prescription depression definition dsm 4, measurement and prevention of oxidative stress in male reproductive physiology order bupron sr 150 mg anxiety jacket for dogs reviews. Selenium and fertility in animals and men: a re view discount 150 mg bupron sr with mastercard depression symptoms uk, Acta Veterinaria Scandinavica, 37, 19-25. Effects of selenium deficiency on spermmorpholo gy and spermatocyte chromosomes in mice. Sequential development of flagellar defects in spermatids and epididymal spermatozoa of selenium deficient rats. Selenium supplementation does not af fect testicular selenium status and semen quality in North American men. Deleterious effects of oxygen radicals in ischaemia-reperfusion: resolved and unresolved issue. Effects of sodium selenite on in vitro interactions between platelets and endotelial cells. Effects of Different Medical Treatments on Serum Copper, Selenium and Zinc Levels in Pa tients with Rheumatoid Arthritis. Selenium supplementation in rheumatoid arthritis investigated in a double blind, placebo- controlled trial. Antioxidants and viral infections: host immune response and vi ral pathogenicity. An increase in selenium intake improves immune function and poliovirus handling in adults with marginal selenium status. Selenium- its molecular biology and role in human health, New York: Springer, 299-310. Selenium-its molecular biology and role in human health, New York: Springer, 287-298. Oxidative stress and bone markers in plasma of patients with long-bone fixative sur gery: Role of antioxidants. Vitamin E effect on controlled ovarian stimulation of unexplained infertile women. Nanomolar vitamin E alpha-tocotrienol inhibits glutamate-induced activation of phospholipase A2 and causes neuroprotection. Tocotrienols re duce 25-hydroxycholesterol-induced monocyteendothelial cell interaction by inhibit ing the surface expression of adhesion molecules. Role of vitamin E in the protection of the resident macrophage membrane against oxidative damage. Vita min E suppresses isoprostane generation in vivo and reduces atherosclerosis in ApoE-deficient mice. In vitro supplementation with different tocopherol homologues can affect the function of immune cells in old mice. Involvement of vitamin E and protein thiols in the inhibition of microsomal lipid peroxidation by glutathione. Oxidative stress and antioxidants for idiopathic oligoasthenoteratospermia: s it justified? Health beneficial effects at physiologic doses versus deleterious ef fects at high doses. Effect of antioxidants on the occurrence of pre-eclampsia in women at increased risk: a randomized trial. Identification of the catalytic site of rat liver glutathione peroxidase as selenocysteine. A new selenoprotein from human lung adeno carcinoma cells: purification, properties, and thioredoxin reductase activity. Roles of selenium in endotoxin-induced lipid peroxidation in the rats liver and in nitric oxide production in J774A. Smoking and bladder cancer in Spain: effects of tobacco type, timing, environmental tobacco smoke, and gender. The health economics of bladder cancer: a Comprehensive review of the published literature. Efficacy of antioxidant supple mentation in reducing primary cancer incidence and mortality: systematic review and meta-analysis. Efficacy of Antioxidant Vitamins and Se lenium Supplement in Prostate Cancer Prevention: A Meta-Analysis of Randomized Controlled Trials. Potential hepatoprotective effects of vitamin E and selenium on hepatotoxicity induced by malathion in rats. It is necessary for the synthe sis of collagen, a protein that has many connective functions in the body. Among the sub stances and structures that contain collagen are bone, cartilage and the surrounding material, as well as carrier substances and materials of union muscle, skin and other tissues. Participate in the liver for detoxification of toxic sub stances and blood level for immunity. As an antioxidant reacts with histamine and peroxide for reducing inflammatory symptoms. The requirement for vitamin C for adults is well defined but they have not been uniform across different cul tures, so their need has been defined as culture-specific. Some epidemiological data mentioned its usefulness in reducing cold with increasing consumption of foods rich in vitamin, so people sometimes ingest an overdose of it. In most reports mention that discrete increases in blood levels of this vitamin reduces the risk of death in all conditions. Antioxidants play important roles in cellular function and have been implicated in processes associated with aging, including vascular, inflammatory damage and cancer. History Since the nineteenth and early twentieth century research on these compounds led to the discovery of vitamins. Since 1901, a publication of Wildiers first described the stimulating4 effect of small amounts of organic material in the growth of yeast; this effect was the subject of many publications and only after several years was universally accepted. Wilders gave the name "bios" to the substance or substances causing increased growth of yeast. Definition Vitamin C is defined as hexuronic acid, cevitminic acid or xiloascrbic acid. The term vita min C is generally used to describe all these compounds, although the representative of which is ascorbic acid. Structure, formula and chemical characteristics Ascorbic acid is the enolic form of one -ketolactone. Ascorbic acid solution is easily oxi dized to the diketo form referred to as dehydroascorbic acid, which can easily be converted into oxalic acid, diketogulonic acid or threonic acid. Physical and chemical properties Ascorbic acid contains several structural elements that contribute to their chemical behavior: the structure of the lactones and two enolic hydroxyl groups and a primary and secondary alcohol group. Enediol structure motivates their antioxidant properties, as can be oxidized easily enediols to diketones. Ascorbic acid forms two bonds intermolecular hydrogen bonds (shown in red in the figure) that contribute substantially to the stability and with it the chemical qualities of the structure endiol. Hydrogen bridges formed by ascorbic acid Ascorbic acid is rapidly interconvert in two unstable diketone tautomers by proton transfer, though it is most stable in the enol form. The proton of the enol is lost, and again acquired by the electrons from the double bond to produce a diketone. Vitamers or vitameric forms The vitamer of a particular vitamin is any chemical compound which generally has the same molecular structure and each shows a different vitamin activity in a biological system which is deficient of the vitamin. The vitamin activity of multiple vitamers is due to the ability (sometimes limited) of the body to convert one or many vitamers in another vitamer for the same enzymatic cofactor which is active in the body as the most important form of the vitamin. As part of the defini tion of the vitamin, the body can not completely synthesize an optimal amount of vitamin activity of foodstuffs simple, without a certain minimum amount of vitamer as base.

To learn more or locate a result of some form of blockage or disruption in the practitioner purchase bupron sr 150mg with amex teenage depression symptoms quiz, contact Nurse Healers-Professional flow of energy in the energy field generic bupron sr 150 mg free shipping depression definition apa, the energy centers 150 mg bupron sr visa depression test dsm iv, Associates International at 801-273-3399 or www bupron sr 150mg sale definition von depression. Practices such as acupressure on transferring or channeling energy into specific areas and acupuncture work to open the flow of energy in of the body. Other practices such as Healing Touch, on the body, but an experienced Reiki practitioner may Reiki, and Therapeutic Touch work primarily with the also place his/her hands on other areas of the body to energy field and energy centers. Reiki can also be modalities are done with the client fully clothed done off the body. There is passed down in an oral tradition from a Reiki master to research to support the use of these modalities for a student. For more information about Reiki, contact accelerated wound healing, pain management, and The Reiki Alliance at 208-783-3535 or on the web at decreased anxiety. All of these lic concern over national and international environ- practices should be seen as complementing traditional mental conditions led to increasing federal government medical care. Policies enacted by the federal government include the Suggested Reading National Environmental Policy Act; the Federal Barnett, L. Reiki energy medicine: Bringing Insecticide, Fungicide, and Rodenticide Act; the Toxic the healing touch into home, hospital and hospice. Accepting your power to heal: The personal practice Environmental epidemiology, which is the study of of therapeutic touch. Vector-borne illnesses are those that stem from a nonhuman carrier of disease organisms and are Environment The effects of the environment on generally of greater concern in developing countries health have long been recognized. Mosquitoes, flies, industrial growth and increasing urban population cen- rats, and mice can all spread disease to human popula- ters in the mid-19th century resulted in concern about tions. Of particular concern is malaria, which is spread the water supply and sewage management. Malaria is one of the most widespread increasing use of coal-burning furnaces and the subse- vector-borne diseases. Soil-borne parasites also pose a quent soot and cinders in the air led to public fear and, health threat. Adequate sewage treatment was also a pri- how health is affected by peoples work environment ority, although, due to economic limitations, strategies and living environment. States would authorize cities to substances including poisonous chemicals, dyes, metals, regulate smoking nuisances (if the states were to do any- and radiation. The local ordinances developed took a variety of to the association between place of residence and forms including modest fines for dense smoke emissions health. While some of this association can be attributed to responsibility of an owner to eliminate smoke emis- to factors such as air/water pollution and lead expo- sions from his/her facility. Other ordinances prohibited sure, other factors related to place of residence are the use or sale of coals with certain ash and sulfur con- considered to have effects on health outcomes. The enforcement of these laws was difficult as the example, resources such as easy access to medical care, agencies had little resources for enforcement. Finally, in 1955, the federal government got nity support and the behavioral norms in an area are involved through the Air Pollution Act of 1955. The location 249 Environment of stores that sell nutritious foods, alcohol, and ciga- Uranium can damage living tissue and a single high rettes can have an effect on health as can the amount dose can be fatal. Finally, for infectious diseases, the prevalence of who work with x-rays need to take precautions against diseased people in the area and the amount of contact uranium exposure. Exposure assess- other chemicals and man-made pesticides may have ment is a vital part of environmental epidemiology but similar effects. Even when exposure information exists, and cleanup of hazardous waste sites, less money it is often not complete. For example, several different has been spent on addressing health risks from pieces of information on the exposure are often needed chronic low-level exposures to hazardous substances. Studies of communities Pesticides are widely used in the United States, with more exposed to environmental contaminants are also prob- than 1 billion pounds of synthetic organic pesticides pro- lematic. Similarly, often the have speculated that these pesticides are a promoter of endpoints of interest are rare and/or have a long breast cancer. Mercury Many associations between environmental expo- is a widespread persistent air pollutant and organic sures and disease have been noted in spite of these mercury (a mercuric compound) has been found in the limitations, although some of these associations are aquatic food chain. While it is rare for asbestos to be installed common in women than in men, have been linked to today, previous exposure or exposure during asbestos certain pharmaceuticals and solvents. Specifically, removal, renovation, or maintenance of buildings are of lupus has been associated with both hydrazine (an concern. Asbestos fibers enter the body through inhala- industrial chemical) and tartrazine (a food additive). Black This inhalation or ingestion of the fibers may cause lung (or pneumoconiosis) occurs when particles such disabling or fatal disease. More commonly, homes in lead paint chips that have separated from the pollutants and chemicals in the air are known triggers wall, which may be pulverized into dust. Lead exposures have been associated with negative reproductive effects in Episiotomy Episiotomy is a procedure designed men and women and long-term exposure of lead in to enlarge the vaginal opening at the time of delivery of children has been associated with reductions in cogni- the fetal head. It is performed when the babys head is tive abilities and shorter attention spans. Options for pain relief suggested that levels of lead in children have been during the procedure include local injection of an declining over the years, perhaps in part to increased anesthetic such as lidocaine, epidural anesthesia, intra- attention to this issue. The procedure The environment, defined in multiple ways, plays is performed by making a vertical incision at the mid- a major role in the health of the population. Air and line directly below the vagina between the vagina and water quality, containment of hazardous wastes, and the anus (midline episiotomy) or creating an incision vectors that transmit disease are all important environ- at a 30 angle from the vertical (mediolateral epi- mental factors. In the United States, the midline technique is ones environment, more broadly defined, meaning most common. It was thought that routine episiotomy ing of the safety of our environment and increased decreased the length of the second stage of labor understanding of the specific aspects of the environ- (pushing) and protected the babys head, as well as ment that are associated with detrimental health protected the mother from damage to the anal sphincter effects. It is hoped that continued study and monitor- and long-term problems with bowel and bladder incon- ing of these factors will result in a healthier population tinence. Current indications for episiotomy include shoul- Suggested Reading der dystocia (impaction of the babys shoulder against Blumenthal, D. Introduction to environ- the maternal symphysis pubis), breech delivery, and mental health (2nd ed. These are all circumstances in health: How to conceptualise, operationalise and measure them? Episiotomy and laceration (cut or tear) repair are generally performed using a continuous length of Suggested Resources absorbable synthetic suture. Infection is generally treated by remov- vehicle for advancing womens rights beyond those ing the sutures and prescription of oral antibiotics. A already achieved with the passage of the 19th hematoma may be evacuated by removing the sutures Amendment, which had given women the right to vote. This may require women of equal treatment in the eyes of the law and in surgery at a later date. There was a split with some womens groups which feared that the labor laws that Suggested Reading had been enacted to protect women would be jeopar- Baxley, E. Episiotomy for vaginal birth strong women leaders on the left were openly suspi- (Cochrane review). Preventing fessional women at the expense of wage-earning perineal trauma during childbirth: A systematic review. This while not identical to its earlier incarnation, neverthe- change of support reflected the changing political and less adhered to the same basic premise: that sex should economic atmosphere within the country. However, with the Unfortunately, the inability to carefully lay out a definite introduction of the Civil Rights Act of 1964, new and strategy to promote the proposed amendment helps more powerful forms of protection supplanted the explain why it ultimately failed to be ratified in the older protective laws.

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